G46(P) Outcome of children with inflammatory bowel disease after surgery

Abstract

AimTo investigate the outcome after surgery in children with inflammatory bowel disease (IBD).MethodCase notes of patients who had surgery for IBD between November 1999 and January 2011 at a tertiary hospital in the UK were reviewed. Data related to relapses, acute readmissions, weights and heights one year before and up to a maximum of three years after surgery were collected. Mean Standard Deviation scores (SDS) were calculated for weights and heights. Outcomes were analysed using the paired t test.Results38 patients were eligible for the study. Of these case notes were available for 31 patients. 61% (n=19) had Crohn’s Disease (CD) and 39% (n=12) had Ulcerative Colitis (UC). The commonest indication for surgery was failure of medical management (48%). Surgical interventions included subtotal colectomy with ileostomy (18), extended right hemicolectomy (11), total colectomy (1) and limited ileal resection (1).74% (n=14) of CD patients had no relapses in the follow up period after surgery. The average number of relapses (in 12 patients for whom data was available) came down from 2.3 in the year before surgery to 0.4 in year after surgery with a mean reduction of 1.9 (p=0.0001; 95% CI: 1.2 to 2.7). There was no statistically significant difference in the average number of acute readmissions between these periods. At one year after surgery the increase in mean SDS was 0.78 (p=0.01 CI: 0.2 to 1.3) for weight and 0.3 (p=0.002; CI: 0.13 to 0.46) for height.UC does not recur after total proctocolectomy. Hence there were no relapses after surgery. In the six patients for whom data was available, there was an insignificant increase in the average number of hospital admissions from 1 in the year before surgery to 1.5 in the year after (mean increase 0.5; 95% CI: 1 to 2; p=0.45). At one year after surgery the change in mean SDS was −0.1 (p=0.5; CI: −0.4 to 0.2) for weight and 0.18 (p=0.07; CI: −0.02 to 0.4) for height.ConclusionsThere was improvement in growth and reduction in number of relapses after surgery in CD patients. For UC patients no significant improvement was seen either in terms of readmissions or growth