Laparoscopic Total Colectomy & Ileoanal Pullthrough
Ulcerative colitis and Familial Adenomatous Polyposis (FAP) affect only the lining of the large bowel, therefore the colostomy and ileoanal reserve procedure (IAR) can cure these diseases. Surgical treatment includes removal of the colon (colostomy) and creation of a temporary ileostomy stoma. We have found that there are fewer complications when we create a temporary ileostomy stoma.
Surgery for creation of an internal J-pouch or reservoir can be performed in either two or three operations referred to as "stages." Your medical care team will decide if the three stage procedure or the two stage procedure is best for you. This recommendation will be base on your specific condition and your health. Your surgeon and your Gastroenterology (GI) doctor will discuss this with you.
You and your family may find it helpful to discuss the operation with someone else who has already had the procedure. Your surgeon or outpatient nurse will make every effort to match you up with someone of similar age and gender to speak with either by phone or in person.
Boston Children's Hospital's approach to total colectomy for Ulcerative Colitis (UC) and Familial Adenomatous Polyposis (FAP) is unique when compared to many other pediatric hospitals. Many children with UC or FAP may be candidates for a laparoscopic operation.
In traditional "open" surgery, the surgeon uses a single incision to enter into the abdomen. In laparoscopic surgery, the surgeon uses several small (3-5 millimeter) incisions through which surgical instruments are inserted and withdrawn. Each incision site is called a "port incision". At each port incision, a tubular instrument, called a trocar, is inserted into the abdomen. Specialized small instruments and a special tiny camera, called a laparoscope, are passed through the trocars during the operation.
At the beginning of the procedure, the abdomen is inflated (filled) with filtered air to provide a space for the surgeon to work. This space also helps the surgeon view the abdominal organs more easily. The laparoscope sends images (pictures) from the abdominal cavity to high-resolution video monitors in the operating room. During the operation the surgeon watches detailed images of the abdomen on the monitor. This system allows the surgeon to perform the same operation as traditional "open" surgery, but with smaller incisions.
We use these laparoscopic techniques to safely remove the entire colon and the lining of the rectum. This operation is performed using a combination of the incisions described above and a small version of the incision that babies are delivered through during C-section deliveries. Dissolvable stitches are used to close the incision sites.
- Laparoscopic surgery is sometimes referred to as "minimally invasive surgery".
- Each patient's clinical condition will determine whether an open or laparoscopic surgical procedure is recommended by the surgeon.
- Patients who have a laparoscopic procedure may recover more quickly and return to normal activity in a shorter period of time.
- Some benefits of laparoscopic surgery include: less post-operative pain, decreased length of hospital stay, smaller incisions, lower risk of cardiopulmonary complications, and reduced risk of small-bowel obstruction.
- Patients who have had previous abdominal surgery may still be candidates for laparoscopic surgery.
- Scars after laparoscopic surgery are significantly smaller than the scar left after a traditional "open" operation.