Total colectomy refers to the surgical removal of the entire large intestine (colon) in children. The method commonly used for this procedure is laparoscopic (minimally invasive) surgery.

Total colectomy is performed for various medical conditions.

Inflammatory Bowel Diseases: Pediatric surgeons may need to remove the colon especially in chronic inflammatory bowel diseases such as colitis (ulcerative colitis) or Crohn’s disease.

Familial Polyposis: Familial polyposis syndrome is a genetic disease that causes the formation of many polyps in the colon, increasing the risk of cancer.

Severe Constipation: Surgeons may consider removing the colon in cases of treatment-resistant and severe constipation in children.

Colon Cancer: Although rare, children can develop colon cancer. In such cases, surgeons may perform colectomy.

Other Causes: Colectomy may also be done for other reasons such as bowel obstruction or trauma.

Treatment

Laparoscopic total colectomy involves the complete removal of the colon and usually connecting the small intestine to the rectum. Before surgery, the child usually undergoes a series of tests and evaluations. Preparations such as nutrition and bowel cleansing are important. The laparoscopic surgery is performed by making several small incisions in the abdominal wall. A laparoscope and special surgical instruments are inserted through these incisions. The colon is completely removed and the small intestine is connected to the rectum (ileorectal anastomosis). Alternatively, an ostomy (colostomy or ileostomy) may be performed to allow stool to exit the body. After surgery, the child is generally monitored in the hospital for a period. Support is provided for nutrition, pain management, and the healing process.

Although laparoscopic total colectomy is generally a safe procedure, complications may rarely occur. These include infection, bleeding, delayed bowel function recovery, leakage at the suture sites, and ostomy-related problems.

The laparoscopic (minimally invasive) surgical method minimizes the potential impacts of total colectomy on the child and speeds up the recovery process. If such surgery is being considered in children, careful evaluation by a pediatric surgeon and a multidisciplinary health team is important.

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