Prophylactic colectomy for children with familial adenomatous polyposis: resource utilization and outcomes for open and laparoscopic surgery.

Autor:	Ferrantella A; Division of Pediatric Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA., Saberi RA; Division of Pediatric Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA., Willobee BA; Division of Pediatric Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA., Quiroz HJ; Division of Pediatric Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA., Langshaw AH; Division of Pediatric Gastroenterology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA., Pandya S; Division of Pediatric Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA., Thorson CM; Division of Pediatric Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA., Sola JE; Division of Pediatric Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA., Perez EA; Division of Pediatric Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Jazyk:	angličtina
Zdroj:	Translational gastroenterology and hepatology [Transl Gastroenterol Hepatol] 2021 Jul 25; Vol. 6, pp. 40. Date of Electronic Publication: 2021 Jul 25 (Print Publication: 2021).
DOI:	10.21037/tgh-20-190
Abstrakt:	Background: Laparoscopic approach for the surgical management of familial adenomatous polyposis (FAP) has become increasingly common for pediatric patients. The purpose of this study was to compare short-term outcomes and resource utilization between open and laparoscopic surgery for prophylactic colectomy in children with FAP. Methods: The Kids' Inpatient Database (2009 and 2012) was analyzed for children (age ≤20 years) with FAP that underwent prophylactic total colectomy or proctocolectomy. Patient demographics, treating hospital characteristics, hospital charges, and short-term outcomes were compared according to the surgical technique utilized (open versus laparoscopic). Results: Overall, we identified 216 patients with FAP that underwent elective total colectomy, of which 95 cases were performed by open surgery and 121 were done laparoscopically. The majority of patients were treated at large, not-for-profit, urban teaching hospitals, and the median age was equal (16 years) in both groups. Complications that were more common for open procedures included accidental perforation or hemorrhage (4% vs. 0%, P=0.023), reopening of surgical site (3% vs. 0%, P=0.049), and pneumonia (3% vs. 0%, P=0.049). Simultaneous proctectomy was performed more commonly in the open cohort (91% vs. 71%, P<0.001) as well as ileostomy creation (74% vs. 49%, P<0.001). The median length of stay was similar in the open and laparoscopic groups (7 vs. 6 days, P=0.712). Median total hospital charges were also similar ($67,334 vs. $68,717, P=0.080). Conclusions: A laparoscopic approach for prophylactic colectomy can be safely performed in children with FAP, and total hospital charges are equivalent compared to open surgery. However, simultaneous proctectomy was performed less often with laparoscopic surgery. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tgh-20-190). The series “Current Topics in Pediatric General Surgery” was commissioned by the editorial office without any funding or sponsorship. Dr. SP served as the unpaid Guest Editor of the series. Dr. EAP served as the unpaid Guest Editor of the series and serves as an unpaid editorial board member of Translational Gastroenterology and Hepatology from Jan 2019 to Dec 2020. The authors have no other conflicts of interest to declare. (2021 Translational Gastroenterology and Hepatology. All rights reserved.)
Databáze:	MEDLINE
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