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• W1966313612 abstract "The overall impression gained from the experience of the Departments ofPaediatric Gastroenterology and Surgery attached to St Bartholomew's Hospital are the enormous benefits that surgery has to confer on the large percentage of children with both Crohn's disease and idiopathic proctocolitis who require it. The surgical procedures described in this chapter have been accompanied by a remarkably low complication rate, dispelling the impression that morbidity in such cases would be high. This must in large measure be due to the fact that the children who come to surgery are in as good a state of nutrition as can be achieved by means of the various forms of enteral and parenteral feeding now available. Anxiety about healing of anastomoses and the development of fistulas after surgery for example, has not been a feature of the surgical care of these patients. The principal benefit of surgery has been a clear demonstration of animprovement in growth velocity in both Crohn's disease and idiopathic proctocolitis patients provided always that surgery is correctly timed. It is the author's experience that maximum benefit is achieved if the bulk of the diseased bowel can be removed. Plainly relief of symptoms such as abdominal pain and diarrhoea has also been rewarding. In many instances second procedures such as restorative protectomy in idiopathic proctocolitis can be timed to fit in with educational commitments. In Crohn's disease the likelihood of recurrence in adult life is high but these patients are in a fit state to cope with further therapy including surgery should the need arise. From the management point of view the close cooperation betweenphysicians and surgeons at all stages has been crucial, firstly to achieve smooth preparation prior to surgery and satisfactory after care. But of even more importance in the assessment of Crohn's disease is the presence of all clinicians involved in the case in the operating theatre so that surgical options are fully assessed. This united approach avoids any unnecessary anxiety when, as inevitably happens, recurrence of symptoms due to relapse occurs. The involvement of patients of whatever age, and parents in all thedecision making processes from the time of diagnosis has been vital. Early discussion about stomas involving members of the Stomatherapy Department has been invaluable. One final important aspect of the management of these patients is theseamless hand-over of care to an adult combined medical and surgical clinic at an appropriate time, usually at the age of 17 years. It happens that the surgical team which deals with the children in the author's hospital also looks after adult patients with chronic inflammatory bowel disease, thus ensuring such continuity. Until such time as the cause of these distressing conditions is elucidated surgery will remain an essential and rewarding therapeutic option." @default.
• W1966313612 created "2016-06-24" @default.
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• W1966313612 date "1994-03-01" @default.
• W1966313612 modified "2023-10-16" @default.
• W1966313612 title "Surgical therapy of chronic inflammatory bowel disease in childhood" @default.
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• W1966313612 doi "https://doi.org/10.1016/s0950-3528(06)80024-2" @default.
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