Surgical management of crohn disease in children

Abstract

Surgery plays an important role in the treatment of Crohn disease. Crohn disease has a major impact on the quality of life in the pediatric population, and, unfortunately, despite the dramatic improvements in medical therapies, 70-80% of patients who carry the diagnosis of Crohn disease undergo some type of surgical procedure at some point during the course of their disease. The indications for surgery have evolved over time with a trend toward less invasive procedures and fewer emergency surgery operations because of an acute complication of the disease. However, the basic role of surgery has not changed. Crohn disease cannot be cured in the operating room so the procedures are primarily employed to treat complications of the disease including obstruction, perforation, and medically refractory disease. Surgery is unavoidable in some cases and the preferred treatment option in many others. As with many diseases in children, studies specific to the pediatric population are not always available making it necessary to extrapolate the results of adult series when considering treatment options for younger patients. Although some differences between the patient populations exist, the philosophy remains the same. Surgical intervention is an integral part of the management of patients with Crohn disease but should be invoked judiciously to avoid the potential for long-term consequences and procedures should always be carried out with the long-term potential for short bowel syndrome in mind.