Colectomy (Total Colectomy, Partial Colectomy, Colon Removal)

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.
• The night before, eat a light meal or drink clear liquids as directed, and do not eat or drink anything after midnight unless told otherwise by your doctor.
• Wear comfortable clothing.

Anesthesia

You will receive general anesthesia for the 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.

After Procedure

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

How Long Will It Take

The procedure takes 1 to 4 hours or more.

Will It Hurt?

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

This surgery typically requires 5 to 6 days of recovery in the hospital.

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 to 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 to 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.