Colectomy

Overview

A colectomy is a surgical operation that entails the removal of all or a portion of the colon, which is a long, tube-like organ at the end of the digestive system and a part of the large intestine. This procedure is often necessary for treating or preventing various conditions affecting the colon.

There are several types of colectomy surgeries:

• Total colectomy: This procedure involves the removal of the entire colon.
• Partial colectomy (also known as subtotal colectomy): This surgery includes the removal of a part of the colon.
• Hemicolectomy: This operation involves removing either the right or left section of the colon.
• Proctocolectomy: This involves the removal of both the colon and rectum.

Typically, colectomy surgeries also require additional procedures to reconnect the remaining parts of the digestive system and allow for the expulsion of waste from the body.

Reasons for undergoing the procedure

Colectomy, a surgical procedure involving the removal of all or part of the colon, is used to treat and prevent various conditions:

• Bowel obstruction: An emergency situation where a blocked colon may require a partial or total colectomy.
• Colon cancer: Depending on the cancer stage, colectomy may involve removing a small section or a larger portion of the colon.
• Uncontrollable bleeding: Severe colon bleeding might necessitate a colectomy to remove the affected area.
• Crohn’s disease: If medications are ineffective, removing the affected part of the colon can provide temporary relief. Colectomy is also considered if precancerous changes are detected during a colonoscopy.
• Ulcerative colitis: Total colectomy or proctocolectomy might be recommended if medications fail to control symptoms, or if precancerous changes are found.
• Diverticulitis: Surgery to remove the affected colon portion may be advised if diverticulitis recurs or leads to complications.
• Preventive surgery: For individuals at high risk of colon cancer, such as those with familial adenomatous polyposis or Lynch syndrome, a total colectomy may be performed to prevent future cancer.

Risks

Although rare, a colectomy can present several risks, including excessive bleeding, the potential for infection, the possibility of damage to nearby organs, and leakage at the anastomosis site, which is the surgical connection made between different parts of the intestines.

Before the procedure

In the days leading up to your colon surgery, your doctor may require you to undergo several preparatory steps:

• Health screening: Prior to scheduling a colectomy, your healthcare team will assess your suitability for surgery. This evaluation involves a physical examination and review of your medical history, along with the following tests:
  • Blood tests
  • X-rays
  • Electrocardiogram (EKG) test
  • Urinalysis
  • Colonoscopy
• Pre-operative counseling: Your healthcare providers will ensure that you fully comprehend the procedure before giving your consent. During counseling, they will discuss:
  • Surgical risks
  • Adjusting to life with a colostomy, if necessary
  • Pain management options
• Discontinue certain medications: To minimize the risk of complications during surgery, your doctor may advise you to discontinue specific medications before the procedure.
• Bowel preparation: It’s crucial for your bowels to be empty before bowel surgery. You will need to prepare for this a few days in advance, which may involve:
  • Following a clear liquid diet
  • Fasting before the surgery (no food or drinks)
  • Using a laxative or enema, such as polyethylene glycol, to cleanse your bowels. Specific instructions will be provided for these bowel preparations.
• Antibiotics: In some instances, your doctor might prescribe antibiotics to suppress the naturally occurring bacteria in your colon and reduce the risk of infection.

It’s important to note that preparing for a colectomy may not always be possible, especially in emergency situations like bowel obstruction or perforation, where immediate surgery may be required.

During the procedure

On the day of your surgery, your healthcare team will prepare you for the procedure in a dedicated room. They will closely monitor your blood pressure and breathing, and you may receive an antibiotic through an intravenous line in your arm.

Following this, you will be taken to the operating room and positioned on an operating table. General anesthesia will be administered to induce a sleep-like state, ensuring you remain unaware and pain-free during the surgery.

The surgical team will proceed with your colectomy, which can be performed in two primary ways:

• Open colectomy: In open surgery, a longer incision is made in your abdomen to access the colon. The surgeon utilizes surgical instruments to free the colon from the surrounding tissue and may remove either a portion or the entire colon.
• Laparoscopic colectomy (minimally invasive colectomy): This approach involves making several small incisions in your abdomen. Through one incision, a tiny video camera is inserted, and specialized surgical tools are passed through the other incisions. The surgeon watches a video screen in the operating room to guide the procedure. The colon is carefully freed from surrounding tissue, brought out through a small incision, and operated on outside the body.

The choice of surgical technique depends on your specific medical condition and your surgeon’s expertise. Laparoscopic colectomy may offer advantages such as reduced post-operative pain and faster recovery, but not everyone is a suitable candidate. Sometimes, a laparoscopic procedure may need to be converted to an open colectomy based on the circumstances.

After repairing or removing the colon, your surgeon will restore the continuity of your digestive system. This can be achieved through different methods:

• Colon reconnection: The surgeon may suture together the remaining segments of your colon or join your colon to your small intestine, creating an anastomosis. This allows stool to exit your body as it did before the surgery.
• Stoma creation: Your surgeon may connect your colon (colostomy) or small intestine (ileostomy) to an opening made in your abdomen. This opening, known as a stoma, provides a route for waste to exit your body. You may need to wear a pouch on the outside of the stoma to collect stool. Stoma creation can be permanent or temporary.
• Ileoanal anastomosis: In cases where both the colon and rectum are removed (proctocolectomy), the surgeon might use a section of your small intestine to create a pouch that connects to your anus. This allows for the normal expulsion of waste, although you may experience several watery bowel movements daily. In some cases, a temporary ileostomy may be part of this procedure.

Your surgeon will thoroughly discuss these options with you before the operation, considering your specific medical needs and circumstances.

After the procedure

During your hospital stay following the surgery, your recovery period typically spans from a few days, possibly extending to a week, contingent on the nature of the operation and your overall condition. During this phase, you’ll undergo constant monitoring for any procedure-related complications, a gradual reduction in pain medication, consumption of a liquid or soft diet, and the anticipation of bowel function restoration. Additionally, you will receive counseling on self-care instructions for post-discharge, encompassing wound and ostomy care as well as dietary guidance.

Outcome

• Duration of recovery: Recovery at home typically takes up to six weeks. Although many people are able to resume most of their usual routines within two weeks after surgery, it’s important to approach this period with care.
• Gentle self-care: During the initial days after returning home, it’s crucial to be exceptionally gentle with yourself. While it’s encouraged to get up and walk around, you may feel a bit weak. Avoid pushing yourself too hard or attempting to do too much too soon.
• Diet after colectomy: Your post-colectomy diet should be discussed with a dietitian or nutritional counselor who can provide personalized advice. Generally, you may be advised to follow a low-fiber diet for about a month after surgery. Low-fiber foods are easier on your healing colon. Additionally, it’s important to increase your water intake to stay well-hydrated.

You should contact your healthcare provider if you experience any of the following:

• Incision issues: If you notice redness, swelling, or a foul odor near the incision site.
• Increasing pain: Especially if you feel worsening abdominal pain.
• No bowel movements: If you haven’t had any bowel movements after returning home.
• Signs of infection: Such as fever or vomiting.

Remember, your healthcare team is there to support you during your recovery, and it’s crucial to communicate any concerns or unusual symptoms promptly.