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Long-term Outcomes After Surgery on Pediatric Patients With Crohn Disease

Piekkala, Maija*; Pakarinen, Mikko*; Ashorn, Merja; Rintala, Risto*; Kolho, Kaija-Leena*

Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e318279871c
Original Articles: Gastroenterology
Abstract

Objective: Of pediatric patients with Crohn disease, 20% to 30% undergo surgery within 10 years. Although disease relapses and reoperations are common, long-term functional outcomes and quality of life (QoL) are unclear.

Methods: In 2010, we reviewed the hospital records of all pediatric patients with CD who had undergone intestinal resections during childhood in 2 major tertiary care hospitals between 1985 and 2008 and mailed out questionnaires that asked about health outcomes and QoL. We compared the QoL of the patients and a group of matched controls randomly chosen from the Population Register Centre.

Results: In total, 36 children had undergone bowel resection a median of 10 years earlier and had at least 2 years of follow-up. Disease activation (verified at endoscopy) requiring medical or surgical treatment occurred in 94% (median 1.8 years after primary resection). At least 1 surgical complication occurred in 77%, and 54% underwent re-resection. The patients reported a median stool frequency of 3 stools during the day and zero at night, with 33% being totally continent. Overall, 96% were completely or moderately satisfied with the outcome of the surgery. The QoL was comparable between the patients and controls, but school or work absences diminished the QoL of the patients.

Conclusions: Surgery for pediatric-onset CD is risky even under expert care. Disease relapses and bowel re-resections are common during the first decade after primary surgery. In the long term, however, bowel function is acceptable and the QoL is comparable between patients and their peers.

Author Information

*Children's Hospital, Helsinki University Central Hospital and Helsinki University, Helsinki

Department of Pediatrics, Tampere University Hospital, Tampere, Finland.

Address correspondence and reprint requests to Maija Piekkala, Children's Hospital, University of Helsinki, PO Box 281, FIN-00029 HUS Helsinki, Finland (e-mail: maija.piekkala@helsinki.fi).

Received 5 June, 2012

Accepted 29 August, 2012

The present study received funding from the Finnish Pediatric Research Foundation, the Päivikki and Sakari Sohlberg Foundation, and the Helsinki University Central Hospital Research Fund.

The authors report no conflicts of interest.

Copyright 2013 by ESPGHAN and NASPGHAN