Single-Incision Laparoscopic Ileocecectomy in Pediatric Crohn's Disease: A 15-Year Experience.

Abstract

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 and evaluate the impact of operative experience. Methods: We completed a single-institution retrospective review of patients who underwent SILS ileocecectomy for Crohn's disease from January 1, 2009 to March 31, 2024. Operative and inpatient characteristics were collected to determine complication rates. Subgroup analysis was completed comparing previously studied patients (January 1, 2009 to February 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 (interquartile range: 15.0, 17.8). The median length of stay (LOS) was 96 hours (72, 186). The overall complication rate was 17%. On subgroup analysis, patients operated on after 2013 were older (P = .012), had a longer disease length before operating room (OR) (P = .051) and were more likely to be on anti-tumor necrosis factor therapy (P = .014). Mean operative time was significantly lower in the newer cohort (70 mins versus 85 mins, P = .007). The patients in the newer cohort had a shorter median LOS (72 hours compared to 108 hours, P = .149) and had a lower complication (13% versus 23%, P = .283) and re-operation rate (4% versus 15%, P = .159). Conclusions: SILS ileocecectomy is effective and safe in pediatric patients with Crohn's disease. As operative experience increases, we have observed a clinically significant decrease in operative time and complication rates. Level of Evidence: III, Retrospective study.