Single Incision Minimally Invasive Surgery for Children with Crohn’s Disease
Laura A. Boomer, MD, Victoria Pepper, MD, Justin Huntington, MD, Karen A. Diefenbach, MD, Jennifer L.
Dotson, MD, MPH, Benedict C. Nwomeh, MD, MPH
Purpose: Single incision minimally invasive surgery (SiMIS) has been described in adults with Crohn’s
disease (CD), but its use in pediatric IBD patients has been limited. The purpose of this study was to
review our experience with SiMIS in pediatric patients with CD.
Methods: A retrospective review was performed for patients diagnosed with CD within the IBD registry
who underwent small bowel resection or ileocecectomy at a free-standing children’s hospital from
January 2007 to September 2014. Data collected included demographic data, family history, time from
diagnosis to surgery, urgency of operation, operative time, length of stay, and post-operative outcomes.
Results: Nineteen patients underwent open surgery (OS), while 41 patients underwent SiMIS. One
patient in the SiMIS group was converted to OS. Demographic characteristics were similar. The most
common indication for surgery was stricture/obstruction (70.7% for SiMIS versus 68.4% for OS, p=0.86),
and ileocecectomy was the most common primary procedure performed (90.2% in SSLS versus 100% in
OS). The operative time was significantly longer with SiMIS (135 + 50 versus 105 + 37 minutes, p=0.02).
This difference disappeared, however, when the 20 most recent SiMIS cases were compared to all cases
of OS (123.3 + 34.2 versus 105 + 36.5, p=0.12), suggesting a learning curve. Post-operative length of stay
was similar in both groups (SiMIS 6.5 + 2.2 days for SSLS versus 7.4 + 2.2 days for OS, p=0.16). Overall
complication rate was 24.4% in SiMIS compared to 26.3% in OS, p=0.16.
Conclusion: SiMIS is feasible in pediatric patients with CD with outcomes similar to OS. As experience
increased, operative times also became comparable.
N (%)
Age, years
Male Sex, N (%)
Race, Caucasian, N (%)
Weight, kg
BMI, kg/m2
Superficial SSI
Deep SSI
Urgent Operations, N (%)
SiMIS
41 (68.3%)
15.7 + 2.8
21 (51.2%)
33 (80.5%)
52.0 + 14.9
19.6 + 4.0
5 (12.2%)
3 (7.3%)
24 (58.5%)
Open
19 (31.7%)
14.9 + 1.7
10 (52.6%)
13 (68.4%)
50.1 + 15.2
19.4 + 4.8
1 (5.3%)
1 (5.3%)
15 (78.9%)
p-value
0.26
0.92
0.31
0.66
0.85
0.41
0.77
0.13