Presenter Status
Resident/Ph.D/Post graduate (> 1 month of dedicated research time)
Abstract Type
Research
Primary Mentor
Shawn St. Peter, MD
Start Date
13-5-2025 12:00 PM
End Date
13-5-2025 12:15 PM
Presentation Type
Oral Presentation
Description
Purpose: In refractory Crohn’s disease, the terminal ileum is a common site requiring excision. Laparoscopic ileocecectomy is the procedure of choice and we use a single-incision laparoscopic technique (SILS). We have previously reported our experience with SILS ileocecectomy with a sizeable cohort compared to other series. This project aims to expand on our single institutional experience with SILS ileocecectomy and evaluate the impact of experience.
Methods: We completed a retrospective review of patients who underwent single-incision laparoscopic (SILS) ileocecectomy for Crohn’s disease from 1/1/2009-3/31/2024 at a single institution by a single surgeon. Operative and inpatient characteristics were collected to determine overall complication rates. Subgroup analysis was completed comparing previously studied patients (1/1/2009-2/1/2013) to our updated cohort.
Results: Seventy-eight patients underwent SILS ileocecectomy for Crohn’s disease and had a median age of 16.5 years (IQR 15.0, 17.8) and a median BMI of 20 kg/m2 (17.4, 23.3). The most prevalent indications for surgery included pain (82%, N=64), obstruction (77%, N=60), and abscess (6%, N=5). All cases were completed SILS, and the median length of stay (LOS) was 96 hours (72, 186). The overall complication rate was 17% (N=13) and included small bowel obstruction (N=3), wound infection (N=2), small bowel perforation (N=1), anastomotic leak (N=1), and abscess (N=6). 6 patients required reoperation and 3 patients underwent drainage with interventional radiology. On subgroup analysis, patients operated on after 2013 were older (P=0.012), had a higher BMI (P=0.054), had a longer disease length prior to OR (P=0.051), and were more likely to be on anti-TNF therapy (P=0.014). Mean operative time was significantly lower in the newer cohort (70 mins compared to 85 mins, P=0.007). Although not statistically significant, the patients in the newer cohort had a shorter median LOS (72 hrs compared to 108 hrs, P=0.149) and had a lower complication (13% compared to 23%, P=0.283) and re-operation rate (4% compared to 15%, P=0.159).
Conclusions: We conclude that SILS ileocecectomy is an effective and safe technique in pediatric Crohn’s patients. As operative experience has increased, we have observed a clinically significant decrease in operative time and complication rates.
Single-Incision Laparoscopic Ileocecectomy in Pediatric Crohn’s Disease: A 15-Year Experience
Purpose: In refractory Crohn’s disease, the terminal ileum is a common site requiring excision. Laparoscopic ileocecectomy is the procedure of choice and we use a single-incision laparoscopic technique (SILS). We have previously reported our experience with SILS ileocecectomy with a sizeable cohort compared to other series. This project aims to expand on our single institutional experience with SILS ileocecectomy and evaluate the impact of experience.
Methods: We completed a retrospective review of patients who underwent single-incision laparoscopic (SILS) ileocecectomy for Crohn’s disease from 1/1/2009-3/31/2024 at a single institution by a single surgeon. Operative and inpatient characteristics were collected to determine overall complication rates. Subgroup analysis was completed comparing previously studied patients (1/1/2009-2/1/2013) to our updated cohort.
Results: Seventy-eight patients underwent SILS ileocecectomy for Crohn’s disease and had a median age of 16.5 years (IQR 15.0, 17.8) and a median BMI of 20 kg/m2 (17.4, 23.3). The most prevalent indications for surgery included pain (82%, N=64), obstruction (77%, N=60), and abscess (6%, N=5). All cases were completed SILS, and the median length of stay (LOS) was 96 hours (72, 186). The overall complication rate was 17% (N=13) and included small bowel obstruction (N=3), wound infection (N=2), small bowel perforation (N=1), anastomotic leak (N=1), and abscess (N=6). 6 patients required reoperation and 3 patients underwent drainage with interventional radiology. On subgroup analysis, patients operated on after 2013 were older (P=0.012), had a higher BMI (P=0.054), had a longer disease length prior to OR (P=0.051), and were more likely to be on anti-TNF therapy (P=0.014). Mean operative time was significantly lower in the newer cohort (70 mins compared to 85 mins, P=0.007). Although not statistically significant, the patients in the newer cohort had a shorter median LOS (72 hrs compared to 108 hrs, P=0.149) and had a lower complication (13% compared to 23%, P=0.283) and re-operation rate (4% compared to 15%, P=0.159).
Conclusions: We conclude that SILS ileocecectomy is an effective and safe technique in pediatric Crohn’s patients. As operative experience has increased, we have observed a clinically significant decrease in operative time and complication rates.
