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.
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
Injury to the bowel, rectum or perineum
Intestinal bleeding from diverticulosis, inflammation or damage to the colon
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.
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:
Minimally invasive surgery involves inserting special instruments and a laparoscope through small incisions in the abdomen. The laparoscope is a thin, lighted instrument with a small camera that sends pictures of the abdomen and colon to a video screen. Your surgeon sees the inside of your abdomen on the screen while performing 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. Surgical tools are threaded around structures, such as muscle or tissue, instead of cutting through or displacing them as in open surgery.
Open surgery involves making a large incision in the abdomen. Open surgery allows your surgeon to see and access the surgical area directly. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. 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.
Surgeons sometimes combine a minimally invasive procedure with an open surgery. In addition, your surgeon may decide after beginning a minimally invasive procedure that you require an open surgery to safely and most effectively complete your surgery.
Your surgeon will advise you on which type of surgery is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different colectomy procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform a colectomy using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.
You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
What to expect the day of your colectomy
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will also have a catheter inserted into your bladder to collect urine after you are asleep. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
As with all surgeries, a colectomy involves risks and possible complications. Most colectomy surgeries are successful, but complications may become serious and life threatening in some cases. Complications can occur during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Potential complications of colectomy
Complications of a colectomy include:
Complications specific to the colostomy, if needed. This can include blockage or collapse of the colostomy opening (stoma).
Damage to other abdominal organs
Intestinal scar tissue, which could cause a bowel obstruction
Intestinal leakage through damaged or sewn-together sections of the intestine
Opening of the external abdominal incision
Paralysis of the intestine (paralytic ileus, which is usually a temporary condition)
Reducing your risk of complications
You can reduce the risk of some complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This includes physical therapy, occupational therapy and other rehabilitation treatments.
Informing your doctor if you are nursing or there is any possibility that you may be pregnant
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for a colectomy by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Following diet restrictions as directed by your doctor. This may include a clear liquid diet the day before surgery. Your surgeon will also restrict eating and drinking before surgery. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. You may also need to take antibiotics, enemas, or a special bowel preparation medication before surgery to reduce the number of bacteria in the colon. Your doctor will give you instructions for taking your medications and supplements.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. It is also a good idea to bring a list of questions to your appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need colectomy? Are there any other options for treating my condition?
What type of colectomy procedure will I need?
How long will the surgery take? When can I go home?
What kind of diet can I eat after surgery?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
Will I need physical therapy or rehabilitation?
How do I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
Knowing what to expect can help make your road to recovery after colectomy as smooth as possible.
How long will it take to recover?
You will stay briefly in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. When you wake up, you may have a tube in your nose that runs down your throat into your stomach. This tube releases air and drains fluid from your stomach until your body is able to process these substances by itself again.
You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
Patients usually move from the recovery room to a regular hospital room. Sometimes, a stay in an intensive care unit (ICU) is needed for complex cases. ICUs provide 24-hour specialized monitoring and care.
You will stay in the hospital for five to seven days. Your care team will monitor your healing and help you gradually transition back to eating and drinking. In about a day, you will be given clear liquids. If you can tolerate those, you will start to consume increasingly thicker liquids and then solid foods.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, your general health, age, and other factors. Full recovery takes four to six weeks.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery, including soreness of your incision(s). Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after colectomy. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Change in alertness, such as passing out, unresponsiveness, or confusion
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's instructions about when to call for a fever.
Inability to urinate, have a bowel movement, or pass gas
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication, new pain, or severe abdominal pain
Sudden and new abdominal swelling
Unexpected drainage, pus, redness or swelling of your incision
How might colectomy affect my everyday life?
A colectomy may cure your condition or significantly reduce your symptoms so you can lead a more active life. For example, a colectomy may help relieve abdominal pain and allow you to resume eating many of the foods you love.
Life after colectomy generally includes many former everyday activities, such as exercising and working. Many people who have colectomies even enjoy activities they were not able to do before surgery.
Colectomy also causes significant changes to your body that may affect your dietary habits. You may have to avoid certain types of food, and eat smaller, more frequent meals. Your bowel movements may become more frequent. Your doctor and perhaps a nurse or dietician, will teach you how to adapt your dietary habits so that you can feel satisfied and comfortable with your new digestive processes.