title: Long-term outcomes after surgery on pediatric patients with Crohn disease.
abstract: OBJECTIVE
  Of pediatric patients with Crohn disease, 20% to 30% undergo surgery within 10 years. Although disease relapses and reoperations are common, long-term functional outcomes and quality of life (QoL) are unclear.
  
  
  METHODS
  In 2010, we reviewed the hospital records of all pediatric patients with CD who had undergone intestinal resections during childhood in 2 major tertiary care hospitals between 1985 and 2008 and mailed out questionnaires that asked about health outcomes and QoL. We compared the QoL of the patients and a group of matched controls randomly chosen from the Population Register Centre.
  
  
  RESULTS
  In total, 36 children had undergone bowel resection a median of 10 years earlier and had at least 2 years of follow-up. Disease activation (verified at endoscopy) requiring medical or surgical treatment occurred in 94% (median 1.8 years after primary resection). At least 1 surgical complication occurred in 77%, and 54% underwent re-resection. The patients reported a median stool frequency of 3 stools during the day and zero at night, with 33% being totally continent. Overall, 96% were completely or moderately satisfied with the outcome of the surgery. The QoL was comparable between the patients and controls, but school or work absences diminished the QoL of the patients.
  
  
  CONCLUSIONS
  Surgery for pediatric-onset CD is risky even under expert care. Disease relapses and bowel re-resections are common during the first decade after primary surgery. In the long term, however, bowel function is acceptable and the QoL is comparable between patients and their peers.
authors.affiliation: Children's Hospital, Helsinki University Central Hospital and Helsinki University, Helsinki, Finland. maija.piekkala@helsinki.fi
authors.forename: Maija
authors.initials: M
authors.lastname: Piekkala
authors.forename: Mikko
authors.initials: M
authors.lastname: Pakarinen
authors.forename: Merja
authors.initials: M
authors.lastname: Ashorn
authors.forename: Risto
authors.initials: R
authors.lastname: Rintala
authors.forename: Kaija-Leena
authors.initials: KL
authors.lastname: Kolho
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D002648:Child; D003424:Crohn Disease / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007422:Intestines / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008499:Medical Records; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011788:Quality of Life; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D055502:Secondary Prevention; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers