J Surg Res. 2024 Mar:295:399-406. doi: 10.1016/j.jss.2023.11.007. Epub 2023 Dec 8.

Alicia C Greene ¹, Marc M Mankarious ¹, Adam Finkelstein ², Jessica C El-Mallah ¹, Audrey S Kulaylat ³, Afif N Kulaylat ⁴

Author information

¹Department of Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania.

²The Pennsylvania State University College of Medicine, Hershey, Pennsylvania.

³Division of Colon and Rectal Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania.

⁴Division of Pediatric Surgery, Penn State Children's Hospital, Hershey, Pennsylvania. Electronic address: akulaylat@pennstatehealth.psu.edu.

Abstract

Introduction: While minimally invasive surgery (MIS) approaches are commonly utilized in the elective surgical setting for pediatric ulcerative colitis (UC), their role in urgent and emergent disease is less clear. We aim to assess trends in the surgical approaches for pediatric UC patients requiring urgent and emergent colectomies and their associated outcomes.

Methods: Retrospective review of 81 pediatric UC patients identified in National Surgical Quality Improvement Program Pediatric who underwent urgent or emergent colectomy (2012-2019). Trends in approach were assessed using linear regression. Patient characteristics and clinical outcomes were stratified by approach and compared using standard univariate statistics. Multivariable analysis was used to model the influence of covariates on postoperative length of stay.

Results: The proportion of MIS cases increased by 5.53% per year (P = 0.01) over the study interval. Sixty-three patients (77.8%) received MIS resections and 18 patients (22.2%) received open resections. Patients undergoing open colectomies were younger and had a higher proportion of preoperative conditions, most notably preoperative sepsis (27.8% versus 4.8%, P = 0.01), and higher American Society of Anesthesiologists [III-IV] classification (83.3% versus 58.8%, P = 0.004). Mean operative time was comparable (open, 173.6 versus MIS, 206.1 min). In the univariate analysis, open approach was associated with increased postoperative length of stay (13.1 versus 7.2 d, P = 0.002). However, after adjusting for confounders, there was no significant difference.

Conclusions: There has been a steady increase in the adoption of laparoscopy in urgent and emergent colectomy for pediatric UC. Short-term outcomes between approaches appear comparable.