Risk factors for early postoperative complications after minimally invasive surgery in pediatric ulcerative colitis

OBJECTIVE: To report a single-center experience with a multidisciplinary minimally invasive surgical approach for pediatric ulcerative colitis (UC) and identify risk factors for early postoperative complications (EPC). METHODS: A retrospective analysis was conducted on UC patients followed at the Gastroenterology Unit of Meyer Children's Hospital, who underwent surgery between 2010 and 2023. RESULTS: Seventy-four surgical procedures in 31 patients were analyzed. All patients underwent subtotal colectomy; 24 proceeded to ileal-pouch-anal anastomosis (IPAA), and 19 had completed ileostomy closure at the time of analysis. Twenty-five (80.7%) colectomies were laparoscopic, and 6 (19.3%) were open. Among IPAA procedures, 20.8% (n = 5) were open, 50% (n = 12) were laparoscopic, and 29.2% (n = 7) were robotic. Eight patients (25.8%) experienced EPC after colectomy. Univariate analysis identified diagnosis before 6 years of age (very early onset inflammatory bowel disease) as a significant risk factor for EPC (p = 0.026; OR: 10.5; 95% CI: 1.4-38). Open and laparoscopic approaches showed comparable EPC rates (colectomy: 16.7% vs. 28%, p = 0.998; IPAA: 20% vs. 8.3%, p = 0.515). Laparoscopic surgery was associated with a significantly lower time to enteral feeding, bowel function recovery, and hospital discharge for both colectomies (p = 0.005, 0.002, and 0.025, respectively) and IPAA procedures (p = 0.008, 0.001, and 0.044, respectively). Robotic approach further shortened return of bowel function compared to both laparoscopic and to open approach (p = 0.032 and p = 0.002, respectively). CONCLUSIONS: Minimally invasive surgery for pediatric UC is safe and associated with improved postoperative recovery. Younger age and poor nutritional status may increase the risk of early complications. The robotic approach also shows promise in further improving recovery times.