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The Effect of Biologics on Postoperative Complications in Children With Inflammatory Bowel Disease and Bowel Resection

Mitsuya, Jennifer B.*,†; Gonzalez, Raquel; Thomas, Ron§; El-Baba, Mohammad*,†

Journal of Pediatric Gastroenterology and Nutrition: March 2019 - Volume 68 - Issue 3 - p 334–338
doi: 10.1097/MPG.0000000000002159
Original Article: Gastroenterology: Inflammatory Bowel Disease

Objectives: There has been limited investigation of pediatric patients with inflammatory bowel disease (IBD) who have been treated with biologic agents and undergo operative management. Postoperative complications in the adult setting have been mixed and in the pediatric population the data have been limited. This study compares children with IBD treated with biologic agents to patients treated with nonbiologic therapy before bowel resection.

Methods: This is a single-center, retrospective chart review study of 62 children with IBD who underwent bowel resection between 2001 and 2017. Analysis included patient demographics, medications used before surgery, incidence of postoperative complications, indication for surgery, type of operation, and additional surgeries required. Postoperative complications were defined as superficial skin infection, leak at anastomotic site, intra-abdominal abscess, wound dehiscence, and so on. Complications were compared based on medical therapy.

Results: Of the 62 children reviewed, 21 carried the diagnosis of ulcerative colitis, 40 had Crohn disease, and 1 had IBD-unspecified. Thirty-seven of the patients were treated with infliximab, adalimumab, or vedolizumab before their bowel resection. There were 4 complications documented within 30 days of the operation, with an overall complication rate of 6.45%. There were 2 complications in each of the cohorts, including intra-abdominal abscess (2), abdominal wall abscess (1), and pouchitis (1).

Conclusion: The number of complications was the same between those who did and did not receive a preoperative biologic agent. This study suggests that biologics may be safe to use in patients undergoing bowel resection.

*Division of Pediatric Gastroenterology, Department of Pediatrics, Children's Hospital of Michigan

Carman Ann Adam Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI

Department of Surgery, Johns Hopkins All Children's Hospital, Saint Petersburg, FL

§Children's Research Center of Michigan, Children's Hospital of Michigan, Detroit, MI.

Address correspondence and reprint requests to Mohammad El-Baba, MD, Division of Pediatric Gastroenterology, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 (e-mail:

Received 13 June, 2018

Accepted 9 September, 2018

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,