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Definition

An operation to remove all or part of the colon

Parts of the Body Involved

Large intestine (or colon)

Reasons for Procedure

Colectomy is performed to treat a variety of conditions, including the following:

• Colorectal cancer
• Inflammatory intestinal diseases (eg, colitis, Crohn’s disease)
• Intestinal obstruction
• Trauma to the intestine
• Diverticular disease
• Precancerous polyps, especially those seen in familial polyposis
• Colonic perforation
• Bleeding from the colon

Risk Factors for Complications During the Procedure

• Having neurological, cardiovascular, or respiratory conditions
• Age: older than 70 years
• Obesity
• Smoking
• Previous abdominal surgery
• Acute perforation or infection

What to Expect

Prior to Procedure –

Your doctor will likely do the following:

• Physical Exam
• Blood Tests
• Ultrasound Exam of the Abdomen–a test that uses sound waves to visualize the inside of the abdomen
• Barium X-ray–x-ray exam of the abdomen, after swallowing a barium drink and/or receiving a barium enema
• CT Scan–a type of x-ray that uses a computer to make pictures of the inside of the body
• MRI Scan–a test that uses magnetic waves to make pictures of the inside of the body
• Colonoscopy With Biopsy Samples–visual exam and removal of tissue inside of the large intestine using a flexible tube that is attached to a light and a viewing device

In the days leading up to your procedure:

• Drink at least eight 8-ounce glasses of water daily.
• Follow a special diet, if recommended by your surgeon.
• Follow your doctor’s instructions for cleansing your colon; this may include enemas, laxatives, drinking a special liquid preparation, and/or a clear-liquid diet.
• Take antibiotics, if prescribed by your doctor.
• If your doctor asks you to, shower the night before your procedure using antibacterial soap.
• Arrange to have someone drive you to and from the procedure, and for help at home after your procedure.
• The night before, eat a light meal or clear liquids as directed, and do not eat or drink anything after midnight unless told otherwise by your doctor.
• Wear comfortable clothing.

Anesthesia –

General Anesthesia: You will be given medications through an intravenous needle that will put you to sleep for the duration of your surgery.

Description of the Procedure –

The surgeon makes a single long incision (open colectomy) or several smaller incisions (laparoscopic colectomy) in your abdomen.

If only part of your colon is removed (partial colectomy), your surgeon sews the open ends of the intestine together after the central portion has been removed.

If all of your colon is removed (total colectomy), or your surgeon determines your intestine needs time to heal and rest after the procedure, you may need a colostomy or ileostomy.

In a colostomy or ileostomy procedure, your surgeon makes a small opening, called a stoma, in the front of your abdominal wall. The open end of your intestine is then pulled through the abdominal wall and attached to the skin. Your waste will exit your body through this opening. You will wear a pouch, or an ostomy bag, on the outside of your body, where waste material will be collected. The stoma may be either temporary or permanent.

After the procedure is complete, your surgeon closes the muscles and skin of the abdomen with stitches or staples, and applies a sterile dressing.

	Surgical Bowel Resection and Colostomy

After Procedure –

The portion of the colon that was removed will be sent to a pathologist for examination.

How Long Will It Take –

1-4 hours or more

Will It Hurt –

No. Anesthesia prevents pain during surgery. Patients typically experience pain during recovery, but receive pain medication to relieve the discomfort.

Possible Complications –

• Damage to neighboring organs or structures
• Infection
• Bleeding
• Hernia at the incision site
• Blood clots in the vein (phlebitis) that may travel to the lungs (embolism)
• Hematoma (accumulation of blood in the wound)
• Pneumonia and other risks of general anesthesia

Average Hospital Stay –

5-6 days

Postoperative Care –

You will receive instructions about when and what you can eat, and how you need to restrict your activity. During the first few days after surgery, you may be restricted from eating. You will need to take it easy for 1-2 months, as you recover from your surgery.

If you have a colostomy:

• A specialized nurse or your surgeon will teach you how to care for the stoma site and change the ostomy bag.
• In the first days after your operation, you will progress from a clear liquid to a bland, low-fiber diet. During this time, you should avoid high-fiber foods, including corn, celery, apples, nuts, popcorn, grapes, and other foods with hulls, peels, and seeds. You will likely be able to return to your regular diet 6-8 weeks after surgery.
• Alert your physicians and pharmacist that you cannot take medications that are considered time-released or time-sustained.
• Do not use laxatives because postcolostomy stools are usually quite liquid.
• Drink eight 8-ounce glasses of liquid daily because extra fluids will be lost in your stool.

Outcome

The outcome varies depending on why you had the colectomy. If you have colon cancer and the entire cancerous area is removed with a colectomy, your outcome is good. A colectomy may also reduce your risk of developing colon cancer if you had it to treat a precancerous condition, including familial polyposis, ulcerative colitis, or colon polyps. Most people who have colectomies go on to live normal, active lives, and the colon adapts to return bowel activity to normal.

Call Your Doctor If Any of the Following Occurs

It is essential for you to monitor your recovery once you leave the hospital. That way, you can alert your doctor to any problems immediately. If any of the following occur, call your doctor:

• Signs of infection, including fever and chills
• Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
• Cough, shortness of breath, chest pain, or severe nausea or vomiting
• Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
• Pain and/or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain
• Diarrhea
• Blood in your stool, or black, tarry stools
• Severe abdominal pain
• Feeling weak or dizzy
• Irregular urination
• Bleeding from the stoma
• Not collecting stool in the ostomy pouch

RESOURCES:

American Cancer Society
http://www.cancer.org

American Society of Colon and Rectal Surgeons
http://www.fascrs.org

National Cancer Institute
http://www.cancer.gov

CANADIAN RESOURCES:

BC Health Guide, British Columbia Ministry of Health
http://www.bchealthguide.org

References:

Alves A, Panis Y, Mathieu P, et al. Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study. Archives of Surgery. 2005;140:278-283.

Dictionary of cancer terms. National Cancer Institute website. Available at: http://www.cancer.gov/dictionary/. Accessed September 24, 2005.

Feo CV, Zerbinati A, Giacometti M, et al. The ideal length of hospital stay in the surgical treatment of colorectal cancer. Ann Ital Chir. 2002;73:13-16.

A patient guide to colostomy care. Northwestern Memorial Hospital website. Available at: http://www.nmh.org/nmh/patientinformation/patientguidecolostomycare.htm. Accessed September 28, 2005.

Perioperative management. American Society of Colon and Rectal Surgeons website. Available at: http://www.fascrs.org/displaycommon.cfm?an=1&subarticlenbr=127. Accessed September 24, 2005.

What is the treatment for Crohn’s disease? National Digestive Diseases Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/ #treat.

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