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Crohn's disease (CD) is a chronic inflammatory condition that may affect any part of the gastrointestinal tract. It is transmural in nature and complications such as fistula, strictures and peri-anal disease may occur. There is more extensive anatomic involvement (50% ileocolonic, 20% colonic, 30% with upper GI symptoms) and a higher surgical risk in pediatrics than adults (50% vs 14% by age 30). Studies have shown 3.4%-7.9% of patients require surgery in first year after diagnosis, 13.8-47.2% by 5 years and 28%-35% by 10 years (1). There are three major surgical categories: ileocecal resection, treatment of complication, (fistula/stricture-figure 1,2) or salvage procedure for severe refractory disease. In addition, surgery may be considered with active short segment disease or children illustrating poor growth despite optimized medical therapy (ESPGHAN). Unfortunately, much data on pediatrics is derived from single centers rather than population-based cohorts and the most recent societal reports were based on studies with minimal biologic use (18-24%) (1). Despite larger use of biologics, resection is still needed in 20%- 34%, thus effective peri-operative management of pediatric CD is imperative (1). |
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