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Dotlacil V, Lerchova T, Coufal S, Kucerova B, Schwarz J, Hradsky O, Skaba R, Rygl M. Comparison of laparoscopic and open ileocecal resection for Crohn's disease in children. Pediatr Surg Int 2023; 39:140. [PMID: 36847848 PMCID: PMC9971069 DOI: 10.1007/s00383-023-05419-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Ileocecal resection (ICR) is the most frequently performed surgery in paediatric Crohn's disease (CD) patients. The aim of the study was to compare laparoscopic-assisted and open ICR. METHODS Retrospective review of consecutive CD patients undergoing ICR between March 2014 and December 2021 was performed. The patients were divided into open (OG) and laparoscopic (LG) groups. Compared parameters included patients' demographics, clinical characteristics, surgery, duration of hospitalisation and follow-up. Complications were classified according to the Clavien-Dindo classification (CDc). Risk factors were identified using multivariable analysis. RESULTS Sixty-two patients (29 females, 46.7%) were included in the analysis, forty-two patients in OG. The median duration of surgery was 130 in OG versus 148 in LG (p = 0.065) minutes. Postoperative complications were reported in 4 patients (12.1%). There was no significant difference in postoperative complications according to CDc (OG 7.14 vs LG 5%, p = 1). The median length of hospitalisation was 8 in OG and 7 days in LG (p = 0.0005). The median length of follow-up was 21.5 months. CONCLUSION The laparoscopic-assisted approach had shorter hospital stay and was not associated with increased risk of 30-day postoperative complications. Laparoscopic surgery should be considered the preferred surgical approach for primary ICR.
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Affiliation(s)
- V Dotlacil
- Department of Paediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Praha 5, 150 06, Prague, Czech Republic.
| | - T Lerchova
- Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - S Coufal
- Laboratory of Cellular and Molecular Immunology, Institute of Microbiology, Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - B Kucerova
- Department of Paediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Praha 5, 150 06, Prague, Czech Republic
| | - J Schwarz
- Department of Paediatrics, Faculty of Medicine in Pilsen, Faculty Hospital, Charles University in Prague, Pilsen, Czech Republic
| | - O Hradsky
- Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - R Skaba
- Department of Paediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Praha 5, 150 06, Prague, Czech Republic
| | - M Rygl
- Department of Paediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Praha 5, 150 06, Prague, Czech Republic
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Kucerova B, Kovacova AS, Polivka N, Cejnarová K, Doucha M, Coufal S, Hlava S, Wasserbauer M, Dotlacil V, Kyncl M, Snajdauf J, Koucky V, Pohunek P, Rygl M. CT findings predicting lung resection in children with complicated community-acquired pneumonia. Pediatr Surg Int 2022; 38:431-436. [PMID: 35092464 DOI: 10.1007/s00383-022-05071-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate computed tomography (CT) features which predict lung resection in children with complicated community-acquired pneumonia. METHODS A retrospective study of CT findings of patients with complicated pneumonia treated between January 2010 and December 2019. Fisher's exact test and ROC curves were used for statistical analysis. RESULTS The study cohort consisted of 84 patients who underwent chest CT for complicated pneumonia. Lung resection was performed in 36 patients, 3 patients were treated by lung decortication, 45 patients were cured conservatively. Seven CT features were found statistically significant among the patients who underwent lung resection. 80.5% of patients from the resection group had two or more of these features on the initial CT scan, 64% had three or more. According to ROC analysis, simultaneous occurrence of multiple cavities equal to or greater than 3 cm and lung abscess predicted a pulmonary resection. CONCLUSION The combination of CT features which clearly predict lung resection are the simultaneous occurrence of multiple cavities ≥ 3 cm and lung abscess. The most common triple combination of CT signs in the resected group of patients were multiple cavities ≥ 3 cm, consolidation of lung tissue and pleural effusion < 3 cm.
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Affiliation(s)
- Barbora Kucerova
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic.
| | - A S Kovacova
- Department of Radiology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - N Polivka
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic
| | - K Cejnarová
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic
| | - M Doucha
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic
| | - S Coufal
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - S Hlava
- Department of Internal Medicine, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - M Wasserbauer
- Department of Internal Medicine, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - V Dotlacil
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic
| | - M Kyncl
- Department of Radiology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - J Snajdauf
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic
| | - V Koucky
- Department of Pediatrics, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - P Pohunek
- Department of Pediatrics, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - M Rygl
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic
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