Surgical Procedures: Colectomy | OncoLink

Author: Marisa Healy, BSN, RN

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Last Reviewed: October 27, 2022

What is a colectomy?

A colectomy is surgery done to remove all of or part of your colon. The colon is part of your large intestine. Your stool (bowel movement) leaves your small intestine and goes into your colon, where it becomes more solid and gets ready to exit your body through the anus.  A colectomy can also be called a large bowel resection.

A colostomy may be needed after colectomy. A colostomy is an opening to the outside of your body that lets stool exit into a bag. In some cases, the cut parts of the colon will be reattached so that bowel movements can happen, and a colostomy is not needed.

How is it done?

A colectomy can be done using a laparoscopic or open technique. 

• Laparoscopic colectomy: A probe with a lighted camera and other surgical tools are put into the abdomen (belly) through many small incisions (cuts).  
• Open colectomy: A large abdominal incision is made to do the surgery. 

A colectomy may be used to treat:

• Cancers of the colon. 
• Precancerous polyps. 
• Cases of an inherited (passed down from your parents) genetic mutation where colectomy may stop colon cancer from growing. 
• Bowel obstruction (a blockage). 
• Infection or bleeding. 
• Diverticulitis. 
• Crohn’s disease. 
• Volvulus (twisted intestines).
• Ulcerative colitis. 
• Intussusception (when the intestine folds into itself).

There are many types of colectomy:

• Total colectomy: The whole colon is removed.
• Partial colectomy: Part of the colon is removed.
• Hemicolectomy: The right or left side of the colon is removed.
• Total proctocolectomy: The colon and the rectum are removed. The rectum is the part of the colon that attaches to the anus. The small intestine may be attached to the anus to let stool exit normally. For some, a temporary ileostomy (opening to the outside of the body for stool removal) may be needed.
• Abdominal perineal resection: The sigmoid colon (part of the colon that attaches to the rectum), rectum, and anus are removed. A permanent colostomy is needed after this surgery.
• Segmental resection: A small part of the affected colon is removed.
• Low anterior resection: The uppermost (highest) part of the rectum is removed.
• Sigmoidectomy: The lowest part of the colon is removed.

What are the risks of having a colectomy?

As with any surgery, there are risks and possible side effects. These can be:

• Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it, and to manage pain. Reactions can include wheezing, rash, swelling and low blood pressure).
• Bleeding.
• Blood clots.
• Infection.
• Damage to nearby organs like the bladder, ureter, blood vessels, and/or small intestines.
• Incisional hernia (This is when tissue in the belly pushes through the muscle. It can look like a lump and can be painful or tender when touched).
• Adhesion/scar tissue (An adhesion is scar tissue that joins 2 pieces of tissue that should not be joined. They are often painless and do not need treatment. Serious cases can cause a blockage in the bowel or limit blood flow.)
• Your incision opening or coming apart.
• Issues with your colostomy, such as infection and leaking. 
• Bowel obstruction (A blockage in the bowel).
• Anastomotic leaks (A leak in the area reconnecting the bowel. This fluid leaks into the body).

What is recovery like?

Recovery from a colectomy depends on the procedure you have had. How long you need to stay in the hospital depends on the surgery and the time needed for recovery.

You will be told how to care for your surgical incisions and stoma (if present) and will be given any other instructions before leaving the hospital. Full instructions on caring for the stoma (if present) will be given to you by a specially trained stoma nurse/therapist.

Your care team will talk with you about the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention and/or other conditions.

Your provider will tell you what you should and should not do when you go home. Often, you should:

• Not lift anything over a certain weight, do any climbing, or any strenuous activity until you are told that you can. 
• Change your diet as told. You may be asked to eat a low-residue (low fiber) diet after surgery.
• Drink 8 to 10 glasses of water per day unless told otherwise.
• Not strain to have a bowel movement.
• Not drive while taking pain medication.
• Often, you can return to work in 2-3 weeks, depending on your job.
• Speak with your healthcare team about showering, putting your surgical incisions under water, diet, sexual activity, and stoma care.

What will I need at home?

• Thermometer to check for fever (101°F, 38.3 °C) which can be a sign of infection.
• Loose clothes and underwear.
• Incision and stoma care supplies. These are supplied by the hospital, your healthcare team or the stoma nurse/therapist.

When should I call my provider?

You should call your provider if you have:

• A fever and/or chills.
• Signs of infection, which include redness, bleeding, odor or drainage at the incision.
• Nausea.
• Any new or worsening pain.
• Belly pain and/or swelling.
• Not had a bowel movement for 2-3 days after surgery.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation. 

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.

Colectomy – Types, Procedure & Risks

By Julie Lynn MarksMedically Reviewed by Robert Jasmer, MD

Reviewed: October 23, 2015

Medically Reviewed

Bowel obstruction, cancer, or an inflammatory bowel disease may require removal of part or all of the large intestine.

A colectomy is a procedure to remove part or all of your colon (large intestine).

The surgery is performed to prevent or treat conditions that affect the colon, such as:

• Colon cancer
• A bowel obstruction
• Severe bleeding of the colon
• An inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis
• Precancerous colon polyps
• Genetic conditions such as Lynch syndrome or polyposis

Sometimes, other procedures are required after a colectomy to reattach parts of your digestive system and allow waste to leave the body.

Types of Colectomy

There are at least four different types of colectomy surgery:

• Total colectomy (removal of the entire colon)
• Partial colectomy (removal of part of the colon)
• Hemicolectomy (removal of the right or left portion of the colon)
• Proctocolectomy (removal of both the colon and the rectum)

The procedure can be performed as a standard open colectomy (requiring a larger incision) or a laparoscopic colectomy (requiring several small incisions).

Discuss the different options with your doctor. In some cases, you may be able to choose which procedure is best for you.

The Colectomy Procedure

You’ll be given general anesthesia during your colectomy, which means you won’t be conscious.

If you’re having a standard open colectomy, the surgeon will make a large incision in your abdomen and cut out all or part of your colon.

If you’re having a laparoscopic colectomy, the surgeon will perform the procedure through several small incisions in your abdomen.

A tiny video camera is inserted through one of the incisions, and small surgical tools are placed in the other cuts.

Once all or part of the colon is removed, the surgeon will reconnect your digestive system in one of the following ways:

• Attaching the remaining parts of your colon together
• Connecting your remaining intestine to an opening created in your abdomen (colostomy or ileostomy)
• Connecting your small intestine to your anus

Before a Colectomy

Before your surgery, tell your doctor about any medicines you’re taking. You might have to stop taking certain drugs before the procedure.

You may also need to not eat or drink for several hours before your colectomy. Your doctor will tell you if this is the case.

Your doctor may give you a laxative solution to mix with water at home and drink over the course of several hours before your surgery.

This will help empty your colon before the procedure. You may also be asked to use an enema.

Your doctor may also prescribe antibiotics before the procedure to help prevent infection.

Sometimes a colectomy is performed as an emergency procedure, so you may not be able to plan ahead.

After a Colectomy

After your colectomy, you will probably stay in the hospital for three to seven days.

You may not be able to eat solid foods right away.

In most cases, it will be about two to three weeks before you can resume your normal activities.

Risks From a Colectomy

A colectomy may lead to complications, including:

• Infection
• Internal bleeding
• Scar tissue
• Hernia (tissue bulging through abdominal muscle, especially under an incision site)
• Blockage of intestines
• Damage to nearby organs
• Blood clots
• A leak where the intestines are sewn together

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Editorial Sources and Fact-Checking

• Colectomy; Mayo Clinic.
• Colectomy: Frequently Asked Questions; The University of Chicago Medicine.
• Colectomy; Johns Hopkins Medicine.
• Total Abdominal Colectomy; MedlinePlus.

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Colectomy – procedure, indications, contraindications

Colectomy is a procedure to remove part or all of the colon. The operation is prescribed for the treatment and prevention of diseases affecting the final part of the digestive tract.

Types of colectomy

Colectomy is classified into several types:

• Total. Surgical manipulation involves the removal of the entire colon.
• Partial (or subtotal). Involves resection of a specific part of the bowel.
• Hemicolectomy. In this case, the right or left half of the colon is removed.
• Proctocolectomy. Includes removal of both colon and rectum.

Usually, the operation is accompanied by additional procedures to restore the digestive system. This is necessary to normalize the processes of removing waste from the patient’s body.

When a colectomy is indicated

Colectomy is used to treat or prevent the following conditions and diseases:

• Heavy bleeding. Severe internal colonic bleeding may require emergency surgery.
• Intestinal obstruction. Violation of the passage of contents through the intestines is an emergency. Often it can be stopped only with the help of a total or partial colectomy.
• Colon cancer. Cancer at an early stage is eliminated by excision of a small area of ​​the colon. Oncology in the later stages often requires resection of a larger part of the organ.
• Crohn’s disease. Colectomy is used when drug therapy has failed. Also, the procedure is indicated for the detection of precancerous changes during colonoscopy.
• Ulcerative colitis. Surgery is indicated for similar reasons as for Crohn’s disease.
• Diverticulitis. Surgical intervention is necessary in case of recurrence of the disease, as well as the occurrence of complications after it.
• Preventive surgery. Colectomy is performed when the patient has a high risk of developing oncology and precancerous tumors. This will prevent the occurrence of cancer in the future. Also, the operation is indicated for hereditary predisposition to adenomatous polyposis, Lynch syndrome and other diseases.

Complications and risks

The risks of having a colectomy depend on the person’s current health and the type of surgery chosen. Complications include:

• Internal bleeding
• Deep vein thrombosis and pulmonary embolism
• Infections
• Bladder or small intestine injury
• Rupture of sutures between adjacent parts of the digestive system.

After the operation, the patient needs inpatient care, which will last from a few days to a week.

Preparing for a colectomy

Before a planned colectomy, the patient is prescribed a series of examinations:

• Complete blood count
• Urinalysis
• Biochemical blood test (bilirubin, total protein, AST, ALT, creatinine, urea, C – reactive protein)
• Blood sugar
• Coagulogram (blood clotting time, bleeding time, INR, prothrombin index, fibrinogen, APTT)
• Blood group and Rh factor
• Tests for infectious diseases (hepatitis B and C, HIV, syphilis)
• Electrocardiogram (ECG)
• CT scan of intestine
• Colonoscopy of the large intestine.

Preparation requirements must be completed a few days before surgery. They include the following recommendations:

• Stopping medication. Some drugs increase the risk of complications. During the initial consultation, inform the doctor about the medications you are taking. You may need to stop taking certain medications.
• Compliance with a special diet. A few hours before the colectomy, it is necessary to refrain from taking gas-forming foods high in fiber and cereals
• Bowel cleansing. To do this, the doctor prescribes a laxative. In rare cases, an enema is prescribed.
• Taking antibiotics. Antibiotic drugs are used to kill bacteria that grow in the colon. This measure can significantly reduce the risk of infection.

Despite the importance of preparation, sometimes a colectomy is performed without it. This only happens in emergency cases:

• bowel perforation
• intestinal obstruction.

During a colectomy

The operation is performed in two ways:

• Open colectomy. During the operation, the surgeon makes an incision in the abdominal cavity with a scalpel, and then removes the affected areas of the colon. In severe cases, a complete resection of the organ is performed.
• Laparoscopic colectomy. Laparoscopic colectomy is a minimally invasive procedure that is done through small incisions in the abdomen. Through them, the doctor launches a video camera and instruments. Thanks to the optical system, the surgeon performs actions guided by the image on a widescreen monitor.

The advantage of laparoscopic colectomy is the ability to operate on the colon outside the patient’s body. To do this, the doctor takes it out through a small incision, performs the necessary manipulations and places the organ in accordance with the anatomically correct location.

The type of intervention depends on the individual clinical case and the skill of the surgeon. Laparoscopic colectomy significantly reduces the patient’s recovery time, but is not suitable for everyone. In some cases, surgeons resort to open resection, starting with a minimally invasive intervention.

After removing the colon, the surgeon will restore the excretory functions of the digestive system. This is done in several ways:

• Stitching parts of the colon. The surgeon connects parts of the organ to each other or sews the large intestine to the small intestine, creating an anastomosis.
• Connection of the intestine to the opening in the abdominal cavity. The surgeon may attach a colostomy or ileostomy to the opening in the abdomen. At the same time, waste is collected in a stoma – a special reservoir fixed outside the body. This measure can be either permanent or temporary.
• Connecting the small intestine to the anus. After a proctocolectomy, the surgeon may use part of the small intestine to create an ileoanal anastomosis. Sometimes a temporary ileostomy is performed as part of this procedure. In this case, bowel movements occur naturally, but with watery secretions.

After a colectomy

At first you won’t be able to eat solid food, so you will be fed intravenously. After a while, you can switch to a drinking diet. After the final restoration of the intestines, it is allowed to eat solid food.

When creating a colostomy or ileostomy, a special waste collection container will be attached to the outside of the abdomen. It’s called a stoma. Your doctor will tell you how to properly care for your stoma and how to replace it yourself.

After you are discharged, you will need 2 weeks of sick leave. During the home recovery period, weakness may be felt, but over time, strength will return again. Full recovery can take 6 to 8 months.

Share:

Scientific sources:

1. Baltaitis Yu.V. Clinical assessment of colectomy with rectal demucation by sileoanal anastomosis // Khirurgiya.- 1986.- No. 9.- P. 114-117.
2. Brusilovsky M.I. Intestinal microflora in patients after total colectomy. Mater. All-Union Conf. Physiology and pathology of the small intestine. Riga 1970. – S. 307-309.
3. Kanshin N. N. Total colectomy with simultaneous ileorectostomy in severe nonspecific ulcerative colitis complicated by narrowing of the rectum. Vestnik khirurgii im. I.I. Grekova.-2004. Volume 163.-№2.-S. 94-96.
4. Strekolovsky V.P. Basic principles of colonoscopy // Klin, medicine. -1978.-No. 2-S.15-138.
5. Yukhvidova Zh.M., Zinoviev O.K., Tikhonov L.F. Method of colonoscopy and its diagnostic capabilities. Klin, medicine. 1974. – T.52.- No. 4.-S. 102-106.

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Subtotal colectomy/colproctectomy

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Indications for subtotal colectomy / colproctectomy

• synchronous malignant neoplasms in the colon and rectum
• ulcerative colitis
• familial adenomatosis of the colon

Preparing for surgery

The Oncology and Coloproctology Department of the Cancer Center of Lapino Clinical Hospital uses a program of accelerated rehabilitation of patients after surgical operations, which includes a system of measures aimed at rapid and early recovery and reduction of inpatient treatment time.

The need for supplementary nutrition is assessed, as malnutrition is often associated with an increase in postoperative complications and worse tolerability of treatment. If necessary, we recommend that patients take balanced nutritional formulas.

It is also important for patients to perform dosed physical activity – this has a positive effect on the tolerability of treatment and leads to a quick return of patients to full daily activity.

Such stereotypes as prolonged fasting before surgery, irrational use of antibiotics, etc. are a thing of the past. At the stage of hospitalization, all patients eat according to the dietary table, and in the morning on the day of surgery, sweet tea is allowed 3 hours in advance – all this prevents a decrease in muscle strength after surgery and leads to a quick rehabilitation of patients.

The optimal bowel preparation method is determined for each patient. Most often, a laxative is prescribed in combination with an intraprosverted antibacterial drug, which leads to a decrease in the frequency of postoperative infectious complications.

Minimally invasive colorectal cancer treatment methods are performed in the oncoproctology department of the Lapino Oncology Center. Minimally invasive surgery is a modern alternative to traditional surgical interventions, in which surgical access to the organ is carried out using mini-incisions on the anterior abdominal wall (pinholes), through which manipulators and an endoscopic camera or through natural physiological openings (NOSE) are inserted. The goal of minimally invasive surgery is to minimize trauma to the surrounding tissues, while the surgical treatment is carried out in full, as in standard open interventions using large incisions.

Procedure

After the patient has been anesthetized, minimally invasive laparoscopic techniques are used to isolate the colon and rectum from the surrounding organs and tissues.

Then, with the help of high-energy devices, large vessels that feed the area of ​​the intestine with a tumor are cut, and lymph node dissection is performed. After removal of the colon, a permanent intestinal stoma can be formed, or the storage function can be restored by forming a small bowel reservoir.