Single surgeon experience with laparoscopic surgery in pediatric patients with inflammatory bowel disease

Purpose: Laparoscopic management of inflammatory bowel disease (IBD) has been well established in adults. Its efficacy and safety are less defined in pediatrics. We reviewed our single surgeon laparoscopic experience with pediatric IBD patients. Patients and Methods: All consecutive patients 17 years old or younger with IBD who underwent initial laparoscopic surgery for management of disease from May 2002 to May 2011 were identified. Patients were analyzed retrospectively with respect to age, gender, weight, American Society of Anesthesiologists classification, history of prior abdominal surgery, operative time, need for conversion to open procedure, estimated blood loss, need for blood transfusion, length of hospitalization, need for intensive care unit monitoring, and patient outcomes within 30 days. Results: In total, 44 pediatric patients underwent 52 laparoscopic surgeries. Forty-two patient cases (80.8%) had had no prior abdominal surgery. Mean operative time was 132 minutes. Two patients (3.8%) underwent conversion from a laparoscopic to open approach. Mean estimated blood loss was 64 mL. The average hospitalization was 5.5 days. Postoperative complications occurred in 10 patients (19.2%): 2 were treated for wound infection or abscess, 7 required re-admission, and 1 required return to the operating room for exploratory laparotomy. Conclusions: Laparoscopic management of IBD has not routinely been implemented in the pediatric population. We demonstrate acceptable perioperative morbidity and rate of conversion to open with an overall successful laparoscopic approach in pediatric patients. This may have particular long-term benefits in a population faced with longer life expectancy. An initial laparoscopic approach is a feasible and safe option for pediatric IBD patients.