Our Summary
This research paper studies the effectiveness of a type of surgery called subtotal colectomy with end ileostomy (STC-I) in treating severe inflammatory bowel disease (IBD) in children. IBD is a group of diseases that cause inflammation in the digestive tract. STC-I is a procedure where most of the large intestine is removed and the end of the small intestine is brought out through an opening in the abdomen to eliminate waste from the body.
The study looked at children aged 5 to 21 years who had this surgery at a specialist pediatric center between 2010 and 2018. The results showed that the surgery was effective in improving the children’s nutrition levels and stopping bleeding from the large intestine. It also allowed the children to stop taking IBD-related medications within four weeks of the surgery.
About half of the children needed additional treatments for inflammation in the remaining part of the rectum, and around two-thirds were able to have their digestive tract reconnected at the same hospital. The study also found that the surgery was safer and recovery was quicker when it was performed using keyhole surgery (laparoscopy).
However, around 37% of the children experienced complications after the surgery, and 24% of these happened soon after the surgery. Around 11% of the children had to be readmitted to the hospital due to blockages in the small intestine.
Overall, the study suggests that STC-I is a safe and effective initial treatment for severe IBD in children. It allows them to stop using medications that suppress the immune system and stops bleeding from the large intestine. Performing the surgery using a keyhole approach can further improve recovery times.
FAQs
- What is a subtotal colectomy with end ileostomy (STC-I) surgery and how does it help in treating severe IBD in children?
- What were the benefits and complications observed in children who underwent STC-I surgery in the study?
- How does the use of keyhole surgery (laparoscopy) affect the outcomes of STC-I surgery in children with severe IBD?
Doctor’s Tip
One helpful tip a doctor might tell a patient about colectomy is to follow a healthy diet and stay hydrated to help with the recovery process. It is important to eat small, frequent meals and avoid foods that may cause discomfort or irritation to the digestive system. Additionally, staying active and following the post-operative care instructions provided by the healthcare team can help promote healing and reduce the risk of complications.
Suitable For
Patients who are typically recommended colectomy include those with severe inflammatory bowel disease (IBD) that is not responding to medication, those with complications such as bleeding or perforation of the large intestine, and those with toxic megacolon (a severe complication of IBD where the colon becomes severely inflamed and dilated).
Other patients who may be recommended colectomy include those with colorectal cancer, familial adenomatous polyposis (an inherited condition that causes numerous polyps in the colon), ulcerative colitis (a type of IBD that affects the colon and rectum), and Crohn’s disease (a chronic inflammatory condition that can affect any part of the digestive tract).
Overall, colectomy may be recommended for patients with severe or life-threatening conditions that cannot be effectively managed with medication or other treatments. It is important for patients to discuss their options with their healthcare provider to determine the best course of treatment for their specific condition.
Timeline
Before colectomy:
- The patient may experience symptoms such as severe inflammation in the digestive tract, bleeding from the large intestine, and difficulty in managing their condition with medication.
- The patient undergoes consultations with healthcare providers to discuss the option of colectomy as a treatment for their severe inflammatory bowel disease.
- Pre-surgical preparations are made, including tests and evaluations to ensure the patient is a suitable candidate for the surgery.
After colectomy:
- The patient undergoes the subtotal colectomy with end ileostomy surgery, removing most of the large intestine and creating an opening in the abdomen for waste elimination.
- Following the surgery, the patient experiences improvements in nutrition levels, cessation of bleeding from the large intestine, and discontinuation of IBD-related medications within four weeks.
- Some patients may require additional treatments for inflammation in the remaining part of the rectum, while others may undergo a procedure to reconnect their digestive tract.
- Complications may arise post-surgery, with around 37% of patients experiencing complications and 24% occurring shortly after the surgery.
- Recovery times are quicker and the surgery is safer when performed using laparoscopy (keyhole surgery).
- Overall, the study suggests that STC-I is a safe and effective initial treatment for severe IBD in children, providing significant improvements in symptoms and quality of life.
What to Ask Your Doctor
Some questions a patient should ask their doctor about colectomy include:
- What are the potential risks and complications associated with a colectomy procedure?
- How long is the recovery period after a colectomy surgery?
- Will I need to make any lifestyle changes after the surgery?
- What are the chances of needing additional treatments or surgeries after a colectomy?
- How will a colectomy affect my digestion and bowel movements?
- Will I need to take any medications or follow a special diet after the surgery?
- What are the long-term effects of having a colectomy?
- How will a colectomy impact my overall quality of life?
- Are there any alternative treatments to consider before undergoing a colectomy?
- How experienced is the surgical team in performing colectomy surgeries, and what is their success rate?
Reference
Authors: Denning NL, Kallis MP, Kvasnovsky CL, Lipskar AM. Journal: J Surg Res. 2020 Nov;255:319-324. doi: 10.1016/j.jss.2020.05.026. Epub 2020 Jun 25. PMID: 32593890