Colectomy

What is a colectomy?

A colectomy (colon resection) is the surgical removal of all or part of the colon (large intestine) to treat certain 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 significantly 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 and should 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 portion removed in the treatment of diverticulitis.
• Proctocolectomy is the removal of the entire colon plus the rectum and anus. The surgeon performs this with an additional procedure called an 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?

Colectomy is a major surgical procedure that your doctor may recommend 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. Talk with your doctor about all of your treatment options and consider getting a second opinion.

A colectomy is recommended for damage or disease of the colon caused by:

• Bowel obstruction from complications associated with such conditions as impacted feces, hernia, 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 inflammation or damage to the colon

How is a colectomy performed?                  

A surgeon will lead a surgical team and perform your colectomy in a hospital.

Your surgeon will make either a large incision or several smaller incisions in your abdomen. He or she then cuts out the diseased part of the colon (partial colectomy) or the entire colon (total colectomy). Your surgeon will then reconnect your digestive tract. In a total colectomy, your surgeon attaches the small intestine to the rectum or anus or to a new opening in your abdominal wall to the skin called a stoma. Feces will exit your body through the stoma into a bag instead of through your rectum.

In a partial colectomy, your surgeon attaches the remaining healthy ends of the colon together. In some cases, your surgeon may connect your colon to the abdominal wall and skin during a partial colectomy. This is often temporary and allows your remaining colon or rectum time to heal. After your colon heals, your surgeon may reconnect the colon so that stool passes normally out of the body through the rectum. You may also need a temporary colostomy until you complete other treatments for your condition.

Surgical approaches to colectomy

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

• Minimally invasive surgery is a procedure performed by inserting special instruments and a laparoscope through small incisions in the abdomen. The laparoscope is a thin, lighted instrument with a small camera that transmits pictures of the inside of your body to a video screen. Your surgeon sees the inside of your abdomen on the screen as he or she performs the surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make a small incision instead of a larger one used in open surgery. He or she can then thread surgical tools around structures, such as muscle or tendons, instead of cutting through or displacing them as in open surgery.
• Open surgery is performed by making a large incision in the abdomen. Open surgery allows your surgeon to directly view and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. This is because it causes more trauma to tissues. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.