Surgery for Ulcerative Colitis in Children

Gastroenterologists at Hassenfeld Children’s Hospital at NYU Langone may recommend surgery for children with ulcerative colitis. Usually, this occurs when medications don’t relieve symptoms, such as bleeding, or when diagnostic tests reveal extensive damage in the large intestine, or colon.

Prior to surgery, you may schedule a hospital tour to help your child prepare for the procedure.

Colectomy and Proctocolectomy

If damage to the colon is severe, a surgeon may perform a colectomy, in which part or all of the large intestine is removed. If the rectum is damaged, it may be removed along with the colon in a procedure called a proctocolectomy.

After doctors perform a resection, in which healthy parts of the colon are reattached after damaged portions are removed, a child’s digestive system typically maintains function. If the entire colon and rectum are removed, the surgeon creates a stoma, which is an opening in the abdominal wall. He or she pulls the bottom tip of the small intestine through this opening, and attaches it to an external pouch, called an ostomy bag, which collects waste from the body. This is called an ileostomy.

These procedures may be performed using a minimally invasive laparoscopic technique, in which the surgeon makes several small incisions and inserts a thin, lighted scope and small instruments to complete the surgery. Doctors may also use an open technique, in which a larger incision is made in the abdomen.

Both types of procedures require general anesthesia. Prior to surgery, your child’s diet may be restricted to clear liquids, such as tea or juice. The surgeon may provide your child with a bowel preparation, which includes laxatives and enemas taken the night before surgery to empty the intestines for the procedure.

Your child remains in the hospital for several days after these procedures. At Hassenfeld Children’s Hospital, parents may visit 24 hours a day, but only one parent or legal guardian may stay in the hospital overnight.

Children with an ileostomy require follow-up visits as the intestine heals.

Ileal Pouch Anal Anastomosis

If the colon and rectum have been removed, the surgeon may perform an ileal pouch anal anastomosis, also called “pouch surgery.” This procedure allows stool to continue to leave the body through the anus, and is an alternative to a temporary ileostomy.

In this procedure, a surgeon creates a pouch using the end of the small intestine, or ileum, and connects it to the anus. The pouch provides an area for waste to collect in the abdomen, mimicking the function of the rectum.

Your child typically stays in the hospital for two to five days for observation after the surgery while he or she heals.

This procedure usually occurs two months after a colectomy and proctocolectomy. In the time between the initial surgery and the ileal pouch anal anastomosis, a temporary ileostomy removes waste from the body.