P434 Surgery management of Crohn's disease in children: our experience

Abstract

Objectives and Study: Classically, surgical treatment in pediatric Crohn's disease (CD) was reserved as a last option after the failure of the available medical treatments. Currently, surgery is offered in patients with localized inflammatory activity despite optimized medical treatment or patients with complications of the disease in early stages. The aim of our study is to review our experience in order to know the phenotype of patients who need surgery, surgical technique used and short- and mediumterm results. Methods: Retrospective cohort study of patients with pediatric CD who underwent surgery (excluding surgery of perianal disease) between 2012 and 2017 in a tertiary pediatric hospital. Epidemiological, clinical, analytical, radiological, endoscopic and surgical variables were collected and analyzed. Results: 25 patients had required surgical treatment (52% males). The average age at diagnosis was 11.6 ± 2.5 years, with a median (IQR) from the onset of symptoms to diagnosis of 0.74 (1) years. The mean time from diagnosis to the date of surgery was 2.5 ± 2 years. 40% had a stenosing behaviour at debut, 4% penetrating and 12% both of them. The most frequent location was ileocolonic (60%). Regarding the treatments received before surgery, 68% had received exclusive enteral nutrition and immunosuppressives, 20% corticosteroids and immunosuppressives, 20% anti-TNF alpha treatment in monotherapy and 84% biological treatment (anti- TNF-alpha/Vedolizumab/Ustekinumab) with immunosuppressives. The most frequent surgical indication was recurrent intestinal obstruction (84%). All interventions were initiated by laparoscopy although 12% were converted to laparotomy. A single resection was performed in 84% of the patients, multiple in 8% and in the remaining, an ileostomy without resection. The ileocecal area was the most frequently resected (78.3%), and only one strictureplasty was performed in 2 patients. The mean surgical time was 3.8 ± 1.2 hours and the average number of days of admission was 8.2 ± 3.3. There were no cases of surgical wound infection or postoperative ileus. In relation to prevention of postoperative recurrence, 96% of patients received biological treatment (anti-TNF alpha, Ustekinumab) ± immunosuppressives. To date, endoscopic control has been performed on 13 patients (between 6-12 months after surgery) with the following Rutgeerts index: i0 46.1%; i1 30.8%; i2 15.4%; i4 7.7%. At follow-up, 1 patient required surgical reintervention. Conclusions: Although the appearance of new biological treatments has reduced the need of surgical treatment in recent years, in selected cases, the surgical approach by experienced teams is an effective and safe alternative to patients with pediatric Crohn's disease.