title: Laparoscopic approach for children with inflammatory bowel diseases.
abstract: BACKGROUND
  Minimally invasive surgery is being increasingly applied to inflammatory bowel diseases (IBDs). Few pediatric series from selected research have been described to date. This study describes a unicentric experience of laparoscopic treatment of children with IBDs.
  
  
  METHODS
  All consecutive patients with IBDs between February 2006 and February 2010 who underwent laparoscopic treatment were included. We reviewed notes and recorded demographic data, indications, perioperative management, surgical details, length of surgery, complications, postoperative management, length of hospitalization and functional outcome.
  
  
  RESULTS
  We performed 25 procedures on 16 patients (12 ulcerative colitis, 3 Crohn's disease, and 1 indeterminate colitis). Median age was 12 years. A total of 50% patients underwent elective surgery; 11 underwent staged laparoscopic subtotal colectomy (LSTC) followed by J-pouch ileorectal anastomosis (JPIRA). Three patients underwent straight LSTC + JPIRA. All procedures included protective ileostomy. Length of surgery ranged between 120 and 380 min depending on the procedure (LSTC ± JPIRA). No conversion was required. Length of hospitalization ranged between 3 and 18 days. We observed six complications (24%) mainly represented by adhesions that were effectively treated laparoscopically. Ten patients were restored (ileostomy closure) and were assessed for continence that turned out to be good in 80%.
  
  
  CONCLUSIONS
  Laparoscopy proved to be feasible, safe and effective for the treatment of IBD in children. Although we observed a relatively low incidence of complications, stoma site adhesions still remain the major issue, which can be effectively dealt with laparoscopically. Functional outcome as well as cosmesis is satisfactory. As results are encouraging, at present we prefer laparoscopy for the surgical treatment of IBD in pediatric patients.
authors: Pediatric Surgery Department, Gaslini Research Institute and Children Hospital, University of Genoa, Largo G. Gaslini, 16100, Genoa, Italy.
authors: Girolamo
authors: G
authors: Mattioli
authors: Alessio
authors: A
authors: Pini-Prato
authors: Arrigo
authors: A
authors: Barabino
authors: Paolo
authors: P
authors: Gandullia
authors: Stefano
authors: S
authors: Avanzini
authors: Edoardo
authors: E
authors: Guida
authors: Valentina
authors: V
authors: Rossi
authors: Luca
authors: L
authors: Pio
authors: Nicola
authors: N
authors: Disma
authors: Leila
authors: L
authors: Mameli
authors: Della Rocca
authors: DR
authors: Mirta
authors: Giovanni
authors: G
authors: Montobbio
authors: Vincenzo
authors: V
authors: Jasonni
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003082:Colectomy / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005769:Gastrointestinal Motility; D006801:Humans; D007082:Ileum / Q000601:surgery*; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000503:physiopathology / Q000601:surgery*; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome