Two-stage, one-stage surgeries safe, effective for paediatric CD

Two-stage and one-stage surgeries are comparably effective and safe in children with Crohn’s disease, reports a recent case series.

Seven patients were evaluated, five of whom underwent two-stage procedures. Both groups were comparable in terms of age at operation, body mass index, surgical site and indication, and anastomosis technique. Two patients in the two-stage arm developed infection, while one had anastomosis leakage after enterostomy leakage. Despite no such incidences in the one-stage group, the researchers recoded no significant difference in the occurrence of complications.

Over a mean follow-up period of 76.2 months, only one patient, belonging to the two-stage group, saw surgical recurrence and received subsequent subtotal colectomy. No such cases of recurrence were reported in the one-stage group. The overall recurrence rate was 14 percent, slightly lower than previously reported in a systematic analysis. [Am J Gastroenterol 2014:109:1739–1748]

Of all the correlates associated, only ileocolonic involvement was potentially associated with recurrence. Meanwhile prior abdominal operation, intestinal perforation, anastomosis technique, or child body mass index were unrelated to recurrence. Notably, the risk of recurrence likewise did not differ significantly between the one-stage or two-stage surgery arms.

The researchers identified no potential risk factor for infection or leakage incidence.

“For paediatric surgeons, hand-sewn end-to-end intestinal anastomosis could be performed with special care of blood supply preservation and tension-free maintenance,” the researchers said. “For paediatric CD patients requiring surgery, both two-stage and one-stage operations could be safe and effective treatment choices.”