Inflammatory Bowel Disease

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Inflammatory Bowel Disease (Ulcerative colitis, Crohn's Disease, Indetermine Colitis)

The UCLA Pediatric Surgeons have extensive experience with surgical management and treatment of complicated inflammatory bowel disease (IBD) in conjunction with the Pediatric Inflammatory Bowel Disease Program at UCLA. This is a multi-disciplinary program that serves children and adolescents with ulcerative colitis (UC), Crohn's disease, or indeterminate colitis. The program is also actively involved in the international Pediatric Inflammatory Bowel Disease Consortium that is helping to establish standards of care and new treatments through multi-disciplinary research for IBD affecting children.

Child holding his stomach while speaking with a doctor

A child that develops symptoms from IBD can not be considered comparable to patients who develop symptoms as adults. Unfortunately, the development of symptoms as a child is associated with a more severe form of IBD, which is more difficulty to treat medically and surgically. Therefore, treatment at experienced and specialized multi-disciplinary IBD centers is recommended for children.

Surgical intervention may be considered in children and adolescents with IBD that do not remain in remission with medical therapy, develop complications from medical therapy, cannot gain weight appropriately, and/or develop persistent severe symptoms or complications from the disease process. Ulcerative colitis principally involves the rectum and colon. In contrast, Crohn's disease may involve a small or significant portion of the small intestine, colon, rectum, and/or anus. Patient with IBD symptoms who can not be categorized as having ulcerative colitis or Crohn's disease may be diagnosed with 'indetermine colitis.' The surgical approach can vary based upon the type and extent of IBD.

Ulcerative Colitis

When appropriate, the standard of surgical care for most all patients with ulcerative colitis is a restorative proctocolectomy. In this procedure, the entire colon and rectum is removed and replaced with a continent reservoir. The reservoir helps reduce the frequency of bowel movements, which can be increased following removal of the colon. The reservoir is generally made by creating a J-pouch (the end of the small intestine is folded and connected to itself to make a pouch before it is connect with the anus). This may be performed in a staged fashion, in which different steps of the procedure are performed at separate operations to allow appropriate healing and minimize complications in patients who are immunocompromised from medications commonly used to treat IBD.

Restorative Proctocolectomy with Ileoanal J-Pouch (Intestinal Surgery for Ulcerative Colitis and FAP)

The goal for this surgery is to remove all of the diseased colon and rectal tissue while preserving anal sphincter mechanism and continence. Used in selected children and adolescents with ulcerative colitis and familial adenomatous polyposis, the lower 8-12 inches of the ileum (a small portion of the downstream small intestine) is constructed into a pouch reservoir shaped in a "J" and secured to the anal canal so that more normal elimination and continence can be achieved. A permanent ileostomy on the abdominal wall is avoided, which had been a standard of care in the past. The restorative proctocolectomy and J pouch operation completely cures the ulcerative colitis and greatly reduces the risk of intestinal cancer in children with UC and intestinal polyposis syndromes.

The recovery from surgery is usually 5 to 7 days in the hospital. Patients can expect to have more frequent bowel movements (approximately 3 to 4 semi-solid or solid stools per day) following the procedure. Pediatric surgeons at UCLA were one of the two original groups pioneering the procedure in the 1980's. UCLA pediatric surgeons can perform the procedure laparoscopically, minimizing scar formation and wound healing problems that can be seen more frequently in immunocompromised patients.

Crohn's Disease: Intestinal Surgery for Crohn's Disease

In general, the Crohn's disease can involved more segments of bowel than ulcerative colitis. Therefore, the surgical approach is typically to minimize bowel loss except in specialized circumstances. Operations for these children are more individualized based on extent of disease and may include: diagnostic laparoscopy, laparoscopic or open, intestinal stricturoplasty, laparoscopic or open intestinal segmental resection, laparoscopic or open colectomy, and temporary or permanent ileostomy.

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