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Laparoscopic total colectomies in children

M. François*, S. Irtan, A. Bonnard, P. de Lagausie, H. Staeyert, JS. Valla, M. Demarche, P. Erpicum, H. Lardy, M. Robert, G. Podevin, Y.Héloury, O. Reinberg, P. Montupet, H. Martelli, JF. Colombani, D. Weil, C. Piolat, M. Lopez*, E. Guye*, F. Varlet*

GECI et *CHU Saint-Etienne

 

ABSTRACT

Aim: To appreciate the feasibility of the total colectomies by laparoscopy in children and their results.

Material and methods: 11 centers of Pediatric Surgery (Paris-Robert Debré, Nice-Lenval, Liege, Turns, Nantes, Lausanne, Paris-Kremlin-Bicêtre, Fort-de-France, Angers, Grenoble and Saint-Etienne) agreed to answer a questionnaire concerning the total colectomy: age, sex, diagnosis, surgical indication, procedure, long-term complications and follow-up.

Results: 44 observations were gathered: 26 girls and 18 boys with an average age of 9.22 years (3 months-17 years), with the following pathology: 10 total colonic Hirschsprung disease, 12 hemorrhagic rectocolitis, 6 inflammatory colitis (Crohn and others) and 16 familial colonic polyposis. The number of trocars that were used: 5 on average. Anastomosis: ileorectal 26 cases (including in 22 cases a Pfannenstiel associated or an enlargement of the trocar incision in FID), ileoanal 17 cases (including 12 cases with a J pouch), impossible in 1 case. The average timing of intervention: 6.5 hours; peroperative complications: 6 (13.6%) including 3 perforations: duodenal, colonic or ureteral; first bowel movement: 3.78 days. Immediate postoperative complications: 19 (43.2%) including 9 serious complications (2 fistulas and 3 anastomotic stenosis, 3 intestinal obstruction and 1 infected urinoma). Hospital stay: 14,7 days (6-55). Late complications: 22/42 (52.4%) like incontinence, anal stenosis, intestinal obstruction, restart of the cortical and imunosupressive treatment when the rectum was preserved in the inflammatory diseases. 1 death that occurred 3 months after the intervention because of an evolutive hemorrhagic rectocolitis. 20 children in 42 did not have any late complication (47.6%). The complications were studied according to each type of pathology and we found serious complications in each one of it, in equivalent proportions.

Conclusion: The total colectomy is feasible by laparoscopy, but they are accompanied by complications during or after the intervention. Some of them are not due to this approach and are directly related to the colonic disease itself, often serious.

 

Key words: sphincteroplasty, laparoscopy