What is a colectomy?

A colectomy is the surgical removal of all or part of the colon (large intestine) to treat disorders of the digestive tract. These include colorectal cancer, bowel obstruction, Crohn’s disease, and diverticulitis.

A subtotal (or partial) colectomy involves removing a damaged or diseased portion of the colon. A total colectomy involves removing the entire colon. A colectomy may cure your condition or reduce your digestive symptoms.

A colectomy, also called a large bowel resection, is a major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having a colectomy. 

Types of colectomy

The types of colectomies include:

  • Left hemicolectomy is the removal of the left side of the colon. The surgeon attaches the remaining healthy parts of the colon back together. 
  • Right hemicolectomy is the removal of the right side of the colon. The surgeon attaches the small intestine to the remaining healthy part of the colon. 
  • Sigmoid colectomy is the removal of the lower portion of your colon. This is the most common surgery to treat diverticulitis.
  • Proctocolectomy is the removal of the entire colon plus the rectum and anus. The surgeon may perform this with an additional procedure called a temporary ileostomy. In an ileostomy, the surgeon attaches the remaining small intestine to a new opening in the abdominal wall to the skin called a stoma. Proctocolectomy is a type of total colectomy.

Why is a colectomy performed? 

You doctor may recommend a colectomy to treat certain diseases and conditions of the large intestine. Your doctor may consider a colectomy for you if other treatment options that involve less risk have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a colectomy.

A colectomy is used to treat colon damage or diseases caused by: 

  • Bowel obstruction from complications associated with such conditions as impacted feces, hernia, volvulus, or twisting of the colon and scar tissue
  • Colorectal cancer. The best chance for a cure and long-term survival is surgical removal of the cancer.
  • Diverticulitis, which is inflammation and infection of small pouches of the bowel
  • Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis 
  • Injury to the bowel, rectum or perineum
  • Intestinal bleeding from diverticulosis, inflammation or damage to the colon

Who performs a colectomy?

General surgeons and colon and rectal surgeons perform colectomies. General surgeons specialize in the surgical care of diseases, injuries and deformities affecting the abdomen, breasts, digestive tract, endocrine system and skin. Colon and rectal surgeons are general surgeons with advanced training in the treatment of colon and rectal problems. 

How is a colectomy performed?

Your colectomy will be performed in a hospital. Your surgeon will make either a large incision or several smaller incisions in your abdomen. Your surgeon then cuts out the diseased part of the colon (partial colectomy) or the entire colon (total colectomy). Your surgeon may reconnect your digestive tract. 

A total colectomy involves removing all of your large intestine and attaching the small intestine to the rectum or anus. Sometimes, this requires diverting the stool and feces will exit the body through a stoma in the wall of the abdomen and empty into a bag instead of through your rectum. This is called an ileostomy.  

A partial colectomy involves attaching the remaining ends of the colon together. In some cases, the colon is attached to the skin to make a colostomy. This is often temporary and allows your remaining colon or rectum time to heal. After healing, a second operation is performed and the colon is reattached so that stool passes normally out of the body through the rectum.

Surgical approaches to colectomy

Your doctor will perform your colectomy using one of the following approaches: