Eur J Pediatr Surg
DOI: 10.1055/s-0043-1764320
Original Article

Children with Localized Crohn's Disease Benefit from Early Ileocecal Resection and Perioperative Anti-Tumor Necrosis Factor Therapy

Elena Weigl
1   Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Bayern, Germany
Tobias Schwerd
2   Department of Pediatric Gastroenterology, Dr. von Hauner Children's Hospital, University Hospital Munich, LMU Munich, Bayern, Germany
Eberhard Lurz
2   Department of Pediatric Gastroenterology, Dr. von Hauner Children's Hospital, University Hospital Munich, LMU Munich, Bayern, Germany
Beate Häberle
1   Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Bayern, Germany
Sibylle Koletzko
2   Department of Pediatric Gastroenterology, Dr. von Hauner Children's Hospital, University Hospital Munich, LMU Munich, Bayern, Germany
3   Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland
Jochen Hubertus
1   Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Bayern, Germany
› Author Affiliations


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.

Supplementary Material

Publication History

Received: 13 November 2022

Accepted: 31 January 2023

Article published online:
16 March 2023

© 2023. Thieme. All rights reserved.

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