Colectomy

A colectomy is a surgical procedure to remove the whole, or part of your colon. Also known as your large intestine, your colon is a tube-like organ that is located at the end of your digestive tract.

A colectomy may be necessary for the treatment or prevention of certain diseases and conditions that affect your colon.

There are various type of colectomy operations:

• Total colectomy: which involves the entire colon.
• Partial colectomy: which involves removing part of the colon and may also be called subtotal colectomy.
• Hemicolectomy: which involves removing the left or right part of the colon.
• Proctocolectomy: which involves removing both the colon and rectum.

Colectomy surgery usually requires other procedure to reattach the remaining portions of your digestive tract and permit waste to leave your body.

Here are the most common reasons to undergo a colectomy.

Colectomy is used in the treatment and prevention of disease and conditions that affect the colon, such as:

• Bleeding that cannot be put under control: Severe bleeding from the colon may require surgery to remove the affected part of the colon.
• Bowel obstruction: A blocked colon is a very serious emergency that may require total or partial colectomy, depending on the situation.
• Colon cancer: Early stage cancers may require only a small section of the colon to be removed during the colectomy. Cancers at a later stage may require more of the colon to be removed.
• Crohn's disease: If medications are not helpful in your case, removing the affected part of your colon may offer temporary relief from the signs and symptoms. A colectomy may also be an option if precancerous changes are found during a test to examine the colon (colonoscopy). 
• Ulcerative colitis: Your doctor may recommend total colectomy if medications are not helping you control your particular signs and symptoms. Colectomy might also be an option if precancerous changes are found during a colonoscopy.
• Diverticulitis: Your doctor may also recommend a colectomy if your diverticulitis recurs or if you experience complications of diverticulitis.
• Preventive surgery: If your risk of colon cancer is high due to the formation of multiple precancerous colon polyps, you may choose to undergo total colectomy to prevent cancer in the future.

Colectomy might be an option for individuals who inherit genetic conditions that increase colon cancer risks, such as familial adenomatous polyposis or Lynch syndrome.

Discuss your treatment options with your doctor. In some situations, you may have to decide between various types of colectomy operations. Your doctor can discuss the benefits and risks of each.

Colectomy carries very serious complications. Your risk of complications is based on your general health, the type of colectomy you undergo and the approach your surgeon uses to perform the operation.

In general, complications of colectomy may include:

• Bleeding
• Formation of blood clots in the legs (deep vein thrombosis) and the lungs (pulmonary embolism).
• Infection
• Injury to organs near your colon, such as the bladder and small intestines, ears in the sutures that reconnect the remaining parts of your digestive tract.

You will spend time in the hospital after your colectomy to allow the healing of your digestive tract. Your health care team will monitor you for any signs of complications from your surgery. You may spend a few days to a week under the hospital's care, depending on your condition and situation.

In order to prepare for a colectomy, your doctor may ask that you:

• Stop taking certain medications: Certain medications can increase your risk of complications during surgery, so your doctor may ask that you stop taking those medications before your surgery.
• Fast before your surgery: Your doctor will give you specific instructions. You may be asked to stop eating and drinking several hours to a day before your procedure.
• Drink a solution that clears your bowels: Your doctor may prescribe a laxative solution that you mix with water at home. You drink the solution over several hours, following the directions. The solution causes diarrhea to help empty your colon. Your doctor may also recommend enemas.
• Take antibiotics: In some cases, your doctor may prescribe antibiotics to suppress the bacteria found naturally in your colon and to help prevent infection.

Preparing for colectomy is not always possible. For instance, if you need an emergency colectomy due to bowel obstruction or bowel perforation, there may not be time to prepare.

Plan for your hospital stay. You will spend at least a few days in the hospital after your colectomy, this depends on your situation. Make arrangements for someone to take care of your responsibilities at home and at work.

It is advisable to think about having the following items during your recovery time in the hospital:

• A robe and slippers.
• Toiletries, such as your toothbrush and toothpaste and, if needed, your shaving supplies.
• Comfortable clothes to wear home.
• Activities to pass the time, such as a book, magazine, computer or games.

Here’s what you can expect before, during, and after your colectomy procedure.

During your colectomy. On the day of your procedure, your health care team will take you to a preparation room. Your blood pressure and breathing will be monitored. You may receive an antibiotic medication through a vein in your arm.

You will then be taken to an operating room and positioned on a table. You'll be given a general anesthesia medication to put you in a sleep-like state so that you won't be aware during your operation. The surgical team will then proceed with your colectomy.

Colon surgery may be performed in two ways:

• Open colectomy: Open surgery involves making a longer incision in your abdomen to access your colon. Your surgeon uses surgical tools to free your colon from the surrounding tissue and cuts out either a portion of the colon or the entire colon.

• Laparoscopic colectomy: Laparoscopic colectomy, also called minimally invasive colectomy, involves several small incisions in your abdomen. Your surgeon passes a tiny video camera through one incision and special surgical tools through the other incisions.

  The surgeon watches a video screen in the operating room as the tools are used to free the colon from the surrounding tissue. The colon is then brought out through a small incision in your abdomen. This allows the surgeon to operate on the colon outside of your body. Once repairs are made to the colon, the surgeon reinserts the colon through the incision.

The type of operation you undergo depends on your situation and your surgeon's expertise.

A laparoscopic colectomy may reduce the pain and recovery time after surgery. But not everyone is a candidate for this procedure. Also, in some situations, your operation may begin as a laparoscopic colectomy, but circumstances may force your surgical team to convert to an open colectomy. Once the colon has been repaired or removed, your surgeon will reconnect your digestive system to allow your body to expel waste.

Options may include:

• Rejoining the remaining portions of your colon: The surgeon may stitch the remaining portions of your colon together, creating what is called an anastomosis. Stool then leaves your body as before.
• Connecting your intestine to an opening created in your abdomen: The surgeon may attach your colon (colostomy) or small intestine (ileostomy) to an opening created in your abdomen. This allows waste to leave your body through the opening (stoma). You may wear a bag on the outside of the stoma to collect stool. This can be permanent or temporary.
• Connecting your small intestine to your anus: After removing both the colon and the rectum (proctocolectomy), the surgeon may use a portion of your small intestine to create a pouch that is attached to your anus (ileoanal anastomosis). This allows you to expel waste normally, though you may have several watery bowel movements each day. As part of this procedure, you may undergo a temporary ileostomy.

Your surgeon will discuss your options with you before your operation.

After your colectomy

After surgery, you'll be taken to a recovery room to be monitored as the anesthesia wears off. Then, your health care team will take you to your hospital room to continue your recovery. You will stay in the hospital until you regain bowel function. This usually takes a couple of days to a week.

You may not be able to eat solid foods at first. You might receive liquid nutrition through a vein, often in your arm, and then transition to drinking clear liquids. As your intestines recover, you can eventually add solid foods.

If your surgery involved a colostomy or ileostomy in attaching your intestine to the outside of your abdomen, you'll meet with an ostomy nurse who will show you how to care for your stoma. The nurse will explain how to change the ostomy bag that will collect waste.

Once you leave the hospital, expect a couple of weeks of recovery at home. You may feel weak at first, but eventually, your strength will return. Ask your doctor when you can expect to get back to your usual activities.