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Single incision laparoscopic ileocecectomy for pediatric Crohn disease

Abstract

Background

Ileocecectomy is a mainstay surgical therapy for pediatric Crohn disease. However, there are few descriptions of single-incision laparoscopic ileocecectomy (SIL-I) in the pediatric population. This video describes our technique of the SIL-I, as well as our initial experience in pediatric patients with Crohn disease. Video runtime: 4:54.

Methods

Records of all patients with Crohn disease who underwent SIL-I between 2010 and 2012 were retrospectively reviewed. Variables including patient demographics, operative information, length of stay, and postoperative complications were collected [13].

Results

Thirty-one SIL-I cases (mean patient age 17 ± 4 years) were reviewed. The average time from Crohn diagnosis to surgery was 4.8 ± 4.5 years. Seven patients (23 %) were below the 5th percentile for weight preoperatively. Three patients had undergone prior abdominal operation. There were no operations where an additional laparoscopic port was placed; however, one operation required extension of the umbilical incision beyond 3.5 cm in the setting of extensive interloop abscesses, dense adhesions and interloop fistulae. All anastomoses were stapled extracorporeally. The mean operative time was 3.8 ± 1.1 h. There were no intraoperative complications. Five postoperative complications were documented, including one superficial wound infection, two intra-abdominal abscesses (one within 30 days of the operation, one more than 3 months post-procedure), one peripherally inserted central catheter (PICC)-associated bacteremia, and one small bowel obstruction. Average postoperative length of stay was 7.1 ± 2.9 days, and median length of follow-up was 5.27 months.

Conclusions

This is the largest reported series of SIL-I in the pediatric surgery population. Our presented technique is safe, effective, and may be adopted by any pediatric surgeon with laparoscopic experience. Further studies are necessary to demonstrate both cost effectiveness and long-term outcomes of SIL-I versus conventional laparoscopic techniques.

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References

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    Saites CG, Bairdain S, Lien C, Johnson V, Zurakowski D, Linden BC (2012) Single incision laparoscopic ileocecectomy for pediatric Crohn disease: O-3. Inflamm Bowel Dis 18:S3

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    Laituri CA, Fraser JD, Garey CL, Aguayo P, Sharp SW, Ostlie DJ, Holcomb GW 3rd, St Peter SD (2011) Laparoscopic ileocecectomy in pediatric patients with Crohn’s disease. J Laparoendosc Adv Surg Tech A 21(2):193–195

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    Garey CL, Laituri CA, Ostlie DJ, Snyder CL, Andrews WS, Holcomb GW 3rd, St Peter SD (2011) Single-incision laparoscopic surgery in children: initial single-center experience. J Pediatr Surg 46(5):904–907

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Disclosures

Drs. Saites, Bairdain, and Linden, and Ms. Lien have no conflicts of interest or financial ties to disclose.

Funding

No external funding was received.

Author information

Correspondence to Constantine G. Saites.

Electronic supplementary material

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Supplementary material 1 (MOV 292,674 kb)

Supplementary material 1 (MOV 292,674 kb)

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Saites, C.G., Bairdain, S., Lien, C. et al. Single incision laparoscopic ileocecectomy for pediatric Crohn disease. Surg Endosc 28, 1991–1992 (2014). https://doi.org/10.1007/s00464-013-3331-7

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Keywords

  • Ileocecectomy
  • Pediatric surgery
  • Minimally invasive surgery
  • Single-incision laparoscopic surgery
  • Crohn disease