THE ROLE OF SURGERY IN CROHN'S DISEASE OF CHILDHOOD

Abstract

There are few reprots of the outcome of surgery for Crohn's disease in childhood. A retrospective study was thus performed of 67 children who have required surgery out of 167 histoogically proven cases of Crohn's disease presenting between 1979-88. Cases were divided into four grops on the basis of disease location. In group 1 (pan-enteric disease, n=3), indications for surgery were failed medical treatment and local sepsis. Results were disappointing; little was achieved to help symptoms or aid growth. In group 2 (diffuse small bowel disease, n=7), surgery was performed for pain or sub-acute bowel obstruction. Results were good, with low morbidity and a lengthy remission in 6/7 cases. In group 3 (ileo-caecal disease, n=30), the results were also impressive. All children had right hemicolectomies, most for poor growth. Long-lasting remission was achieved in 24/30 (80%), with significant acceleration of growth and puberty in most cases. In group 4 (colitis, n=27), the results of surgery were mixed. All of the 7 who had staged resections did badly, as did 3/4 cases given a loop ileostomy to divert faecal flow. Best results were achieved in the 16 children who had a sub-total colectomy, ileostomy and mucous fistula as the primary procedure; 15 have remained well, with only minor problems subsequently. In conclusion, outcome following surgery depended on disease location, but was also influenced by the type of operation. In addition to symptomatic relief, the principal benefits of surgery were acceleration of growth and pubertal advancement.