Surgery for Crohn's Disease in Children

At Hassenfeld Children’s Hospital at NYU Langone, gastroenterologists work closely with surgeons when surgery is recommended for children with Crohn’s disease. Surgery may be the best option when medications or nutritional changes don’t provide your child with relief from symptoms, or when diagnostic tests show that chronic inflammation has caused serious damage to the lining of the gastrointestinal tract.

Your child’s doctor may recommend surgery for several reasons. Surgery may be advised, for instance, if your child has a fistula, which is a tunnel in the intestinal wall that affects a nearby organ. It also may be recommended if your child has a tear in the intestinal wall, an intestinal obstruction that is causing pain and infection, or an abscess, which is a collection of bacteria and pus.

Surgery is not a cure, but it can enable doctors to remove diseased sections of the intestines, reduce inflammation, and lessen your child’s symptoms.

The type of surgery performed depends on your child’s symptoms and the location of inflammation in the gastrointestinal tract. Our doctors determine the best procedure for your child and discuss all of the options with you.

You can schedule a hospital tour with your child prior to surgery to help prepare him or her for the procedure.

Small Bowel Resection

During a small bowel resection, the damaged part of the small intestine is removed. At Hassenfeld Childrens Hospital, this surgery is often performed using a laparoscopic technique. The surgeon makes small incisions in the abdomen and inserts a laparoscope, a thin, flexible instrument with a tiny light and camera at the end, into one of the incisions. Next, the surgeon inserts tiny surgical instruments through another small incision.

The camera produces live images on a monitor, offering the surgeon a clear view inside the abdomen. He or she uses the surgical instruments to remove the damaged section of the small intestine and join together the healthy parts of the intestine.

Sometimes there isn’t enough healthy intestine to create a new connection. When this occurs, the surgeon performs an ileostomy, in which the small intestine is diverted through an opening called a stoma in the abdomen. This allows the contents of the intestine to drain into a sealed pouch, called an ostomy bag, that is outside the body. Your child’s doctor determines whether this is temporary or permanent after assessing your child’s bowel after surgery.

Our pediatric anesthesiologists use general anesthesia for small bowel resection. Your child typically remains in the hospital for up to five days for observation. Parents may visit 24 hours a day, but only one parent or legal guardian may stay overnight.

After an ileostomy, our team of ostomy specialists helps your child adjust to the ostomy bag. They answer questions about how it works and inform parents and children how to care for it.

If the ileostomy is temporary, a surgical procedure to reverse it and reconnect the intestine to the rectum is performed after the intestine has healed. This typically occurs two or more months after the bowel resection. During this time, doctors schedule follow-up appointments as needed to monitor healing.

Intestinal Strictureplasty

Your child’s doctor may recommend an intestinal strictureplasty if a buildup of scar tissue blocks part of the gastrointestinal tract, or if severe inflammation narrows the small intestine, preventing digested food from passing through. This procedure widens the affected area to restore bowel function.

The surgeon determines how to perform the procedure based on the length and location of the stricture, or narrowing, and the results of diagnostic imaging testing.

This surgery requires general anesthesia. Your child stays in the hospital for a few days afterward to heal.

Colectomy and Proctocolectomy

In a colectomy, part or all of the large intestine, or colon, is removed. In a proctocolectomy, the rectum is removed.

Though colectomy is more commonly performed in children with ulcerative colitis, doctors may recommend this procedure if Crohn’s disease has caused ulcers, infection, or strictures in the large intestine, and if symptoms don’t improve after the use of medication. Though it is not a cure, this procedure may relieve symptoms for months or years.

The surgeon may perform a partial or total colectomy, depending on the extent of damage to the colon. If the rectum is damaged, a proctocolectomy is also performed. Children with partial removal of the intestine maintain a functioning digestive system after surgery. Those whose entire colon and rectum is removed require an ileostomy.

Both colectomy and proctocolectomy are performed using general anesthesia. A colectomy may be performed using a minimally invasive laparoscopic technique. If the surgeon requires direct visualization of the colon, he or she may choose an open technique, in which a larger incision is made in the abdomen.

Your child remains in the hospital for several days after these procedures.

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