A retrospective comparison of outcomes for open vs. laparoscopic surgical techniques in pediatric ulcerative colitis.

Autor:	Willobee BA; Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA., Nguyen JA; Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA., Ferrantella A; Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA., Quiroz HJ; Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA., Hogan AR; Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA., Brady AC; Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA., Pandya S; Department of Surgery, UT Southwestern Medical Center, Dallas, TX USA., Langshaw AH; Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA., Sola JE; Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA., Thorson CM; Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA., Perez EA; Daughtry Family 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. 41. Date of Electronic Publication: 2021 Jul 25 (Print Publication: 2021).
DOI:	10.21037/tgh-20-189
Abstrakt:	Background: Ulcerative colitis (UC) is an aggressive disease in the pediatric population and a cause of significant, lifelong morbidity. The aim of this study is to compare surgical complications in pediatric patients undergoing laparoscopic vs. open surgical treatment for UC. Methods: We queried the Kids' Inpatient Database (KID) for all cases of UC undergoing surgical treatment in 2009 and 2012. We identified patients who received total colectomy without proctectomy (n=413) or total proctocolectomy (n=196) and performed univariate and multivariate analyses comparing laparoscopic vs. open procedures. Results: In pediatric UC patients undergoing total colectomy without proctectomy, open procedures were associated with more complications than laparoscopic, including fluid and electrolyte disorders (40% vs. 28%), surgical wound dehiscence (6% vs. 2%), septicemia (18% vs. 2%), and gastrointestinal disorders (16% vs. 7%) among others, all P<0.05. Likewise, in patients with UC undergoing total proctocolectomy, there were more complications in open vs. laparoscopic technique, including increased transfusion requirements (25% vs. 7%, P=0.001) and significantly more gastrointestinal upset, including nausea, vomiting, and diarrhea (11% vs. 1%, P=0.003). In multivariate analysis, patients who underwent total colectomy with or without proctectomy had an increased risk of experiencing any complication when their procedure was performed in an open or non-elective fashion (all odds ratio >2.4; all P<0.001). Conclusions: The laparoscopic approach was associated with significantly lower rates of surgical complications in pediatric patients undergoing total colectomy with or without proctectomy for UC. These findings demonstrate that laparoscopic technique compares favorably, and may be preferable, to the open approach in selected pediatric patients with UC. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tgh-20-189). The series “Current Topics in Pediatric General Surgery” was commissioned by the editorial office without any funding or sponsorship. 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. Dr. SP served as the unpaid Guest Editor of the series. The authors have no other conflicts of interest to declare. (2021 Translational Gastroenterology and Hepatology. All rights reserved.)
Databáze:	MEDLINE
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