Definition and Overview
Colectomy, also referred to as large bowel resection, is a surgical procedure that involves removing a part of or the entire colon due to excessive damage caused by diseases or other medical conditions. The colon is part of the digestive tract and functions mainly as a pathway for the excretion of the body's waste products.
A colectomy can be performed using the traditional method (open colectomy), which involves creating a vertical incision in the abdomen to gain access to the colon, or the laparoscopic method, which makes use of special surgical instruments inserted through a few small holes in the abdomen. The method that will be used is chosen based on the condition of the colon and the skills of the surgeon.
Four main types of colectomy:
- Total colectomy – as the name implies, this removes the entire colon
- Partial or subtotal colectomy – removes a part of the colon
- Hemicolectomy - either the left or right side of the colon is removed
- Proctocolectomy – removes the colon as well as the rectum
Removing the colon is only the first part of the treatment; the other part involves reattaching the remaining affected portions. In a total colectomy, for example, the entire colon is removed and the smaller intestine is attached directly to the anus.
Who should undergo and expected results
While a colectomy surgery is typically performed to treat certain diseases, it can also be preventative in nature. As a form of treatment, a colectomy is only considered if non-surgical forms of treatment fail to improve the patient's condition or if the condition has already progressed into the advanced stages, leaving surgery as the only option.
The colon is prone to a variety of conditions that would require a colectomy. Some of the most common are:
- Bowel obstructions
- Colon cancer
- Ulcerative colitis
- Uncontrolled bleeding
- Crohn's disease
- Colonic inertia or severe constipation
As a preventive measure, colectomy surgery is recommended if the patient presents a high risk of colon cancer or have a high concentration of polyp growth in the colon. Since there is a possibility that at least one the polyps is cancerous, a colectomy is performed right away instead of waiting to see if the polyps develop into cancer. In terms of expectations, patients undergoing open colectomy can expect a longer recovery time and hospital stay. Not only does the incision in the colon need to heal, but also the skin, muscle, and other tissues affected by the incision to open the abdomen.
Laparoscopic colectomy, on the other hand, requires a significantly shorter recovery period and patients, depending on their overall health condition, may not need to stay in the hospital after the procedure. In fact, while laparoscopic colectomy is usually not performed as an outpatient procedure, there have been cases wherein patients were discharged after less than 24 hours. However, the average hospital stay remains at between 3 to 7 days.
The success rate of colectomy surgeries is very high, especially total colectomy procedures. In fact, the majority of patients are able to fully recover and live an active lifestyle, which includes participation in sports and other physical activities aside from regular work duties.
How the procedure works
In an open colectomy, a long incision is made in the abdomen to gain access to the colon. In a minimally invasive laparoscopic colectomy, several small incisions are made in the abdomen near the affected area of the colon. Specially designed instruments are inserted into the incisions making it possible for the surgeon to view the colon on a monitor and create the necessary incisions using another device. Once the surgeon has gained access to the colon, he will either remove a part of or the entire colon, whichever the patient's condition requires.
Regardless of the procedure, preparations typically remain the same. Patients need to abstain from any foods or beverages at least 12 hours before the surgery. During this period, the patient will be treated using laxatives and enemas to clear the colon.
If the patient is on any type of medications, especially blood thinners, these will need to be stopped at least a week before the procedure.
The surgery will be performed while the patient is under general anesthesia. Patients who underwent laparoscopic surgery can expect an easier time recovering from the anesthetic than patients who underwent open surgery. However, some of the side effects of a general anesthetic will still be felt regardless of procedure.
Possible risks and complications
Surgical procedures do present some risks and possibilities of complications. These are discussed with the patient before the procedure is performed, or after the surgery has been recommended.
Common complications include:
- Negative reaction to the anesthetic
- Blood clots
- Internal bleeding
- Damage to other internal organs
- There is also a possibility of a leak occurring where the intestines were sewn together.
- Fry RD, Mahmoud NN, Maron, Bleier JIS. Colon and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 52.