Gastrointestinal complications associated with the surgical treatment of heart disease in children.

BACKGROUND/PURPOSE: The gastrointestinal system is prone to complications following heart surgery. We sought to determine the incidence and factors associated with gastrointestinal complication after cardiac surgery in children. METHODS: A retrospective review of patients aged <16years that underwent cardiac surgery between 2009 and 2013. Primary outcome was occurrence of gastrointestinal complication within 30days. Multivariable logistic regression was performed to identify variables related to occurrence of gastrointestinal complication. Patients with gastrointestinal complication were matched with controls and postoperative lengths of stay compared. RESULTS: Eight hundred eighty-one children underwent 1120 cardiac surgical procedures. At time of operation, 18% were neonates and 39% were infants. Cardiopulmonary bypass was used in 79%. Of 1120 procedures, 31 (2.8% [95% CI 2.0-3.9%]) had gastrointestinal complication. Necrotizing enterocolitis accounted for 61% of complications. Of patients with gastrointestinal complication, 87% survived to hospital discharge. Gastrointestinal complication was associated with preoperative co-morbidity (OR 2.2 [95% CI 1.02-4.8]) and univentricular disease (OR 2.5 [95% CI 1.1-5.5]). Neonates had the highest risk of gastrointestinal complication. Patients with gastrointestinal complications had longer hospital stays than controls (median difference, 13days [95% CI 3-43]). CONCLUSIONS: Serious gastrointestinal complications are uncommon but associated with longer hospital stay. Neonates with univentricular disease and preoperative comorbidity are at highest risk. TYPE OF STUDY: Prognosis study. LEVEL OF EVIDENCE: II.

A comparison of laparoscopic and open restorative proctocolectomy in children.

AIM: Restorative proctocolectomy (RP) is the gold standard for children requiring removal of their colon and rectum. The aim of this study is to contrast conventional (open) and laparoscopic RP. METHODS: All children undergoing RP by one surgeon were prospectively recorded in a customised database. Outcome variables were length of stay in days (LOS), duration of surgery in minutes (DS), blood loss in ml, and complications. Explanatory variables included technique of resection (open or laparoscopic (lap)) and presenting disease. Lap resection was adopted after patient 37. Data are presented as median (range). P<0.05 was regarded as significant. RESULTS: Eighty-two (43 girls) children underwent RP at median age 12 (0.5-20) years. RP was performed as Open (n=37) or Laparoscopic (n=45). Indications were: colitis (n=56), polyposis (n=12), constipation (n=7), Hirschsprung's (n=5), fibrosing colonopathy (n=2). Significantly, more children had three-stage surgery among the lap group (P =0.04). LOS was significantly shorter in the lap group [15 (8-114) days vs 17(13- 60) days; P=0.04], but there was no difference in DS or complication rates between laparoscopic and open surgery. Laparoscopic surgery was associated with significantly lower blood loss [150 (0-840) ml vs. 334 (0-1480) ml; P=0.02]. CONCLUSION: Laparoscopic RP is associated with lower blood loss, shorter LOS, but no difference in duration of surgery or complication rate.