Pediatric Laparoscopic Assisted Ileocecectomy

An ileocecectomy is a procedure to remove the end of the small intestine and the beginning of the large intestine (colon). These areas are removed when the bowel is damaged or blocked by Crohn’s disease or other inflammatory bowel disease (IBD).

Crohn's disease can cause severe inflammation (swelling or irritation), strictures (narrowing of the intestines), and blockages. Removing the affected part of the intestine can improve your child’s health and quality of life.

The surgery is usually done through laparoscopic assisted surgery. The doctor will make three small incisions in the abdomen (belly) and insert a tiny camera and special instruments to see inside and remove the inflamed or diseased areas. The healthy ends of the intestine are then reconnected, creating what is called an anastomosis. If the ends of the intestine are not healthy, sometimes a temporary ileostomy is placed and the intestine is brought out on to the skin. This is reversed at a later time when your child is healthier, and their medicines have improved their disease.

• Day before your child’s surgery:
  • Your child can have a clear liquid diet only. This includes broth, Jell-O, Italian ices, clear fruit juices without pulp, Pedialyte, Gatorade, carbonated beverages, broths, and water.   
  • Your child can drink clear liquids up until two hours before surgery. We also ask that your child drink a carbohydrate-rick drink, such as Gatorade or Powerade, the morning of surgery. Please see the Enhanced Recovery After Surgery (ERAS) handout for more information.
• Your child may be required to do a bowel prep to clean out their intestines.  
• Your child may be required to take antibiotics the night before surgery to help prevent infection.   
• You will also receive a call one to three days before surgery from our pre-operative department to discuss:
  • Time of surgery  
  • When to arrive at the hospital  
  • Instructions for when your child should stop drinking and eating

• The surgical procedure will take about two to three hours. After surgery, your child will stay in the hospital for a few days.   
• We will follow the ERAS protocol:
  • Your child can have clear liquids right after surgery.   
  • We will encourage your child to sit up on the day of surgery and walk the day after surgery.   
  • Before your child is ready to go home, they will need to meet certain requirements. Before they can leave the hospital they need to:
    • Tolerate a regular diet and sit up in a chair for every meal.  
    • Walk out of their room three times.  
    • Pass gas or have a bowel movement.  
    • Have any pain well-controlled by oral pain medicines.  
    • Ask the surgical team any questions and feel comfortable with going home.

• Medicine:
  • Good pain control will help your child feel better and heal faster. Acetaminophen (Tylenol) and/or ibuprofen (Advil or Motrin) are common medicines used to treat pain.  
  • The surgical and gastrointestinal team will tell you when your child can re-start their home medicines.
• How should I care for the surgery site after surgery?
  • Following surgery, your child’s skin will be closed with sutures (stitches) that dissolve. The overlying skin will be sealed with either skin glue (Dermabond) or small white bandages (steri strips).   
  • The skin glue OR steri-strips will stay in place for five to 10 days before falling off on their own. You should not peel, pick or rub the skin glue or steri-strips as this could cause your child’s wound to open before it is healed.   
  • Your child may shower or sponge bathe after surgery, but no tub baths or swimming for two weeks.

• Risks include infection, bleeding, and damage to surrounding structures. Your surgeon uses special procedures to decrease and reduce these risks.   
• There is a small risk (less than 5%) that the anastomosis, or new intestinal connection, can leak. This can cause an infection requiring additional procedures. 
• In some situations, the amount of swelling and disease in the intestines is too great to safely perform the ileocecal resection and reconnect the bowel at the same time. In these situations, a temporary ileostomy (intestine connected directly to the outside of the skin) may be needed. Once the body has had time to heal and the inflammation (swelling) is under better control, your surgeon will perform the ileocecal resection and reconnect the bowel, taking away the ostomy. 
  • If your child does require an ostomy, our wound/ostomy nurse practitioners will teach you how to care for the ostomy at home and make sure you and your child are comfortable with the ostomy before discharge.
• In other situations, your surgeon may be unable to perform the ileocecal removal laparoscopically and may have to make a larger incision to remove the intestine. This is called an open procedure and may leave a larger scar.

Your surgeon would like to see you in clinic about two to four weeks after surgery. This appointment can be in the multidisciplinary IBD clinic or in the surgical IBD clinic.

• To schedule an appointment with the surgical clinic, please call 202-476-2150.  
• To schedule an appointment with the multidisciplinary IBD clinic, please call 202-476-3032.

If you have any questions or concerns about surgery, please email the surgery outpatient team or call at 202-476-5221. The outpatient team is available Monday-Friday from 8 a.m. - 4 p.m. (no holidays). If you have urgent concerns overnight or over the weekend, please call 202-476-5000 and ask to speak to the general surgery resident on call.

When to Call the Doctor After Surgery

• Pain is not controlled by acetaminophen (Tylenol) and/or ibuprofen (Advil or Motrin)   
• Fever greater than 101.4° F  
• Trouble swallowing or painful swallowing
• Vomiting or are unable to tolerate your diet
• Decrease in ostomy output or if the stoma looks different
• Abdomen (stomach) becomes swollen or no longer passing gas
• Any questions or concerns