Pediatric Colorectal Surgery: A Collaborative Approach From a Single Institution

• Published in: The Journal of surgical research Vol. 242; pp. 258 - 263
• Main Authors: Pisano, Courtney, Sapci, Ipek, Karam, Paul A., DeRoss, Anthony L., Costedio, Meagan M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2019
• Subjects: Adolescent; Blood Loss, Surgical - statistics & numerical data; Child; Colectomy - adverse effects; Colectomy - methods; Collaborative approach; Colorectal Surgery - organization & administration; Female; Humans; Inflammatory Bowel Diseases - surgery; Intersectoral Collaboration; Length of Stay - statistics & numerical data; Male; Operative Time; Patient Care Team - organization & administration; Pediatric colorectal surgery; Pediatrics - organization & administration; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Retrospective Studies; Surgeons - organization & administration; Treatment Outcome; Pediatric colorectal surgery; Collaborative approach
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2019.04.038

Inflammatory bowel disease encompasses relapsing gastrointestinal disorders commonly presenting in pediatric patients, with 25% of diagnoses made before age 20 and 4% before age 5. Considering the need for life-long surgical follow-up, a collaborative system involving both pediatric and colorectal surgeons could improve overall patient experiences. We hypothesized that cases performed in collaboration with both pediatric and adult colorectal surgeons may lead to better outcomes. Data were gathered retrospectively for 116 patients 18 y old or younger who underwent colorectal resections for inflammatory bowel disease between 2010 and 2017 at our institution. Data included patient demographics, type of procedure, surgical approach, specimen extraction site, surgeon involvement (pediatric, colorectal, or collaborative), operative time, and estimated blood loss. We analyzed days until passage of flatus and bowel movement, length of stay, type of surgical procedure, and surgical complications. Our data showed that days until flatus (2.27 ± 0.47, P = 0.049), first bowel movement (2.64 ± 0.67, P = 0.006), and length of stay (4.45 ± 1.51, P = 0.006) were the shortest in the collaborative group. We also found that single-incision laparoscopic surgery was significantly more common in the collaborative group (77.8%, P = 0.002). We did not see a difference in surgical complication rates among any of the groups. Our study showed short-term beneficial outcomes in a single institution associated with the collaboration of pediatric surgeons and colorectal surgeons on pediatric colorectal cases in comparison to those performed by pediatric surgeons or adult colorectal surgeons alone.