Single Incision Endosurgery for Inflammatory Bowel Disease in Children and Adolescents: A Case Series

Lena Perger, MD, Carrie A Laituri, MD, Shawn D St. Peter, MD, Oliver J Muensterer, MD PhD, Keith E Georgeson, MD, Carroll M Harmon, MD PhD. Children’s Hospital of Alabama, Birmingham, AL, Children’s Mercy Hospital, Kansas City, MO

Background: Many children with Crohn’s disease develop complications requiring intestinal resection. For ulcerative colitis, proctocolectomy with J-pouch and ileoanal anastomosis is the procedure of choice. Laparoscopy has become a common approach for both procedures in adults and children. We report the initial experience from two pediatric institutions with single incision laparoscopic technique for operating for inflammatory bowel disease.

Materials and methods: Between November 2009 and August 2010 we performed fifteen single incision endosurgical operations on fourteen patients 5 to 17 years old who weighed between 24 and 72 kg. Thirteen patients with Crohn’s disease underwent small bowel resection or ileocecectomy. One patient with ulcerative colitis had a total abdominal colectomy with end ileostomy, followed by proctectomy and J pouch with ileoanal anastomosis. Perioperative complications were recorded.

Results: All Crohn’s disease operations were performed through an umbilical multilumen port. All anastomoses were stapled extracorporealy. Total abdominal colectomy was performed through two multilumen ports, one placed in the umbilicus and one in the right lower quadrant, which was used for subsequent creation of an end ileostomy. The J pouch with ileoanal pull-through was done through a single umbilical multilumen port. There were three post-operative complications: one anastomotic leak 4 days post-operatively, one small bowel obstruction with perforation 2 weeks post-operatively, and one enterocutaneous fistula 3 weeks post-operatively.

Conclusions: Single incision endosurgery appears to be a reasonable alternative in children and adolescents with inflammatory bowel disease who require operative therapy. With improved instrumentation and more experience, we expect an increased use of single incision endosurgery in children with complex intestinal disease.