Impact of Holidays on Pediatric Trauma Admissions to a Community Hospital in South Florida.

OBJECTIVES: The data from temperate regions indicate increases in pediatric traumatic injuries during the spring and summer months with anticipated admission spikes on warm weather holidays; hospitals in southern subtropical regions should not anticipate the same trends. The objectives of this study were to identify holiday-specific spikes in pediatric traumatic injury admissions at a community hospital in South Florida and report injury patterns in age, mechanism of injury, and surgical consults. METHODS: A 5-year retrospective review of pediatric traumatic injuries during holiday periods was conducted; patterns in age, mechanism of injury, and surgical consults were described. A ratio of the mean number of patients seen per day for holiday periods versus nonholiday days of the same month was calculated for each holiday. RESULTS: The most notable spikes in injury volume were for autumn and winter holidays; average volume doubled during the holiday periods for New Year's Day, Super Bowl weekend, Valentine's Day, St Patrick's Day, and Halloween. Holiday periods had increases in the proportion of injuries related to motorcycle crashes. CONCLUSIONS: Hospitals located in southern subtropical climates should consider increasing staffing as necessary during select autumn and winter holidays.

Outcomes of laparoscopic nissen fundoplications in children younger than 2-years: single institution experience.

BACKGROUND: Variation exists in the diagnostic testing for gastroesophageal reflux (GER) in infants and in the application of surgical therapy. There has been an increase in antireflux surgery (ARS) since the development of laparoscopy but the outcomes in high-risk infants is unclear. This study examines the results of laparoscopic fundoplication in infants less than 2 years. METHODS: The results of infants less than 2 years undergoing laparoscopic Nissen fundoplication (Lap-F) from 2012 to 2015 were retrospectively reviewed and outcomes were followed until 2017. RESULTS: There were 106 patients, median gestational age 32.50 weeks ± 6.35 SD and non-corrected age at operation 23.0 weeks ± 19.0 SD, mean weight of 4.81 kg ± 2.10 SD. One of the most common reasons for surgical consultation was improvement in respiratory status after insertion of nasoduodenal feeding tube. Of the Lap-F, 100 were with gastrostomy tube (GT). There were no conversions to open or intraoperative complications. The complication rate was 4.71%, and the reoperation rate was 5.66%, one fundoplication revision and the others gastrostomy revisions. The median time for feeds and to reach goal were 1 (1-14) and 4 (2-279) days, respectively. The 30-day mortality was 0.9% and long-term it was 4.71%. The long-term mortality was related to the underlying medical problems. The median follow-up was 113 (3-286) weeks. One patient required revision of the fundoplication and none required esophageal dilatation during the follow-up period. CONCLUSION: Fundoplication is effective for relief of symptoms of GER in children younger than 2 years. The procedure has a low morbidity and mortality in this population.

Single incision versus standard 3-port laparoscopic appendectomy: a prospective randomized trial.

BACKGROUND: Laparoscopic appendectomy through a single umbilical incision is an emerging approach supported by several case series. However, to date, prospective comparative data are lacking. Therefore, we conducted a prospective, randomized trial comparing single site umbilical laparoscopic appendectomy to 3-port laparoscopic appendectomy. METHODS: After Internal Review Board approval, patients were randomized to laparoscopic appendectomy via a single umbilical incision or standard 3-port access. The primary outcome variable was postoperative wound infection. Using a power of 0.9 and an alpha of 0.05, 180 patients were calculated for each arm. Patients with perforated appendicitis were excluded. The technique of ligation/division of the appendix and mesoappendix was left to the surgeon's discretion. There were 7 participating surgeons dictated by the call schedule. All patients received the same preoperative antibiotics and postoperative management was controlled. RESULTS: There were 360 patients were enrolled between August 2009 and November 2010. There were no differences in patient characteristics at presentation. There was no difference in wound infection rate, time to regular diet, length of hospitalization, or time to return to full activity. Operative time, doses of narcotics, surgical difficultly and hospital charges were greater with the single site approach. Also, the mean operative time was 5 minutes longer for the single site group. CONCLUSION: The single site umbilical laparoscopic approach to appendectomy produces longer operative times resulting in greater charges. However, these small differences are likely of marginal clinical relevance. The study was registered with clinicaltrials.gov at the inception of enrollment (NCT00981136).

Treadmill injuries in the pediatric population.

BACKGROUND: Exercise equipment such as treadmills are becoming commonplace in residential homes, placing small children at risk for injury. These injuries can be severe and may require surgical intervention. While it is our clinical perception that these injuries are on the rise, they remain largely unreported in the literature. Therefore, we reviewed our experience to evaluate the incidence and outcomes of treadmill-associated injuries in children. METHODS: After receiving exempt IRB approval, we retrospectively reviewed all patients who sustained treadmill-related injuries that required evaluation by a surgeon from July 2005 to February 2010. Data collected included patient demographics, injury details, injury management, and outcomes. RESULTS: We identified 19 children who required treatment for treadmill-related injuries. Mean age at injury was 4.1 y (1.3-10.5 y), and 63% were male. The treadmill was in use by another person in 17 cases (89%). The hand was involved in 79%. All burns were <10% body surface area and 18 (90%) were <5 %. Admission was required in two cases, and four (21%) children required skin grafting. Healing was complicated by hypertrophic scarring in four patients (21%). Mean length of active therapy was 9.2 ± 7.0 d and involved a mean of 6.0 ± 3.5 healthcare visits. Mean hospital charges were $5700. CONCLUSION: Treadmill-related burn injuries in children are preventable injuries that can pose a substantial burden on patients and families. Supervision is paramount in prevention of these injuries, and strategies should include child safety features in equipment designs along with consumer awareness.

The lack of efficacy for oral contrast in the diagnosis of appendicitis by computed tomography.

BACKGROUND: Oral contrast is often used with computed tomography (CT) for the diagnosis of appendicitis. This adjunct adds time to evaluation, not all patients can tolerate enteric bolus, and the diagnostic advantages have not been well defined. Therefore, we reviewed our experience to evaluate the impact of oral contrast on diagnostic efficiency and its impact on the patient. METHODS: After obtaining IRB approval, a retrospective review was conducted on patients who underwent CT with oral contrast for the indication of appendicitis over the last 4 years. Data recorded included demographics, CT results, emergency room course, operative findings, and pathology interpretation. All images were reviewed to identify presence/absence of contrast at or beyond the terminal ileum. RESULTS: There were 1561 patients, of whom, 652 (41.8%) were diagnosed with appendicitis and 909 (58.2%) were not (non-appendicitis). Contrast was identified at least to the level of the terminal ileum in 72.4% of the entire population. The contrast was present in 76.2% of the non-appendicitis patients and 67.0% of the appendicitis patients (P = 0.01). Mean time from oral contrast administration to CT imaging was 105.5 min, which was longer in patients with appendicitis (112.2 min) compared with non-appendicitis patients (100.9 min) (P = 0.01). Emesis of the contrast occurred in 19.3% of those with appendicitis and 12.9% of those without appendicitis (P = 0.001). Nasogastric tubes were placed in 5.8% of those with appendicitis and 5.1% of those without (P = 0.37). Appendicitis was confirmed at operation in 94.3% of those with contrast in the area and 94.4% of those without (P = 1.0). Pathology confirmed appendicitis in 90.6% of those with contrast in the area and 94.0% of those without (P = 0.17). CONCLUSION: Nearly 30% of patients receiving oral contrast for the CT diagnosis of appendicitis do not have contrast in the point of interest at the expense of emesis, nasogastric tube placement, and diagnostic delay. These detriments are amplified in patients who have appendicitis. Further, there appears to be no diagnostic compromise in those without contrast in the terminal ileum.

Esophageal perforation in children: a review of one institution's experience.

BACKGROUND: The current approach to esophageal perforation treatment in children has shifted towards conservative management. However, the consensus of what constitutes conservative management is unclear, with various therapies and protocols described, including the need for various decompression and drainage procedures. Our institution utilizes conservative management with minimal intervention guided by the patient's clinical course. The purpose of this study is to report our management and add to the growing evidence for conservative management of esophageal perforation in children. METHODS: We performed a retrospective chart review of all patients with an ICD-9 diagnosis of esophageal perforation from January 1995 to July 2009. Patients with postoperative anastomotic leaks with drains in place were excluded, although patients with anastomotic leaks that were not controlled by drains were included. Data collected included patient demographics, etiology, diagnosis, treatment, complications, and outcome. RESULTS: Eight patients were identified who met inclusion criteria. Mean age was 28 mo (1 d-10 y), and the average time from causative event to diagnosis was 1.4 d (0-2 d). The etiology for esophageal perforation included esophagoscopy with dilation (n = 4), button battery ingestion (n = 1), coin ingestion (n = 1), nasogastric tube placement (n = 1), and leak after stricture resection (n = 1). All the patients were treated conservatively without primary surgery or thoracic drainage, and the mean time to perforation healing was 10.2 d (1-24 d). The average length of antibiotic therapy was 10 d (0-26 d). Enteral nutrition was utilized in five patients, and total parenteral nutrition (TPN) was utilized in five patients. No patient developed a new-onset esophageal stricture. CONCLUSION: Conservative management, guided by the patient's clinical course, with antibiotics and nutritional support is a safe and effective treatment for esophageal perforations in children.

Laparoscopic cholecystectomy in obese and non-obese children.

BACKGROUND: Obesity is an increasing problem in the pediatric population. Despite abundant data on the impact of obesity in adults, little data exist that examines the impact of obesity on surgical outcomes in children. We reviewed our experience with laparoscopic cholecystectomy to evaluate the impact of obesity. METHODS: We performed a retrospective chart review of patients who underwent laparoscopic cholecystectomy between September, 2000 and June, 2009. Demographics, indication, length of operation, length of stay, and complications were examined. Body mass index (BMI) was calculated and BMI percentage according to gender and age was determined. RESULTS: There were 312 patients identified, 150 patients were normal weight (BMI less than 85%), 65 patients were overweight (BMI = 85%-95%), and 97 patients were obese (BMI > 95%). The mean age of the patients was 14 y (range 0-20), and 76% were female. The overweight and obese groups had more females (P = 0.022 and P = 0.0016) and the obese group was older (P = 0.0003). No differences were found between the groups in the indication for cholecystectomy. There was no difference in operative time, length of stay, or complications between normal weight patients and overweight or obese patients. CONCLUSION: Despite the known surgical challenges with overweight patients, laparoscopic cholecystectomy is a safe and equally beneficial procedure in overweight children.

A review of single site minimally invasive surgery in infants and children.

Videoscopic surgery has become the standard approach for most thoracic, abdominal, and pelvic procedures in adults and children. These procedures have widely recognized benefits including decreased postoperative pain, improved cosmesis, and decreased convalescence. In a recent attempt to further improve the cosmetic result of these operations, surgeons have begun to employ a single incision through which all the operating instruments are placed. This article seeks to review the current and future application of innovative minimally invasive surgery to pediatric surgery.

Trauma laparotomy: evaluating the necessity of histological examination.

Trauma laparotomy is the most commonly performed procedure in the acute care setting. As current practice, removed specimens are sent for histological examination. A retrospective review of all trauma laparotomies with specimens removed and sent to pathology during a 12-month period was performed in a Level I trauma center. One hundred five procedures of 244 trauma laparotomies yielded specimens sent for examination. Eighty-six patients were male and 19 patients were female with an average age of 34 +/- 14 years. Fifty-six per cent of the injuries resulted from penetrating trauma and 44 per cent were from blunt trauma. Gunshot wound and motor vehicle crash were the most common penetrating and blunt injuries, respectively. One hundred thirteen specimens were sent to pathology. Forty-three per cent of the specimens were spleen, 24 per cent small bowel, 16 per cent large bowel, 4 per cent kidney, 2 per cent omentum, 3 per cent appendix, 3 per cent pancreas, and 1 per cent for gallbladder and lung. One hundred twelve of 113 grossly normal specimens had normal pathology. One grossly normal specimen exposed abnormal pathology revealing benign appendiceal mucocele. Therefore, 99.1 per cent of grossly normal specimens sent for histological examination after trauma laparotomy were normal. Based on our review, in select patients routine histological examination of tissues removed for traumatic injury is unnecessary.

A standardized guideline for antibiotic prophylaxis in surgical neonates.

Infection following surgical procedures leads to increased morbidity and mortality in all populations. Guidelines to aid providers in the proper use of prophylactic antibiotics exist for adults, but are rare in the neonatal surgical population. A recent emphasis on appropriate antibiotic stewardship had led to the development of more guidelines without a coincident increase in surgical site infection. Robust data from randomized, controlled trials, however, remain sparse.

A review of postoperative feeding regimens in infantile hypertrophic pyloric stenosis.

Infantile hypertrophic pyloric stenosis is a condition well known to pediatric surgeons. Postoperative length of hospital stay is a financial concern and remains a potential target for reduction in hospital costs. Ultimately, these costs are directly affected by the ability to effectively advance postoperative enteral nutrition. This review will serve to: 1) identify clinically relevant postoperative feeding patterns following pyloromyotomy, 2) review the relevant literature to determine an optimal feeding pattern, and 3) identify possible preoperative predictors that may determine the success of postoperative feeding regiments.

Thoracoscopic vertebral body stapling for treatment of scoliosis in young children.

PURPOSE: The management of juvenile idiopathic scoliosis (JIS) in young children can be challenging. Vertebral body stapling (VBS) is a new alternate to bracing and is intended to reduce or eliminate the need for subsequent spinal fusion. In concept, VBS of the anterior spine inhibits curve progression, thus stabilizing the spine as the child grows. There is a paucity of data in the pediatric population on its effectiveness. Therefore, we reviewed our experience with thoracoscopic VBS in children with juvenile scoliosis. SUBJECTS AND METHODS: After Institutional Review Board approval was obtained, a retrospective study was conducted on all patients who underwent thoracoscopic VBS for scoliosis from January 2007 to December 2010. Only patients with a follow-up of at least 2 years were included in this study group. Data obtained were demographics, indications for VBS, degree of curvature, treatment, complications, and follow-up. Cobb angle was used to measure the initial degree of curvature on a standing posterior-anterior spine radiograph. RESULTS: During the study period, 11 patients underwent thoracoscopic VBS for JIS using single lung ventilation in a lateral position. Of those, 7 patients ages 8-11 years (mean, 9 years) with a mean body mass index of 17 kg/m(2) (±2.9 kg/m(2)) had at least a 2-year follow-up and make up the study group for this review. Indications for stapling in these 7 patients were progression of scoliosis (n=3), noncompliance with brace (n=3), and double curve with progression (n=1). The mean preoperative Cobb angle was 34.1±5° (range, 25°-41°), and the mean immediate postoperative Cobb angle was 23±5° (range, 16°-30°). The staples encompassed a mean number of 6.4 vertebral bodies. The mean duration of chest drainage was 2.7 days (range, 2-6 days), and the mean length of hospitalization was 3.9 days (range, 3-7 days). The mean operative time was 156.2±39.5 minutes (range, 101-214 minutes). There were no intraoperative complications or mortality. Postoperatively, 1 patient developed a pleural effusion on the contralateral side that required drainage. These 7 patients have been followed up for a mean of 34 months (range, 29-44 months). The mean Cobb angle at last follow-up was 24.7° (range, 15-38°). No patient has required postoperative bracing or spinal fusion. CONCLUSIONS: Thoracoscopic VBS is a safe and effective method of treatment for progressive scoliosis in young children. Pediatric surgeons may be asked to assist their spine surgeons with this new approach to juvenile scoliosis.

Overnight observation in former premature infants undergoing inguinal hernia repair.

BACKGROUND: Overnight observation for apneic events is standard practice in former preterm infants. However, the literature supporting current protocols is dated. Therefore, we retrospectively evaluated the post-anesthetic risks in these patients. METHODS: A retrospective review was conducted on former preterm infants admitted after an inguinal herniorrhaphy between 1/00 and 10/09. The protocol for overnight admission was for patients born before 37 weeks gestation who are less than 60 weeks post-conceptional age (PCA). RESULTS: There were 363 patients, of which 23 were <40 weeks PCA (group 1), 244 were 40 to 49.9 weeks PCA (group 2), and 96 were 50 to 60 weeks PCA (group 3). Events registered by alarms occurred in 4 patients (1.1%), 2 from group 1 and 2 from group 2. In Group 1, one occurred during nasogastric tube placement and resolved spontaneously. In group 2, one was apnea-induced bradycardia that resolved spontaneously, and one was in a patient on home monitors with an event similar to home reports. There were no events in group 3. CONCLUSION: Conservative guidelines for overnight observation after inguinal hernia repair could be set for patients born before 37 weeks gestation who are under 50 weeks PCA.

Utility of pH/multichannel intraluminal impedance probe in identifying operative patients in infants with gastroesophageal reflux disease.

INTRODUCTION: Gastroesophageal reflux is a common clinical problem in infants, but identifying which infants may benefit from a fundoplication remains a conundrum. Esophageal pH and multichannel intraluminal impedance (MII) measurements are useful diagnostic tools in adults and older children, but their diagnostic efficacy in infants is unclear. Therefore, we reviewed our experience with the combined pH/MII probe in this population. SUBJECTS AND METHODS: A retrospective review of patients ≤ 6 months of age who were studied with the pH/MII probe from 2006 to 2010 was performed. Test results, interventions, and outcomes were reviewed. Patients were divided into operative and nonoperative groups, and pH probe and MII results were compared. RESULTS: Fifty-seven patients (53% male) were identified. Mean age at the time of pH/MII probe was 3.1 months. Regarding the operative group (n = 33), 21% had an abnormal pH probe, and 100% had an abnormal MII; 97% had symptom improvement at a mean follow-up of 16 months (range, 0.4-38 months). In the nonoperative group (n = 24), 29% had an abnormal pH probe, and 100% had an abnormal MII. There was no significant difference in reflux index, Boix-Ochoa score, or percentage of acid and non-acid reflux between the two groups. CONCLUSIONS: The pH and MII studies are poor indicators of pathologic reflux in infants and do not adequately discern which patients will benefit from fundoplication.

Distribution of feeding styles after pyloromyotomy among pediatric surgical training programs in North America.

INTRODUCTION: The feeding regimen employed after pyloromyotomy for pyloric stenosis continues to be a topic of debate and has yet to be evaluated in a prospective, randomized trial. To understand the spectrum of current feeding schedules being utilized in the various training programs, we queried the program directors or representatives about their feeding schedules. METHODS: Through the use of multiple electronic communication resources, we surveyed 47 pediatric training programs in the United States and Canada about their postpyloromyotomy feeding schedules. Questions included time to first feed, how the schedule is advanced, and criteria for stopping feeds and discharge. RESULTS: Responses were received from 34 of the 47 institutions. Six programs had variable times of delay before instituting feeding whether ad libitum (ad lib) or protocol. The average time of delay was 4.3 hours. Six programs reported both ad lib feed and protocol feeding regiments. Twelve institutions used ad lib feeding regiments. Eight started feeding without delay. Twenty-six programs including our institution currently employ a protocol-based feeding regiment. Of these programs, seven begin the protocol without delay. CONCLUSIONS: Despite retrospective evidence in support of ad lib feeds after pyloromyotomy, the majority of teaching institutions employs protocols for the postpyloromyotomy feeding schedule. There is clearly a role for a prospective, randomized trial to compare ad lib to schedule feeding.

Quality of life assessment between laparoscopic appendectomy at presentation and interval appendectomy for perforated appendicitis with abscess: analysis of a prospective randomized trial.

PURPOSE: The current study examined the impact of immediate laparoscopic surgery vs nonoperative initial management followed by interval appendectomy for appendicitis with abscess on child and family psychosocial well-being. METHODS: After obtaining Internal Review Board approval, 40 patients presenting with a perforated appendicitis and a well-formed abscess were randomized to surgical condition. Parents were asked to complete child quality of life and parenting stress ratings at presentation, at 2 weeks postadmission, and at approximately 12 weeks postadmission (2 weeks postoperation for the interval appendectomy group). RESULTS: Children in the interval arm experienced trends toward poorer quality of life at 2 and 12 weeks postadmission. However, no group differences in parenting stress were observed at 2 weeks postoperation. At 12 weeks postadmission, participants in the interval condition demonstrated significant impairment in both frequency and difficulty of problems contributing to parenting distress. CONCLUSION: Families experience significant parenting distress related to the child's functioning and disruption in the child's quality of life that may be because of the delay in fully resolving the child's medical condition. In addition, parents experience negative consequences to their own stress as a result of the delay before the child's appendectomy.

Morgagni hernia repair in children: comparison of laparoscopic and open results.

INTRODUCTION: Morgagni hernias are anteromedial diaphragmatic defects that are typically simple to repair. As opposed to posterolateral defects, which are very difficult to expose laparoscopically, the anterior defects can be easily seen with this approach. We reviewed our experience with laparoscopic and open repair of Morgagni hernias in children and their associated outcomes. MATERIALS AND METHODS: A retrospective review was conducted on all patients who underwent repair of Morgagni hernia from January 1994 to May 2009. RESULTS: Seventeen patients were identified, of whom 9 underwent laparoscopic repair and 8 underwent an open repair. The mean age at operation was 3 years (newborn to 14 years) with a mean weight of 20.7 kg (3.6-87.6 kg). Intraoperatively, the diaphragmatic defect size in maximal dimension ranged from 3 to 11 cm. There was no difference in the average age, weight, and defect size among both groups. Of those who underwent laparoscopic hernia repair, 5 patients were closed with a Surgisis-Gold (SIS) patch, 1 was closed primarily with interrupted sutures, and 3 were closed with transabdominal sutures. In the open group, 7 were closed primarily and 1 required SIS patch for closure. Mean length of stay was 3.0 ± 1.5 days in the open group compared with 1.1 ± 0.4 days in the laparoscopic group (P < 0.01). There were no intraoperative complications and no recurrences. CONCLUSIONS: Laparoscopic repair of Morgagni hernias is a relatively simple and effective method of repair in children with accentuated advantages of minimally invasive surgery.

Outcomes in children with hypoplastic left heart syndrome undergoing open fundoplication.

BACKGROUND/PURPOSE: Some institutions recommend early fundoplication in patients with hypoplastic left heart syndrome (HLHS) with signs of gastroesophageal reflux disease because of the risk of reflux-related cardiac events. However, their cardiac physiology may impose high perioperative morbidity and mortality. Therefore, we reviewed our experience with fundoplication in this population to allow for assessment of the risk-benefit ratio. METHODS: A retrospective review of patients with a diagnosis of HLHS who underwent a fundoplication from January 1990 to July 7, 2009, was performed. All patients underwent open fundoplication between first and second stages of cardiac repair. RESULTS: Thirty-nine patients were identified. There were 3 intraoperative complications: hemodynamic instability (n = 2) and a pulmonary hypertensive crisis requiring extracorporeal membrane oxygenation and termination of the procedure (n = 1). There were 27 postoperative complications in 16 patients. There were 2 deaths (4%) within 30 days, and there were 9 deaths (23%) in patients between their first and second stage of cardiac repair during the study period. CONCLUSIONS: Noncardiac surgical procedures in patients palliated for HLHS have a high morbidity and mortality. We recommend that routine fundoplication in this population should only be performed under prospective protocols until the relative risk of operation vs risk of reflux is delineated.

Single-incision laparoscopic surgery in children: initial single-center experience.

BACKGROUND: In continued efforts to further improve the advantages of minimally invasive surgery to patients, surgeons have developed single-incision laparoscopic techniques. We report our initial experience in children with a variety of single-site procedures. METHOD: A retrospective chart review was performed on patients who underwent a single-site procedure from April 2009 to April 2010. RESULTS: There were 142 consecutive procedures: 24 cholecystectomies, 103 appendectomies for nonperforated appendicitis, 2 splenectomies, 1 combined splenectomy/cholecystectomy, 8 ileocecectomies, 2 Meckel diverticulectomies, 1 small bowel duplication resection, and 1 jejunal stricture resection. There were 12 conversions to conventional laparoscopy: 10 during appendectomy and 2 during cholecystectomy. Mean operative time was 34 minutes for appendectomy, 73 minutes for cholecystectomy, 90 minutes for splenectomy, 116 minutes for combined splenectomy/cholecystectomy, 86 minutes for ileocecectomy, and 43 minutes for the small bowel procedures. The only complications were umbilical surgical site infections after appendectomy in 6 patients. CONCLUSION: This institution's preliminary experience suggests that single-incision laparoscopic surgery in children has at least comparable outcomes to conventional laparoscopic surgery. However, prospective data are needed to prove that single-incision laparoscopic surgery is superior to conventional laparoscopy.

Laparoscopic ileocecectomy in pediatric patients with Crohn's disease.

INTRODUCTION: Definitive management for medically refractory ileocecal Crohn's disease is resection with primary anastomosis. Laparoscopic resection has been demonstrated to be effective in adults. There is a relative paucity of data in the pediatric population. We therefore audited our experience with laparoscopic ileocecectomy in patients with medically refractory ileocecal Crohn's disease to determine its efficacy. METHODS: We conducted a retrospective review of all pediatric patients who underwent laparoscopic ileocecal resection for medically refractory Crohn's disease at a single institution from 2000 to 2009. RESULTS: Thirty patients aged 10-18 years (mean: 15.3 years) with a mean weight of 50 kg (standard deviation: ± 15.5 kg) underwent laparoscopic ileocecectomy for Crohn's disease. Five of these were performed using a single-incision laparoscopic approach. The indications for surgery were obstruction/stricture (21), pain (10), abscess (3), fistula (3), perforation (2), and bleeding (1). Some patient's had multiple indications. There were a total of five abscesses encountered at operation. Eight patients were on total parenteral nutrition at the time of resection. Twenty-five patients (83.3%) were being treated with steroids at operation. The anastomosis was stapled in 26 patients and hand-sewn in 4. Two patients developed a postoperative abscess, and both of them were taking 20 mg of prednisone daily. One patient developed a small bowel obstruction due to a second Crohn's stricture that manifested itself after the more severe downstream obstruction was relieved with ileocecectomy. Of the 5 patients who underwent a single-incision laparoscopic operation, 3 underwent for obstruction/stricture and 2 for perforation. There were no intraoperative or postoperative complications. The patients were followed up for a maximum of 80.7 months (average: 14.7 months; median: 9.7 months). There were no anastomotic leaks or wound infections. DISCUSSION: This series demonstrates that laparoscopic ileocecectomy, both single-incision laparoscopic approach and standard laparoscopy, is safe and effective in the setting of medically refractory Crohn's disease in pediatric patients.