Journal of Laparoendoscopic & Advanced Surgical TechniquesVol. 29, No. 6 AbstractsFree AccessIPEG 2019 The 28th Annual Congress for Endosurgery in Children March 20–22, 2019, Santiago, ChilePublished Online:28 May 2019https://doi.org/10.1089/lap.2019.29028.abstractsAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Podium AbstractsS001 OUTCOMES OF INITIAL SUBTOTAL COLECTOMY FOR PEDIATRIC INFLAMMATORY BOWEL DISEASENaomi‐Liza Denning, MD, Michelle P Kallis, MD, Charlotte L Kvasnovsky, MD, PhD, Aaron M Lipskar, MD;Cohen Children's Medical Center at Northwell HealthBackground: Subtotal colectomy with end ileostomy (STC‐I) has been well established in the adult literature as an initial surgical treatment for refractory inflammatory bowel disease (IBD) related colitis. However, in the pediatric population, the efficacy of this approach has been less well characterized; likely due to concerns regarding the advisability of leaving a diseased rectum in‐situ. Our aim was to examine the outcomes after STC‐I for refractory inflammatory bowel disease at our pediatric tertiary care center.Methods: An IRB approved retrospective review of patients aged 5 to 21 years who underwent operative treatment with initial STC‐I for medically refractory IBD from January 2010 to August 2018 at our institution. Only complications related to the STC‐I were considered; complications subsequent to reconstruction are excluded from analysis. Early complications were defined as occurring within 60 days of STC‐I. We performed descriptive statistics using Fisher's exact test and Student's t‐test, as appropriate.Results: Over the study period, 37 patients underwent STC‐I, with 75.7% performed laparoscopically. All open procedures were performed in the first two years of the study period. The average age of patients was 12.3 ± 4.2 years. Patients were predominately male (51.4%) and Caucasian (48.6%). Twenty‐nine (78.4%) colectomies were performed for ulcerative colitis (UC), 3 (8.1%) for Crohn's disease, and 5 (13.5%) for indeterminate colitis.Average post‐operative length of stay was shorter in the laparoscopic group compared to those undergoing open operations (5.1 ± 2.2 vs 6.9 ± 1.6 days, P = 0.03), excluding one patient in the laparoscopic group with a post‐operative stay of 43 days secondary to complications of toxic megacolon. 30‐day readmission rate was 21.1%. Patients experiencing unplanned readmission or unplanned operations were similar between groups (22.2% vs 39.3% p = 0.3 and 22.2% vs 21.4%, p = 0.9 respectively).Overall, 14 patients (37.8%) experienced a complication with many patients experiencing multiple complications. Early complications occurred in 9 (24.3%) patients. These included venous thromboembolism (5.4%), small bowel obstruction (5.4%), and intestinal perforation (2.7%). There were 3 patients with rectal stump dehiscence (8.1%), one resulting in mortality and one requiring emergent proctectomy. Late complications occurred in 24.3% of patients and included readmissions for dehydration (5.4%) or abdominal pain (2.7%). There were four patients (10.8%) with five admissions for bowel obstruction, two of whom required operative intervention (5.4%).Nutritional status improved post colectomy. Albumin levels of 3.3 ± 0.8 preoperatively increased to 4.3 ± 0.47 post‐operatively (p < 0.001). Among patients for whom data was available, average time to discontinuation of IBD‐related medications was 4 weeks, with no patient requiring longer than three months of treatment (n = 14). Forty‐seven percent required rectal treatment for proctitis; no patients required oral or intravenous therapy or admission (n = 15). Patients did well long term, with twenty‐five patients (67.5%) reestablishing intestinal continuity at our institution.Conclusions: Utilization of STC‐I as an initial procedure in the treatment of refractory inflammatory bowel disease related colitis in children is a safe and reasonable surgical approach. Implementing a laparoscopic approach to subtotal colectomy provides further benefit by reducing post‐operative length of stay.S002 EARLY EXPERIENCE WITH VARIANT 2‐STAGE APPROACH IN SURGICAL MANAGEMENT OF INFLAMMATORY BOWEL DISEASE COLITIS IN THE PEDIATRIC POPULATIONMichelle P Kallis, MD, Naomi‐Liza Denning, MD, Charlotte L Kvasnovsky, MD, PhD, Aaron M Lipskar, MD;Cohen Children's Medical Center at Northwell HealthBackground: Multi‐staged surgical management of inflammatory bowel disease (IBD), culminating with an ileal pouch‐anal anastomosis (IPAA) can provide a cure for refractory IBD symptoms while maintaining fecal continence. Surgical approaches to IPAA creation have historically included a 3‐stage approach done by subtotal colectomy followed by IPAA with diversion. More recently, a variant 2‐stage approach without diversion at time of IPAA creation has become increasingly utilized, yet evidence as to the efficacy of this approach is limited. Our aim was to examine outcomes of pediatric patients undergoing variant 2‐stage approach for IPAA creation at our tertiary care children's hospital.Methods: An IRB approved retrospective chart review of patients aged 5 to 21 years who underwent operative treatment with initial subtotal colectomy (STC), followed by a total proctocolectomy with IPAA +/‐ diversion for medically refractory IBD from January 2010 to August 2018 (n = 25). Fisher's exact test was used for statistical analysis.Results: The average age of patients at the time of subtotal colectomy was 13.4 ± 3.4 years. Patients were predominately male (53.8%) and Caucasian (53.8%). Indication for initial STC was ulcerative colitis in 84.6% of patients, Crohn's disease in 3.8% of patients, and indeterminate colitis in 11.5% of patients.Majority of IPAA procedures were done laparoscopically (88.5%). Thirteen patients (52%) underwent 2‐stage variant IPAA. Amongst the 12 patients undergoing conventional 3‐stage IPAA, reasons for diversion included physician preference (75%), technical considerations including tension of the anastomosis and extensive pelvic adhesions (16.7%), and 1 patient diverted for preexisting Crohn's disease. There were no significant differences in overall readmission rates (66.7% vs 53.8%, p = 0.5) or reoperation rates (50% vs 30.8%, p = 0.3) between patients undergoing 3‐stage approach and patients undergoing 2‐stage variant.Overall, 40% of patients experienced a complication after completion proctocolectomy with IPAA. Complication rates were similar between 2‐stage and 3‐stage IPAA groups (30.7% vs 50% P = 0.33). Complications within the 2‐stage group included 1 anastomotic leak requiring IR drainage, 2 patients requiring admission for pouchitis, 1 patient with both a wound infection and anastomotic stricture, and 1 patient requiring operation for incarcerated ventral hernia at an old stoma site. Complications within the 3‐stage group included 1 readmission for bloody ostomy output, 1 readmission for dehydration secondary to intractable vomiting, 1 patient requiring dilation for anastomotic stricture, 1 patient admitted twice for small bowel obstruction, 1 patient requiring 2 diagnostic laparoscopies for pouch volvulus, and 1 patient post‐operatively diagnosed with Crohn's and formation of a pouch‐vaginal fistula. There were no mortalities in either group.Conclusions: Treatment of refractory inflammatory bowel disease in children remains challenging to treat, but surgical treatment with subtotal colectomy followed by IPAA is an approach that provides relief of symptoms and preservation of fecal continence. Complication rates remained unchanged whether IPAA was conducted with or without diversion demonstrating that adoption of the 2‐stage variant approach is a safe and feasible surgical treatment plan that may serve to reduce subsequent anesthesia exposure and trips to the operating room.S003 YOUTUBE AS AN EDUCATIONAL RESOURCE FOR PEDIATRIC SURGEONS ON LAPAROSCOPIC ASSISTED PULL‐THROUGH IN HIRSCHSPRUNG DISEASEMaricarmen Olivos, MD1, Jorge Godoy Lenz, MD2;1Hospital San Juan de Dios, 2Clinica Las CondesYouTube offers an invaluable source of information. During the last decade, videos documenting surgery procedures, patient experiences, and medical commentary have gained hundreds of millions of views and it has become a common way for surgeons to update their knowledge on surgical procedures.This study evaluates the quality and utility of the YouTube content regarding Laparoscopic Pull‐Trough in Hirschsprung Disease (LPTHD).Methods: Using the YouTube search feature, a search using the terms laparoscopic + pull‐through + Hirschsprung's Disease was performed. The resulting videos were analyzed to determine the content and relevance.The exclusion criteria were videos not related to LPTHD, related to adults patients and repeated videos.Results: The search revealed 281 videos and video playlists, and of the 254 watched videos only 38 were related to LPTHD. 7 videos had an institutional origin and 31 were private uploads. Regarding the language, English was most common, with n = 29, followed by Spanish with 5, Italian‐2 and Russian‐2. Only 10 of the videos had an audio explanation for the procedure.Regarding the content, 3 of them show an explanation for Hirschsprung's disease and the diagnosis, 4 showed operative results and outcomes. In 15 videos laparoscopic colonic biopsy technique was showed and in 17 transanal stage was available as well. Finally, in 4 videos a comparison between the transanal and the open technique was made. No preference for country of origin was found.Discussion: Although a popular resource for surgical study material, YouTube videos can present biased information. Most videos are private uploads without any regulation or validation. These videos can be a help when planning a surgery, but all surgeons, specially trainees, should be aware of the possible biases within the videos and be prepared to verify the information.We believe that IPEG and IPEG's members have the opportunity and the responsibility to provide reliable audiovisual material for pediatrics surgeons and relatives of Hirschsprung's Disease patients.S004 LAPAROSCOPIC TRANSABDOMINAL COLOPEXY FOR PROLAPSE OF A NEWBORN END COLOSTOMYVictoria Ko, MD1, Luciana Roman, RN, MSN, ANP2, Keith A Kuenzler, MD, FACS, FAAP3, Jason C Fisher, MD, FACS, FAAP3;1Division of Pediatric Surgery, Hackensack Meridian School of Medicine at Seton Hall, Joseph M. Sanzari Children's Hospital, Hackensack, NJ; Department of Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, 2Division of Pediatric Surgery, Hackensack Meridian School of Medicine at Seton Hall, Joseph M. Sanzari Children's Hospital, Hackensack, NJ, 3Division of Pediatric Surgery, Hackensack Meridian School of Medicine at Seton Hall, Joseph M. Sanzari Children's Hospital, Hackensack, NJ; Division of Pediatric Surgery, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, New York, NYPurpose: Treatment of infants with anorectal malformations may necessitate colostomy creation prior to definitive repair. Standardized placement of a newborn colostomy at the level of the distal descending colon has significantly decreased the rate of prolapse by taking advantage of the natural tether provided by the left colon attachment to the retroperitoneum. Despite this, colostomy prolapse may still occur due to normal variation in the fixation of the left colon, albeit notably less so when compared to loop colostomies.When prolapse occurs, efforts to treat the colostomy without re‐opening the primary incision have been described. One such method involves packing the colostomy lumen with petroleum gauze to produce a palpable mass, and then utilizing transabdominal sutures to blindly pexy the colon to the anterior abdominal wall. While anecdotally successful, the approach lacks direct visualization and risks injuring or obstructing the bowel. We present a novel laparoscopic approach to treating symptomatic colostomy prolapse in infants which significantly reduces the risk of bowel injury without requiring larger incisions.Methods: A 2 month old child presenting with recurrent episodes of obstructive prolapse was brought to the operating room for laparoscopic colopexy. Five millimeter trocars were placed at the umbilical and right upper quadrant positions, while a 3mm grasper was placed through a subxyphoid stab incision (Figure 1A). A 5mm‐30 degree camera was then placed through the right upper quadrant trocar. We observed complete lack of normal fixation of the descending colon to the retroperitoneum, an anatomic variant we hypothesize accounted for the prolapse. A #10 Hegar dilator was inserted through colostomy for manipulation of the bowel and to maintain lumenal integrity during suture colopexy. Three 4‐0 vicryl sutures were placed transabdominally through stab incisions (Figure 1B). The sutures were then grasped intraabdominally and sutured to the anti‐mesenteric border of the descending colon in three places (Figure 1C and 1D), with the sutures delivered back out through the abdominal wall using an Endoclose device. The presence of the Hegar dilator during suturing protected against inadvertent “back‐wall” suturing of the mesenteric side of the colonic wall.Results: After tolerating the procedure well, the infant was stooling and eating normally within hours after surgery and with no further evidence of prolapse. The patient was discharged home the following day and is now five months out from surgery with no further complications in regards to his colostomy prolapse.Conclusions: Currently, the only published data on laparoscopic colopexy in infants includes one case report involving the treatment a volvulus in a 32 month female. Therefore, to our knowledge we present the first case of a successful laparoscopic colopexy for end colostomy prolapse, modeled on a variation of the “blind” transabdominal colopexy. Addition of a Hegar dilator ensures lumenal patency and provides an added measure of safety without requiring additional incisions.S005 USE OF MANEUVERS TO INCREASE MESENTERIC LENGTH IN CHILDREN UNDERGOING ILEAL POUCH‐ANAL ANASTOMOSISMichael D Traynor, MD, N P Mckenna, MD, E B Habermann, PhD, MPH, J Yonkus, MD, C R Moir, MD, D D Potter, MD, M B Ishitani, D B Klinkner, MD, MEd;Mayo ClinicBackground: Operative maneuvers to increase mesenteric reach during ileal pouch‐anal anastomosis (IPAA) are well described in adults, but limited data exist on the need for their use in children.Methods: We reviewed children (age <18) considered for IPAA creation at a single tertiary referral center from 2007 to 2017. Patient factors, operative details, and thirty‐day postoperative complications were abstracted. Body mass index (BMI) was normalized to BMI percentile‐for‐age‐and‐sex and classified as underweight (BMI <5th percentile), healthy weight (5th≤BMI percentile <85th), or overweight/obese (BMI ≥85th percentile).Maneuvers were identified from operative notes and included creation of mesenteric windows, high ligation of the ileocolic pedicle, ligation of terminal pouch vessels, and/or additional mobilization of the small bowel mesentery after a failed test of pouch length. Operative times were stratified by pediatric surgeon, group (in the case of adult colorectal surgery), and whether colectomy was performed at the same operation as the IPAA. Univariate analysis was performed to determine factors associated with the use of maneuvers. A multivariable model was built to determine independent factors affecting the need for operative maneuvers.Patients: Of 103 patients, 52 underwent total proctocolectomy with attempted IPAA and 51 underwent subtotal colectomy, 9 did not undergo an attempt at IPAA creation (reasons included growth concerns (n = 4), ongoing medical evaluation (n = 2), patient preference (n = 2), and obesity (n = 1)).Results: Of 94 patients who underwent attempt at initial IPAA creation, 91 (97%) had successful IPAA creation and 3 (3%) failed to reach. Failure occurred due to inability to reach in 3 patients, with specific mention of patients' obesity in 2 (BMI percentiles: 88, 98), and pouch ischemia in 1 (BMI percentile 82). In the 91 patients with successful IPAA, median age was 15 (Range: 1.5–17) and 57% were female. IPAA creation was performed as a one‐stage operation in 21 (23%), a two‐stage operation in 29 (32%), a modified two‐stage operation in 9 (10%), and as part of a three‐stage operation in 32 (35%). A laparoscopic approach was successful in 75 (82%) with 4 (4%) conversions to open, and 12 (13%) planned open procedures.Sixty (66%) patients required maneuvers to lengthen the mesentery. On univariate analysis, overweight patients required maneuvers more often than non‐overweight patients (93% versus 61%, p = 0.03). A positive trend for requirement of maneuvers existed across increasing BMI classification (p = 0.02, FIGURE). Performing maneuvers was associated with operative times above a surgeon's median operative time in operations that required colectomy (61% versus 32%, p = 0.04), but no difference was noted in operative times for completion proctectomy operations or 30‐day maximum Clavien‐Dindo scores (both p > 0.05). Being overweight/obese remained an independent risk factor for maneuvers (OR: 9.3, 95% CI: 1.1–82.8) after adjusting for age, sex, height, operative stage, and operating surgeon.Conclusion: Surgeons need to be prepared to perform mesenteric lengthening maneuvers when operating on overweight and obese pediatric patients in order to ensure minimal tension on IPAA. Whether these maneuvers have an impact on long‐term pouch function is undetermined.S006 PROPHYLACTIC COLECTOMY FOR CHILDREN WITH FAMILIAL ADENOMATOUS POLYPOSIS: A COST AND OUTCOMES ANALYSIS COMPARING OPEN AND LAPAROSCOPIC SURGERYAnthony Ferrantella, MD1, Brent A Willobee, MD1, Hallie J Quiroz, MD1, Thomas A Boyle, BS1, Amber H Langshaw, MD1, Samir Pandya, MD2, Chad M Thorson, MD, MSPH1, Juan E Sola, MD1, Eduardo A Perez, MD1;1University of Miami, 2UT SouthwesternBackground: A laparoscopic approach for the surgical management of familial adenomatous polyposis (FAP) is becoming increasingly common for pediatric patients. The purpose of this study was to evaluate the clinical outcomes and costs associated with laparoscopic compared to open surgery for elective prophylactic colectomy in children with FAP.Methods: The Kids' Inpatient Database (2009 and 2012) was queried for all children (age ≤20 years) with a diagnosis of FAP without malignancy that underwent elective open or laparoscopic colectomy with or without proctectomy. The patient demographics, concurrent diagnoses, frequency of complications, length of stay, treating hospital characteristics, and total hospital charges were compared.Results: Overall, we identified 216 patients with FAP that underwent elective colectomy, of which 95 cases were performed open and 121 were laparoscopic. The median age was similar (16 years) in each group. While chronic pulmonary disease was less common in the open cohort (4% vs 16%, P = 0.007), liver disease (3% vs 0%, P = 0.049) and coagulopathy (3% vs 0%, P = 0.049) were more common in the laparoscopic cohort. Complications were more common in open procedures, including accidental perforation or hemorrhage (4% vs 0%, P = 0.023), reopening of surgical site (3% vs 0%, P = 0.049), and pneumonia (3% vs 0%, P = 0.049). Diverting ostomy was performed more commonly in the open cohort (74% vs 49%, P < 0.001). There were no significant differences in the treating hospital characteristics with regard to location, bed size, teaching status, or ownership. The median length of stay was similar in the open and laparoscopic groups (7.0 vs 6.0 days, P = 0.712). Median total hospital charges were also similar ($67,334 vs $68,717, P = 0.080).Conclusion: Our findings suggest that a laparoscopic approach to prophylactic colectomy can be safely performed for children with FAP. Laparoscopic colectomy was associated with fewer complications and a lower frequency of ostomy creation compared to an open approach. Furthermore, there was no significant difference in length of stay or cost.S007 LAPAROSCOPIC THREE‐POINT FIXATION FOR INTRACTABLE RECTAL PROLAPSE IN CHILDRENSameh Shehata, MD, Mohamed Abouheba, MD, Ahmed Mokhtar;Alexandria UniversityAim: Rectal prolapse in children is a common condition in infancy and early childhood that usually responds to conservative measures. Surgery is reserved only for refractory cases that fail to respond to conservative measures. This study was designed to evaluate the efficacy of 3‐point fixation concept (retrorectal dissection, rectopexy to presacral fascia of the sacral promontory and sigmoidopexy onto the anterior abdominal wall) in treatment of complete rectal prolapse in children using laparoscopy.Methods: This prospective study was conducted on 18 cases with persistent complete rectal prolapse who failed to respond to adequate conservative measures from July 2015 to July 2017. The technical details of the procedure are described. Patients were followed up for at least 6 months and were assessed clinically and radiologically for continence and constipation using the appropriate scoring systems.Results: Eighteen patients were included, 12 females and 6 males, laparoscopic rectopexy and sigmoidopexy were done for all cases. Age ranged between 6–38 months (mean 18.4) The mean duration for surgery was 58.4 min. No intraoperative complications recorded. One case (5.5%) had partial thickness recurrence and 2 cases had skin stitch sinus. Three patients had constipation requiring laxatives after surgery.Conclusion: The laparoscopic rectopexy and sigmoidopexy is an effective approach for the treatment of refractory complete rectal prolapse in children. The 3‐point fixation proved efficient in preventing rectal prolapse in children with minimal complications.S008 COMPARISON OF OUTCOMES FOR OPEN VS LAPAROSCOPIC SURGICAL TECHNIQUES IN PEDIATRIC ULCERATIVE COLITISBrent A Willobee, MD1, Hallie J Quiroz, MD1, Anthony Ferrantella, MD1, Thomas A Boyle, BS1, Chad M Thorson, MD1, Samir Pandya, MD2, Juan E Sola, MD1, Eduardo A Perez, MD1;1The University of Miami, 2UT Southwestern Medical CenterBackground: Ulcerative colitis (UC) is an aggressive disease in the pediatric population and a cause of significant, lifelong morbidity. As with many other diseases, our treatment approach has been modified by the rise of minimally invasive surgical techniques. The aim of this study is to compare surgical complications in pediatric patients undergoing laparoscopic vs. open surgical treatment for UC.Methods: We queried the triennially released Kids' Inpatient Database (KID) for all cases of UC undergoing surgical treatment in 2009 and 2012. We identified patients who received total colectomy without proctectomy (n = 413) or total proctocolectomy (n = 196). We performed univariate and multivariate analyses comparing laparoscopic vs. open procedures with regards to demographics, surgical complications, and outcomes.Results: In UC patients undergoing total colectomy without proctectomy, median length of stay was longer in open vs. laparoscopic procedures (14 vs. 11 days, p = 0.01). Open procedures were associated with more complications than laparoscopic, including pneumonia (5% vs. 1%), coagulopathy (9% vs. 3%), neurologic disorders (8% vs. 2%), fluid and electrolyte disorders (40% vs. 28%), surgical dehiscence (6% vs. 2%), septicemia (18% vs. 2%), and gastrointestinal disorders (16% vs. 7%), all p < 0.05. Likewise, in patients with UC undergoing total proctocolectomy, there were more complications in open vs. laparoscopic technique, including increased transfusion requirements (25% vs. 7%, p = 0.001) and significantly more gastrointestinal upset (11% vs. 1%, p = 0.003). There was no difference with respect to length of stay or cost.In a multivariate model, patients who underwent total colectomy without proctectomy demonstrated a statistically significant association to complications with open procedures (46% vs. 23%, OR 2.75) and non‐elective admissions (37% vs. 19%, OR 2.47). Similarly, patients who underwent total proctocolectomy also demonstrated statistically significant association to complications with open procedures (33% vs. 11%, OR 3.83) and non‐elective admissions (41% vs. 15%, OR 3.91), all p < 0.001. Finally, complications were also higher in the group who underwent colectomy without proctectomy regardless of surgical technique (30.5 vs 21.9%, p = <0.001) although a significantly higher proportion of these cases were also done non‐electively.Conclusions: The rates of numerous surgical complications were significantly reduced when utilizing laparoscopic surgical techniques in the treatment of pediatric ulcerative colitis. These findings demonstrate that laparoscopic technique compares favorably to open in this disease process.S010 ALTERING THE TRADITIONAL APPROACH TO RESTORATIVE PROCTOCOLECTOMY AFTER SUBTOTAL COLECTOMY IN PEDIATRIC PATIENTSM D Traynor, MD, J Yonkus, MD, C R Moir, D B Klinkner, D D Potter;Mayo ClinicPurpose: Restoration of intestinal continuity by ileal pouch‐anal anastomosis (IPAA) following subtotal colectomy may not require a temporary, protective ileostomy. We compared the outcomes of pediatric patients undergoing modified two‐stage to three‐stage IPAA after recovering from subtotal colectomy.Methods: We reviewed children (age <18) who underwent IPAA creation for ulcerative or indeterminate colitis from January 1, 2007 to December 31, 2017. Patient characteristics, operative details, 30‐day complications, and post‐operative length of stay (LOS) were abstracted. Total LOS for the three‐stage group included both the IPAA and the ileostomy reversal operations. Univariate comparisons between patients undergoing modified two‐stage and three stage operations were performed.Results: A total of 41 patients underwent IPAA after subtotal colectomy; 9 (22%) underwent a modified two‐stage approach and 32 (72%) a three‐stage technique. Median age, sex, or operative approach did not differ between the groups (all p > 0.05, TABLE 1). Operative approach was laparoscopic in 31 (76%), converted to open in 1 (2%), and planned open in 10 (24%). Single‐incision technique was employed in 10 of 31 (32%) of laparoscopic cases.Modified two‐stage procedures had shorter total median LOS (6 days versus 9 days, p = 0.003). Incidence of post‐operative leak, readmission, return to the operating room, and maximum 30‐day Clavien‐Dindo scores at the time of IPAA creation did not differ between modified‐two and three stage approaches (all p > 0.05).Conclusion: The modified two‐stage approach to IPAA creation resulted in fewer hospital days compared to the three‐stage approach. Decisions regarding protective ileostomy after completion proctectomy with IPAA must weigh these benefits with the slight increased risk of leak.S011 FOLLOW‐UP REPORT OF LAPAROSCOPIC FUNDOPLICATION IN DIFFERENT TYPES OF ESOPHAGEAL HIATAL HERNIA IN CHILDRENYeming Wu, Cheng Cheng, Weihua Pan, Jun Wang;Xinhua Hospital affiliated to Shanghai Jiaotong Univ. Medical SchoolBackground: Esophageal hiatal hernia can be classified into four types (type I through IV). It has been reported that most of the complications occurred in patients with type II to IV hernia compared with type I hernia. The aim of this study was to investigate and compare the efficacy, complications and long‐time outcome after laparoscopic fundoplications between different types of esophageal hiatal hernia in children.Methods: 110 children (ages 9 days to 6 years) underwent laparoscopic Nissen‐Rosetti fundoplication or Thal fundoplication from 2008 to 2017 in our hospital were included. A total of 81 children were followed up for an average of 47.95 months (range: 12 to 124 months.Results: All 110 children underwent laparoscopic fundoplication (97 cases of Nissen‐Rossetti and 13 cases of Thal fundoplication) and none converted to open surgery. The mean age of the children at the time of operation was 10.42 ± 11.14 months, and the mean weight was 7.35 ± 3.33 kg. Of 110 children, type I, II, III and IV each accounted for 50.9%, 17.3%, 6.4% and 19.1%. There was no significant difference of time of operation, time to full feeding and length of hospital stay between type I and type II to IV esophageal hiatal hernia. The follow‐up information of 81 children (73.6%) were obtained. The score of postoperative symptoms were comparable between type I and type II to IV esophageal hiatal hernia. The incidence of dysphagia shortly after surgery was 12.3%, but there is only 1 patient still had severe dysphagia at the time of follow up. 9 children (11.1%) had symptoms of gastroesophageal reflux and 3 children still needed antacids. The recurrence rate was 12.3%. The difference in incidence of post‐operative dysphagia (14.6% versus 10.5%; P = .419) and gastroesophageal reflux symptoms (17.1% versus 5.3%; P = .96) and recurrence rate (12.2% versus 13.2%; P = .581) after laparoscopic fundoplication between type I and type II to IV hernia was not significant. The quality of life of three aspects improved significantly after laparoscopic fundoplication in all types of esophageal hiatal hernia children.Conclusions: Laparoscopic Nissen‐Rosetti fundoplication was an effective approach for all types of esophageal hiatal hernia. Type II to IV hernia could obtain a comparable therapeutic effect and long‐time outcome with type I hernia despite its increased complexity of the anatomy and the required laparoscopic repair procedure.S012 ENDOSCOPIC SLEEVE GASTROPLASTY IN CHILDREN AND ADOLESCENTS WITH OBESITY: OUTCOMES DURING THE FIRST YEARAayed R Alqahtani, MD, FRCSC, FACS1, Abdullah Al‐Darwish, MD2, Yara Alqahtani, MD2, Mohamed O Elahmedi, MD2;1Department of Surgery, King Saud University