Surgical endoscopy · 2026
Risk factors for postoperative intra-abdominal abscess following minimally invasive ileocecal resection in children with Crohn's disease.
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Sauvée Angélique, Glénisson Mathilde, Martinez-Vinson Christine, Ali Liza, Lefébure Chloé, Pardessus Pierre, Bonnard Arnaud, Montalva Louise
Аннотация
BACKGROUND: Pediatric-onset Crohn's disease (CD) is associated with a more severe disease course than adult-onset CD, with earlier progression to complications, and frequent need for surgery. Ileocecal resection (ICR) is the most commonly performed surgery. Postoperative intra-abdominal (IAA) abscess is a frequent and potentially severe complication following ICR in children. The aim of this study was to identify independent risk factors associated with postoperative IAA following minimally invasive ICR in children with CD.
METHODS: We conducted a retrospective single-center study including patients < 18 years who underwent laparoscopic or robotic ICR for CD between January 2000 and December 2023. Clinical, surgical, and postoperative data were collected. The primary outcome was the occurrence of IAA within 30 days of surgery. Univariate and multivariate logistic regression were performed to identify independent predictors.
RESULTS: Seventy-eight patients were included. The overall incidence of postoperative IAA was 19%. Multivariate analysis identified three factors associated with postoperative IAA: intraoperative identification of an abscess and/or fistula (OR 34.79; 95% CI [3.25-374.86]; p = 0.009), intraoperative complications (OR 12.83; 95% CI [1.93-84.53]; p = 0.01), and performance of an additional surgical procedure during ICR (OR 83.40; 95% CI [4.63-1503.55]; p = 0.001). Occurrence of IAA was associated with prolonged postoperative hospital stay and delayed initiation of medical therapy.
CONCLUSIONS: Postoperative IAA after minimally invasive ICR in children with CD was associated with intraoperative disease severity and surgical complexity. These findings highlight the importance of careful intraoperative assessment and individualized surgical decision-making in patients with complex disease or intraoperative complications.
METHODS: We conducted a retrospective single-center study including patients < 18 years who underwent laparoscopic or robotic ICR for CD between January 2000 and December 2023. Clinical, surgical, and postoperative data were collected. The primary outcome was the occurrence of IAA within 30 days of surgery. Univariate and multivariate logistic regression were performed to identify independent predictors.
RESULTS: Seventy-eight patients were included. The overall incidence of postoperative IAA was 19%. Multivariate analysis identified three factors associated with postoperative IAA: intraoperative identification of an abscess and/or fistula (OR 34.79; 95% CI [3.25-374.86]; p = 0.009), intraoperative complications (OR 12.83; 95% CI [1.93-84.53]; p = 0.01), and performance of an additional surgical procedure during ICR (OR 83.40; 95% CI [4.63-1503.55]; p = 0.001). Occurrence of IAA was associated with prolonged postoperative hospital stay and delayed initiation of medical therapy.
CONCLUSIONS: Postoperative IAA after minimally invasive ICR in children with CD was associated with intraoperative disease severity and surgical complexity. These findings highlight the importance of careful intraoperative assessment and individualized surgical decision-making in patients with complex disease or intraoperative complications.