Fast-track management is safe and effective after bowel resection in children with Crohn's disease

被引:45
作者
Vrecenak, Jesse D. [1 ]
Mattei, Peter [1 ]
机构
[1] Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA
关键词
Crohn's disease; Fast track; Laparoscopic; Postoperative management; NONSTEROIDAL ANTIINFLAMMATORY DRUGS; OPEN ILEOCOLIC RESECTION; SURGERY; ADOLESCENT; COLITIS; INFANTS; CARE;
D O I
10.1016/j.jpedsurg.2013.09.038
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Background: "Fast-track" management (FT) challenges traditional postoperative tenets in order to minimize discomfort and optimize inpatient care. We examined the outcomes of consecutively performed laparoscopic-assisted ileocecectomy for Crohn's disease (CD), with particular focus on FT's effects in patients with underlying bowel inflammation. Methods: We retrospectively reviewed all patients undergoing isolated laparoscopic-assisted ileocecectomy for CD at our institution between 12/2000 and 12/2010, excluding patients with multiple areas of surgical CD, bladder involvement, or age >18 years. Results: Seventy-one patients aged 8-18 years underwent isolated laparoscopic-assisted ileocecectomy for CD, of which 45 met FT criteria. Individual practice patterns primarily determined which patients were FT-managed. FT management led to decreased length of stay (LOS), time to first stool, time to full diet, and intravenous narcotic use. No significant difference in complications or disease progression was observed between the two groups during 2-year follow up. Conclusions: Our results suggest that FT is safe and effective in patients with CD. In a chronically ill population, counseling patients and families to expect early discharge is critical to the success of this strategy. Despite CD-related GI pathology, FT patients realized benefits in terms of LOS, time to bowel function, and narcotic use without any increase in complications. (C) 2014 Elsevier Inc. All rights reserved.
引用
收藏
页码:99 / 103
页数:5
相关论文
共 31 条
[1]   Aspirin, Nonsteroidal Anti-inflammatory Drug Use, and Risk for Crohn Disease and Ulcerative Colitis A Cohort Study [J].
Ananthakrishnan, Ashwin N. ;
Higuchi, Leslie M. ;
Huang, Edward S. ;
Khalili, Hamed ;
Richter, James M. ;
Fuchs, Charles S. ;
Chan, Andrew T. .
ANNALS OF INTERNAL MEDICINE, 2012, 156 (05) :350-U170
[2]   Colonic surgery with accelerated rehabilitation or conventional care [J].
Basse, L ;
Thorbol, JE ;
Lossl, K ;
Kehlet, H .
DISEASES OF THE COLON & RECTUM, 2004, 47 (03) :271-277
[3]   Colostomy closure after Hartmann's procedure with fast-track rehabilitation [J].
Basse, L ;
Jacobsen, DH ;
Billesbolle, P ;
Kehlet, H .
DISEASES OF THE COLON & RECTUM, 2002, 45 (12) :1661-1664
[4]   Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition [J].
Basse, L ;
Raskov, HH ;
Jakobsen, DH ;
Sonne, E ;
Billesbolle, P ;
Hendel, HW ;
Rosenberg, J ;
Kehlet, H .
BRITISH JOURNAL OF SURGERY, 2002, 89 (04) :446-453
[5]   A Prospective Population-Based Study of Triggers of Symptomatic Flares in IBD [J].
Bernstein, Charles N. ;
Singh, Sunny ;
Graff, Lesley A. ;
Walker, John R. ;
Miller, Norine ;
Cheang, Mary .
AMERICAN JOURNAL OF GASTROENTEROLOGY, 2010, 105 (09) :1994-2002
[6]   Involvement of Endoplasmic Reticulum Stress in Inflammatory Bowel Disease: A Different Implication for Colonic and Ileal Disease? [J].
Bogaert, Sara ;
De Vos, Martine ;
Olievier, Kim ;
Peeters, Harald ;
Elewaut, Dirk ;
Lambrecht, Bart ;
Pouliot, Philippe ;
Laukens, Debby .
PLOS ONE, 2011, 6 (10)
[7]   A long-term cohort study of nonsteroidal anti-inflammatory drug use and disease activity in outpatients with inflammatory bowel disease [J].
Bonner, GF ;
Fakhri, A ;
Vennamaneni, SR .
INFLAMMATORY BOWEL DISEASES, 2004, 10 (06) :751-757
[8]   Fast-Track Pathways in Colorectal Surgery [J].
Chestovich, Paul J. ;
Lin, Anne Y. ;
Yoo, James .
SURGICAL CLINICS OF NORTH AMERICA, 2013, 93 (01) :21-+
[9]   SCHOOL ABSENCE AMONG CHILDREN WITH CHRONIC ILLNESS [J].
COOK, BA ;
SCHALLER, K ;
KRISCHER, JP .
JOURNAL OF SCHOOL HEALTH, 1985, 55 (07) :265-267
[10]   Laparoscopic-assisted versus open ileocolic resection for adolescent Crohn disease [J].
Diamond, IR ;
Langer, JC .
JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, 2001, 33 (05) :543-547