title: Limited ileo-caecal resection for localised Crohn's disease in childhood: Clinical outcome and predictors of further surgery.
abstract: OBJECTIVE
  To investigate the outcome of limited ileo-caecal resection in children with localised Crohn's disease (CD) and determine predictors of further surgery.
  
  
  METHODS
  Review of children diagnosed with CD and operated on for ileo-caecal disease from 1995 to 2005. Age at diagnosis, endoscopic disease distribution, indication for surgery, site of recurrence and date of last follow-up were recorded. Surgery required removal of only the ileo-caecal junction and caecal pole with removal of the minimum terminal ileal length.
  
  
  RESULTS
  Thirty seven children underwent intestinal resection. Time between primary operation and most recent follow-up was 3.8 years (range 1 month-8.8 years). Indications for surgery were obstruction/stricture (20), treatment-resistant disease (13) and abscess/perforation peritonitis (4). Follow-up was available in 32. Nine (28%) required re-laparotomy. Median time to second laparotomy was 12 months (range 4-58 months). Eighteen children required no endoscopies after surgery (median follow-up 3.4 years).
  
  
  CONCLUSIONS
  Most conservative surgery occurs about 2 years after diagnosis. About 1 in 4 children have a further laparotomy within 12 months. Over half of these require division of adhesions. Limited ileo-caecal resection for localized Crohn's disease is not associated with early peri-anastomotic recurrence. Developments in laparoscopic surgery are likely to further reduce complications from adhesions.
authors.affiliation: Dept. of Surgery, Royal Free Hospital, Hampstead, London, NW3 2QG, United Kingdom.
authors.forename: L
authors.initials: L
authors.lastname: Cook
authors.forename: E
authors.initials: E
authors.lastname: Al-Hendawi
authors.forename: A W
authors.initials: AW
authors.lastname: Bates
authors.forename: M
authors.initials: M
authors.lastname: Brennan
authors.forename: C
authors.initials: C
authors.lastname: Salvestrini
authors.forename: M
authors.initials: M
authors.lastname: Malik
authors.forename: F
authors.initials: F
authors.lastname: Torrente
authors.forename: O
authors.initials: O
authors.lastname: Ogunbiyi
authors.forename: A
authors.initials: A
authors.lastname: Lewis
authors.forename: R B
authors.initials: RB
authors.lastname: Heuschkel