The Schubert-Martin Inflammatory Bowel Disease (IBD) Center at Cincinnati Children’s offers a focused, team
approach for children with inflammatory bowel disease—conditions that include
ulcerative colitis and Crohn’s disease.
Only a small percentage of patients with IBD need surgery. However, if medication and nutrition do not bring symptoms under control or if your child's intestines are significantly damaged by IBD, surgery may be an important and necessary step to achieving a good quality of life.
Our expert IBD team includes pediatric colorectal surgeons and gastroenterologists who work closely together to determine whether your child will benefit from surgery. When possible, our surgeons use the latest minimally invasive (laparoscopic and robotic) techniques available. These techniques are associated with less postoperative pain and shorter hospital stays.
Our pediatric colorectal surgeons perform many IBD surgeries every year, including complex reconstructive surgeries. This level of experience is important in achieving successful surgical outcomes.
Our surgical team offers the full spectrum of surgical procedures for inflammatory bowel disease (IBD). Surgeries for Crohn’s disease and ulcerative colitis are very different.
Pediatric Crohn’s Disease Surgeries
Most surgeries for Crohn’s disease occur because part of the bowel (small and large intestine) has become severely damaged or inflamed. Surgery involves removing the damaged section of the bowel. This type of surgery is called a bowel resection. The surgery is not a cure, but it usually provides substantial relief.
The most common bowel resection surgeries we offer for children include:
- Bowel resection with anastomosis: This type of surgery involves removing the diseased segment of the intestine, then attaching the remaining, healthy segments of the intestines. This allows stool to pass through the body naturally.
- Bowel resection with an ileostomy: This type of surgery involves removing the intestine’s diseased portion, but the surgeon does not attach the two remaining segments of the intestine. Instead, the surgeon creates an ileostomy — an opening in the belly — and gently pulls one end of the remaining intestine through the opening to the outside of the body. A nurse who is specially trained in wound ostomy care will educate you and your child before and after surgery so that you know how to care for the site where the intestine passes through the skin. For some time, the child’s stool will pass through the ileostomy into a bag. Once healing has occurred, the surgeon may recommend another surgery to close the ileostomy and reattach the bowel’s healthy ends.
- Colectomy: A colectomy is a type of bowel resection surgery that involves removing all or part of the colon (large intestine). The surgeon may use an anastomosis or ileostomy after the colectomy, depending on the child’s needs.
Pediatric Ulcerative Colitis Surgeries
The most common type of surgery for ulcerative colitis is called “laparoscopic total proctocolectomy with J-pouch reconstruction.” This surgery involves removing the entire large intestine and creating a new internal pathway for stool to pass through the body.
- Laparoscopic means that the surgery is minimally invasive − the surgeon makes small incisions in the abdomen, not a large, open incision.
- Total proctocolectomy means that the surgeon removes the entire colon (large intestine).
- J-pouch reconstruction means that the surgeon creates a “J”-shaped pouch from a small section of the small intestine. This pouch remains inside the body. A J-pouch allows the body to store stool and pass it through the rectum.
For children with ulcerative colitis, a laparoscopic total proctocolectomy with J-pouch reconstruction usually occurs in planned stages depending on your child’s overall health. Depending on your child’s overall health, the surgeon may recommend one, two or three surgeries to complete the J-pouch reconstruction. These include:
- Temporary ileostomy: The first step may be for the surgeon to create a temporary ileostomy — an opening in the belly. The surgeon will pass one end of the small intestine through this opening so that stool collects in a bag outside your child’s body.
- Subtotal colectomy: Another step may be to do a “subtotal colectomy,” which involves removing some of the large intestine. The surgeon also will create a temporary ileostomy (see above).
- J-pouch completion: J-pouch completion involves closing the ileostomy and connecting the small intestine to the rectum. This allows the child to have bowel movements in the usual manner, although perhaps more frequently than children who don’t have a J-pouch. Your surgeon will discuss this in detail with you prior to surgery.