Brent A Willobee, Jennifer A Nguyen, Anthony Ferrantella, Hallie J Quiroz, Anthony R Hogan, Ann-Christina Brady, Samir Pandya, Amber H Langshaw, Juan E Sola, Chad M Thorson, Eduardo A Perez
{"title":"儿童溃疡性结肠炎的开放性与腹腔镜手术技术的回顾性比较。","authors":"Brent A Willobee, Jennifer A Nguyen, Anthony Ferrantella, Hallie J Quiroz, Anthony R Hogan, Ann-Christina Brady, Samir Pandya, Amber H Langshaw, Juan E Sola, Chad M Thorson, Eduardo A Perez","doi":"10.21037/tgh-20-189","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Ulcerative colitis (UC) is an aggressive disease in the pediatric population and a cause of significant, lifelong morbidity. The aim of this study is to compare surgical complications in pediatric patients undergoing laparoscopic <i>vs.</i> open surgical treatment for UC.</p><p><strong>Methods: </strong>We queried the Kids' Inpatient Database (KID) for all cases of UC undergoing surgical treatment in 2009 and 2012. We identified patients who received total colectomy without proctectomy (n=413) or total proctocolectomy (n=196) and performed univariate and multivariate analyses comparing laparoscopic <i>vs.</i> open procedures.</p><p><strong>Results: </strong>In pediatric UC patients undergoing total colectomy without proctectomy, open procedures were associated with more complications than laparoscopic, including fluid and electrolyte disorders (40% <i>vs.</i> 28%), surgical wound dehiscence (6% <i>vs.</i> 2%), septicemia (18% <i>vs.</i> 2%), and gastrointestinal disorders (16% <i>vs.</i> 7%) among others, all P<0.05. Likewise, in patients with UC undergoing total proctocolectomy, there were more complications in open <i>vs.</i> laparoscopic technique, including increased transfusion requirements (25% <i>vs.</i> 7%, P=0.001) and significantly more gastrointestinal upset, including nausea, vomiting, and diarrhea (11% <i>vs.</i> 1%, P=0.003). In multivariate analysis, patients who underwent total colectomy with or without proctectomy had an increased risk of experiencing any complication when their procedure was performed in an open or non-elective fashion (all odds ratio >2.4; all P<0.001).</p><p><strong>Conclusions: </strong>The laparoscopic approach was associated with significantly lower rates of surgical complications in pediatric patients undergoing total colectomy with or without proctectomy for UC. These findings demonstrate that laparoscopic technique compares favorably, and may be preferable, to the open approach in selected pediatric patients with UC.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":null,"pages":null},"PeriodicalIF":3.0000,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343411/pdf/tgh-06-20-189.pdf","citationCount":"0","resultStr":"{\"title\":\"A retrospective comparison of outcomes for open <i>vs.</i> laparoscopic surgical techniques in pediatric ulcerative colitis.\",\"authors\":\"Brent A Willobee, Jennifer A Nguyen, Anthony Ferrantella, Hallie J Quiroz, Anthony R Hogan, Ann-Christina Brady, Samir Pandya, Amber H Langshaw, Juan E Sola, Chad M Thorson, Eduardo A Perez\",\"doi\":\"10.21037/tgh-20-189\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Ulcerative colitis (UC) is an aggressive disease in the pediatric population and a cause of significant, lifelong morbidity. The aim of this study is to compare surgical complications in pediatric patients undergoing laparoscopic <i>vs.</i> open surgical treatment for UC.</p><p><strong>Methods: </strong>We queried the Kids' Inpatient Database (KID) for all cases of UC undergoing surgical treatment in 2009 and 2012. We identified patients who received total colectomy without proctectomy (n=413) or total proctocolectomy (n=196) and performed univariate and multivariate analyses comparing laparoscopic <i>vs.</i> open procedures.</p><p><strong>Results: </strong>In pediatric UC patients undergoing total colectomy without proctectomy, open procedures were associated with more complications than laparoscopic, including fluid and electrolyte disorders (40% <i>vs.</i> 28%), surgical wound dehiscence (6% <i>vs.</i> 2%), septicemia (18% <i>vs.</i> 2%), and gastrointestinal disorders (16% <i>vs.</i> 7%) among others, all P<0.05. Likewise, in patients with UC undergoing total proctocolectomy, there were more complications in open <i>vs.</i> laparoscopic technique, including increased transfusion requirements (25% <i>vs.</i> 7%, P=0.001) and significantly more gastrointestinal upset, including nausea, vomiting, and diarrhea (11% <i>vs.</i> 1%, P=0.003). In multivariate analysis, patients who underwent total colectomy with or without proctectomy had an increased risk of experiencing any complication when their procedure was performed in an open or non-elective fashion (all odds ratio >2.4; all P<0.001).</p><p><strong>Conclusions: </strong>The laparoscopic approach was associated with significantly lower rates of surgical complications in pediatric patients undergoing total colectomy with or without proctectomy for UC. These findings demonstrate that laparoscopic technique compares favorably, and may be preferable, to the open approach in selected pediatric patients with UC.</p>\",\"PeriodicalId\":23267,\"journal\":{\"name\":\"Translational gastroenterology and hepatology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2021-07-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343411/pdf/tgh-06-20-189.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Translational gastroenterology and hepatology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.21037/tgh-20-189\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2021/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Translational gastroenterology and hepatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/tgh-20-189","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"Medicine","Score":null,"Total":0}
A retrospective comparison of outcomes for open vs. laparoscopic surgical techniques in pediatric ulcerative colitis.
Background: Ulcerative colitis (UC) is an aggressive disease in the pediatric population and a cause of significant, lifelong morbidity. The aim of this study is to compare surgical complications in pediatric patients undergoing laparoscopic vs. open surgical treatment for UC.
Methods: We queried the Kids' Inpatient Database (KID) for all cases of UC undergoing surgical treatment in 2009 and 2012. We identified patients who received total colectomy without proctectomy (n=413) or total proctocolectomy (n=196) and performed univariate and multivariate analyses comparing laparoscopic vs. open procedures.
Results: In pediatric UC patients undergoing total colectomy without proctectomy, open procedures were associated with more complications than laparoscopic, including fluid and electrolyte disorders (40% vs. 28%), surgical wound dehiscence (6% vs. 2%), septicemia (18% vs. 2%), and gastrointestinal disorders (16% vs. 7%) among others, all P<0.05. Likewise, in patients with UC undergoing total proctocolectomy, there were more complications in open vs. laparoscopic technique, including increased transfusion requirements (25% vs. 7%, P=0.001) and significantly more gastrointestinal upset, including nausea, vomiting, and diarrhea (11% vs. 1%, P=0.003). In multivariate analysis, patients who underwent total colectomy with or without proctectomy had an increased risk of experiencing any complication when their procedure was performed in an open or non-elective fashion (all odds ratio >2.4; all P<0.001).
Conclusions: The laparoscopic approach was associated with significantly lower rates of surgical complications in pediatric patients undergoing total colectomy with or without proctectomy for UC. These findings demonstrate that laparoscopic technique compares favorably, and may be preferable, to the open approach in selected pediatric patients with UC.
期刊介绍:
Translational Gastroenterology and Hepatology (Transl Gastroenterol Hepatol; TGH; Online ISSN 2415-1289) is an open-access, peer-reviewed online journal that focuses on cutting-edge findings in the field of translational research in gastroenterology and hepatology and provides current and practical information on diagnosis, prevention and clinical investigations of gastrointestinal, pancreas, gallbladder and hepatic diseases. Specific areas of interest include, but not limited to, multimodality therapy, biomarkers, imaging, biology, pathology, and technical advances related to gastrointestinal and hepatic diseases. Contributions pertinent to gastroenterology and hepatology are also included from related fields such as nutrition, surgery, public health, human genetics, basic sciences, education, sociology, and nursing.