Open Versus Laparoscopic Right Hemicolectomies in Pediatric Patients with Crohn's Disease

• Published in: Journal of laparoendoscopic & advanced surgical techniques. Part A Vol. 30; no. 7; p. 820
• Main Authors: Quiroz, Hallie J, Perez, Eduardo A, El Tawil, Rana A, Willobee, Brent A, Galvez-Cabezas, Kevin, Ferrantella, Anthony R, Thorson, Chad M, Langshaw, Amber H, Sola, Juan E
• Format: Journal Article
• Language: English
• Published: United States 01.07.2020
• Subjects: Adolescent; Colectomy - methods; Crohn Disease - complications; Crohn Disease - surgery; Databases, Factual; Female; Hospital Mortality; Hospitalization; Humans; Lacerations - complications; Laparoscopy - methods; Length of Stay; Male; Pneumonia - complications; Postoperative Complications - etiology; Propensity Score; Respiration Disorders - complications; Retrospective Studies; Risk; Sepsis - complications; Treatment Outcome; laparoscopy; Crohn's disease; right hemicolectomy; pediatric
• ISSN: 1557-9034
• DOI: 10.1089/lap.2019.0814

Surgery remains an important treatment modality for the management of pediatric Crohn's disease (CD). The objective of this study was to perform a comparative analysis of open right hemicolectomy (ORH) and laparoscopic right hemicolectomy (LRH) for the management of pediatric CD. The Kids' Inpatient Database (KID) was queried (2009-2012) for ICD-9 procedure codes for ORH (45.73) and LRH (17.33) in patients with CD (ICD-9 codes: 555.0, 555.1, 555.2, 555.9). Open and laparoscopic procedures were compared using propensity score (PS)-matched analysis (PSMA) of 41 variables. Overall 889 patients were identified and after PS matching, there were 380 ORHs and 380 LRHs. There were zero in-hospital deaths (0/821). ORH patients were more likely to have septicemia, respiratory compromise, pneumonia, perforation and/or laceration, complications, and require blood transfusions (all,  < .05). Although LRH patients were more likely to develop postoperative nausea/vomiting/diarrhea (  < .0001), they had a shorter hospital length of stay (  < .0001) and lower overall hospital charges and cost (  < .001). ORH and LRH in KID have similar low in-hospital mortality in pediatric CD. However, ORH was associated with higher morbidity including an increased risk for respiratory complications, surgical complications, need for blood transfusions, and increased resource utilization than patients who had laparoscopic procedures. In select patients, LRH is safe, feasible, and potentially superior to ORH.