Minimally invasive surgery for paediatric inflammatory bowel disease: Personal experience and literature review

Table 1 List of available publications concerning minimally invasive approach for inflammatory bowel diseases in pediatric population (PubMed, EMBASE, Ovid) n (%)

Ref.	Country	Year	IBD	CD	UC	IBD-U	Complications	Years
Proctor et al[8]	Canada	2002	8	1	5	2	4 (50)	1999-2001
Georgeson[9]	United States	2002	18	0	18	0	NS	NS
Rothenberg et al[10]	United States	2002	15	15	0	0	1 (7)	NS
von Allmen et al[11]	United States	2003	12	12	0	0	1 (8)	1997-2002
Dutta et al[12]	United States	2003	15	15	0	0	2 (13)	1998-2002
Simon et al[13]	United States	2003	29	NS	NS	NS	5 (17)	1991-2002
Bonnard et al[14]	France	2006	11	11	0	0	2 (18)	1999-2004
Meier et al[15]	United States	2007	NS	NS	NS	NS	NS	NS
Fraser et al[16]	United States	2010	27	0	27	0	18 (66)	1998-2008
Flores et al[17]	Argentina	2010	13	0	13	0	4 (31)	1991-2009
Diamond et al[18]	Canada	2010	136	83	50	3	50 (37)	1999-2007
Mattioli et al[19]	Italy	2011	16	3	12	1	6 (24)	2006-2010
Laituri et al[20]	United States	2011	30	30	0	0	3 (10)	2000-2009
Potter et al[21]	United States	2012	9	2	6	1	5 (55)	2010-2011
Linden et al[22]	United States	2013	68	0	68	0	13 (19)	2003-2011
Huang et al[23]	United States	2013	44	25	16	3	10 (22)	2002-2011
Stephens[24]	Ireland	2013	9	0	9	0	3 (33)	2009-2011
Sharp et al[25]	United States	2014	28	28	0	0	8 (29)	2009-2013
Vrecenak et al[26]	United States	2014	71	71	0	0	23 (32)	2001-2010
Total			559	296	224	10	158 (29.2)	1991-2013

Case reports or case series have been excluded. This table provides the overall number of IBDs treated in a selected time span. Whenever available, the series were differentiated into patients with UC, CD and IC. Overall, a relatively high prevalence of major complications requiring some sort of surgical intervention has been reported (higher than 29%), still similar or even lower when compared to what previously published for open surgery. Complications rate was calculated basing on series providing incidence (541 overall patients). IBD: Inflammatory bowel disease; CD: Crohn’s disease; UC: Ulcerative colitis; IBD-U: Inflammatory bowel disease - unclassified; NS: Not stated.

Table 2 Personal series of paediatric inflammatory bowel disease treated laparoscopically

	UC	CD	IBD-U	Overall
Patients	39	20	2	61
Males				25	M:F ratio 0.7:1
Females				36
Age at surgery (yr)				9.5 (1.1-20.2)
Indications
Haemorrhagic colitis	26	3	2	31
Failure of treatment	13	3	0	16
Obstruction/strictures	0	13	0	13
Other	0	11	0	1
Procedures
LSTC	39	4	2	45	Overall 98 procedures
Median operative time (min) (range)				215 (80-350)
Median length of hospitalization (d) (range)				8.5 (3-11)
JPIRA	38	0	0	38
Median operative time (min) (range)				195 (130-260)
Median length of hospitalization (d) (range)				3.5 (2-11)
Segmental resection	0	15	0	15
Median operative time (min) (range)				145 (85-205)
Median length of hospitalization (d) (range)				7 (2-15)
Complications (18 events), n (%) of procedures	8 (13)	4 (30)	1 (50)	18% of procedures	P = 0.08062
Stoma-related issues (6 events), n (%) of procedures)	4 (11)	1 (33)	1 (50)	14% of procedures	P = 0.63223

¹Pelvic abscess due to fistulising CD;

²Statistical analysis was performed to compare the prevalence of complications in CD and UC;

³Statistical analysis was performed to compare the prevalence of complications related to the stoma (14.3%) and that of complications related to other aspect of surgery (12.2%). Overall, we performed 98 primary laparoscopic procedures and 6 laparoscopic management of surgical complications. Complications were experienced by 21% of our patients following 18% of procedures. Though without statistical significance, complications were more likely to occur in patients with CD when compared to those with UC (30% vs 13%). UC: Ulcerative colitis; CD: Crohn disease; IBD-U: Inflammatory bowel disease - unclassified; LSTC: Laparoscopic SubTotal colectomy; JPIRA: J-Pouch Ileo-Rectal restorative anastomosis.