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Who's a candidate for the procedure?

Some examples of urgent or emergency situations that would require this procedure are:

  • abscesses
  • bowel perforation
  • severe bleeding
  • toxic megacolon (the most acute and the least common)

You are a candidate if you have ulcerative colitis and:

  • you are unresponsive to optimal medical management or are unable to be successfully weaned from chronic or long-term steroid therapy
  • you have an urgent or emergency situation in which an operation is necessary to avoid serious consequences
  • you feel it is causing you an unacceptable quality of life. For example:
    • inability to consistently go to school or worse
    • side effects from the long-term use of medication
    • failure to grow or develop normally
    • missing out on sports and other after school activities due to frequent "flareups"
  • if you have familial adenomatous polyposis (FAP)
  • you want to decrease the risk of developing colorectal cancer when there is a family history of abnormal polyps growing in the colon.

Surgical consult

During your outpatient visit at Boston Children's, you will meet many staff members from the general surgery department, including administrative assistants who will schedule surgery, post-operative appointments, and arrange any testing that may be needed.

How you may feel about your surgical consult

You may experience many emotions when you come for a surgical consult. It is not uncommon to feel sad, angry, depressed, or insecure. These are all normal emotions. You may have been ill for some time. It is sometimes hard to believe that surgery will help you achieve a new outlook on life. As you become more comfortable and confident with your ostomy functions, you will hopefully find that it gets easier to deal with.

Assistance

At Boston Children's Hospital, we have a program where you can talk to someone who has already been through the surgery. Most patients and families find this to be an excellent resource. They can help answer your questions about the surgery, help alleviate concerns and talk about recovery and life after surgery.

What are the laparoscopic total colectomy and ileoanal pullthrough procedures?

The laparoscopic total colectomy and illeoanal pullthough procedures were developed in the 1970s to help people who had been diagnosed with ulcerative colitis or familial adenomatous polyposis (FAP). These procedures involve removing the entire colon. The colon is replaced with an internal pouch that your surgeon will create. The pouch is then attached to your anus. Many people prefer this procedure to other alternatives because after all the surgeries, you are able to go to the bathroom the "normal way."

The procedures will involve two to three operations. Your surgeon will create a temporary ostomy, which is a surgically created opening that begins in your intestine (bowel) and goes through the skin of your abdominal wall. This opening is also called a stoma. When you have had an ostomy created, your stool will come out of your stoma (opening) into a bag or pouch that you will wear. Your stool ("poop") will not come out of your anus. This is only temporary until your body has healed from the surgery. Once you have healed, you will be able to go to the bathroom the "normal way."

People with ulcerative colitis and familial adenomatous polyposis have several surgical options. The surgical procedure offered at Boston Children's is the ileoanal reservoir (IAR) procedure with the creation of a J-pouch. It is also known as the ileoanal pullthrough (IAP) procedure. We also perform this procedure laparoscopically, which is a less invasive method.