What is colectomy
Colectomy is a surgical procedure that removes all or part of your colon. Your large intestine is the longest tubular organ at the end of your digestive system. It may be necessary to treat diseases and conditions that affect your colon.
Types of colectomy
There are different types of colectomy operations:
- Total colectomy: The entire colon is removed during a total colectomy.
- Partial colectomy: It involves the removal of part of the colon and is also known as a subcutaneous colectomy.
- Hemicolectomy: It involves the removal of the right or left side of the colon.
- Proctocolectomy: It involves the removal of both the colon and the rectum.
Colectomy surgery generally requires other procedures to reassemble the rest of your digestive system and leave waste in your body.
Reasons for the colectomy surgery
Colectomy can be done to treat several conditions, including:
- Colon or rectal cancer
- Inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease
- Intestinal obstruction
- Intestinal injury
- Small pouches on the colon wall – diverticular disease
- Early polyps, especially those found in familial adenomatous polyposis
- Hole in the colon wall
- Dead colon tissue
- Colon bleeding
For colon cancer, the goal is to eliminate the amount of cancer. If you have a pre-existing condition, you may be preventing the development of cancer. If you have surgery for other conditions, a successful operation can reduce or improve your symptoms.
How to prepare for the procedure?
Your medical team needs a complete evaluation before a colectomy. This is done to plan your cancer step by step and your surgery. This may include special X-rays, blood tests, and EKGs. You may have a colonoscopy. To examine the colon and rectum this procedure is used. This is done with a comfortable, lighted viewfinder and a small video camera.
Before the colectomy surgery
Your intestines must be empty for the surgery. In the days before the surgery, you should make changes to your diet and drink consumption. Follow all instructions from your healthcare team.
- You will need to do a bowel prep 1 to 2 days before the procedure. May contain laxatives and enemas to cleanse the intestine.
- You may be told to drink only clear liquids or broth the day before your surgery. You may also be told that there will be no food or drink for 12 hours before the procedure.
- You can stop taking certain medications the week before surgery. These include drugs that thin the blood.
- Your healthcare provider can give you other instructions.
During the colectomy surgery
You will have general anesthesia for the surgery. It is a drug that puts you to sleep during the process.
- For an open colectomy, the surgeon will make a long cut (incision) in your abdomen. For laparoscopically assisted colectomy, he or she will make several small incisions.
- The surgeon will remove a part of your colon.
- The 2 open ends of the colon are attached. Or a stoma is created.
- Lymph nodes near the cancer site are removed. Surgeons remove at least 12 of these lymph nodes.
- After the surgery is finished, the incision is closed.
After the colectomy surgery
When you use anesthesia after surgery, you will be transferred to a supervised recovery room. Your healthcare team will take you to your hospital room to continue your recovery. You will stay in the hospital until your bowel function returns. This can take some time, few weeks to days.
You may not be able to eat solid foods at first. You can get liquid nutrition through a vein, often by hand, and then switch to drinking clear liquids. When your intestines have recovered, you can finally add solid foods.
If you have a colostomy or ileostomy to attach your intestine to the outside of your abdomen during surgery, you will meet with an ostomy nurse who will show you how to care for your stoma. The nurse explains how to change the waste collection ostomy bag.
After leaving the hospital, expect to recover in a few weeks at home. You may feel weak at first, but eventually, you will regain your strength. Ask your doctor when you expect to return to your normal routine.
Risks of the colectomy surgery
The colectomy can have serious complications depending on the general health of the patient, the type of colectomy, and if a surgical technique is required. These include:
- Deep vein thrombosis (blood clots in the legs)
- Pulmonary embolism (blood clots in the lungs)
- Bowel obstruction caused by scar tissue as a result of surgery
- Injury to the bladder, small intestine, and other nearby organs
- Tears in the suture used to reconnect parts of the digestive system
Recovery from colectomy
Recovery from colectomy depends on the extent of the procedure. How long you stay in the hospital depends on the surgery you had and how long you need to recover.
You will be informed about your surgical incisions and how to care for the stoma (if applicable) and other instructions will be given before you leave the hospital. A stoma nurse/therapist will give you complete instructions on stoma care (if applicable).
Your medical team will discuss with you the medications you are taking for the treatment of pain, blood clots, prevention of infections and constipation, and/or other conditions. Your provider will tell you what to do and what not to do when you go home. It often includes:
- Do not lift anything above a certain weight until you are instructed to climb and be active
- Change your diet as suggested. You may be asked to eat a low-residue (low-fiber) diet after surgery
- Drink 8-10 glasses of water a day if it was not prescribed for you
- Avoid straining to maintain a bowel movement
- Don’t drive while taking narcotics
- You can often go back to work in 2-3 weeks, depending on your type of work
- Talk to your healthcare team about submerging your surgical incisions in bathing, water, diet, sexual activity, and stoma care
Complications of the colectomy
Surgery complications are very rare, but there is some risk for all approaches. Your doctor will review potential problems.
- Damage to other organs or structures
- The hernia occurs at the incision site
- Blood clots
Important points to know about the surgery
- Having a colectomy does not cure or eliminate inflammatory bowel disease (IBD). It removes only the diseased part of the large intestine and you may have a recurrence in other areas (especially Crohn’s disease) at a later time. People with ulcerative colitis who undergo a proctocolectomy no longer experience inflammation in their digestive system (because they do not have a colon, anus, or rectum), although they may experience other IBD symptoms such as fatigue and joint pain.
- Most people recover after a colectomy and return to their normal activities, although there are some who experience a slight improvement in their condition.
- The gastrointestinal tract does not always return to function immediately after surgery, and the time for normal digestion to resume can vary.
- If only part of the colon is removed, you will not notice any change in bowel function or stool frequency.
- Laparoscopic colectomy patients generally experience a faster recovery time and less pain.
- You are at risk of dehydration, as the colon plays an important role in absorbing water from food waste.