Abstract
Introduction In pediatric Crohn's disease ileocecal resection is performed reluctantly as postoperative
recurrence is frequent. Anti-tumor necrosis factor (TNF) therapy reduces postoperative
recurrence rates but increases the risk for infections.
Materials and Methods We retrospectively reviewed pediatric Crohn's disease patients who underwent ileocecal
resection in our center. We compared disease activity and z-scores for height, weight, and body mass index of patients, who continuously received
perioperative anti-TNF therapy (TNF + ), with those who did not (TNF–).
Results Of 29 patients (48% females), 13 and 16 were grouped to TNF+ and TNF–, respectively.
Patients' characteristics did not differ between groups, except a longer follow-up
time in TNF–. We saw significant postoperative improvement but no normalization in
z-scores for weight (1.78 vs. 0.77, p < 0.001), body mass index (1.08 vs. 0.22, p < 0.001), and height (0.88 vs. 0.66, p < 0.001). Disease activity improved significantly more in patients receiving anti-TNF
therapy (moderate improvement in 83% vs. 31%, p = 0.02). Endoscopic recurrence was more frequent in patients without anti-TNF therapy
(80% vs. 20%; p = 0.023), but endoscopic follow-up was incomplete. There was no increase of infections
under perioperative anti-TNF therapy (1 patient each; p = 1.000).
Conclusion In patients with localized Crohn's disease an ileocecal resection leads to short-term
postoperative improvement of disease activity, body mass index, weight, and growth.
For relevant catch-up growth an earlier intervention is necessary. Continuous perioperative
anti-TNF therapy had no increased risk of perioperative infections.
Keywords
Crohn's disease - ileocecal resection - anti-TNF therapy
