Colectomy (Colon Resection Surgery): What You Need to Know
Medically reviewed by Robert Burakoff, MD
A colectomy is a type of surgery that removes part or all of the colon. The colon is part of the large intestine that connects the small intestine to the rectum. The colon is removed either in whole or in part to treat or prevent a disease or condition.
Some of the more common reasons for a colectomy are inflammatory bowel disease (IBD), colon cancer, or diverticular disease.
This article will discuss the types of colectomy, reasons for this surgery, what to expect, recovery, and outlook.
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Is Colectomy a Major Surgery?
A colectomy is a major surgery requiring general anesthesia and a hospital stay of a few days to over a week before going home to continue your recovery.
Many variables affect how a colectomy is performed and how much recovery time is needed. However, in general, this surgery will require several weeks of healing before you can return to regular activities.
If a colectomy is done laparascopically, using specialized surgical tools that are passed through small incisions, the recovery time may be shorter than if the surgery is performed using a large incision.
Types of Colectomy
A colectomy is not one type of surgery; it includes several different types. In some cases, the surgeons may not know exactly what needs to be done until they get inside the abdomen.
If a colectomy is recommended, you should ask questions about the surgery to find out what is expected with each type of colectomy that may be needed.
Partial Colectomy
In a partial colectomy, a section of the colon to include any part is removed. After the part of the colon that is injured or diseased is removed, the two healthy ends are reattached. This type of surgery may be used to treat Crohn's disease (a form of IBD, which also includes ulcerative colitis), colon cancer, or diverticular disease.
Hemicolectomy
A hemicolectomy is when the colon's left or right side is removed. A left hemicolectomy removes the descending colon (located on the left side of the abdomen). When the ascending colon, which runs along the right side of the abdomen, is removed, it is known as a right hemicolectomy.
This type of colectomy might be done most commonly for colon cancer. However, it could also be used to treat:
IBD (Crohn's disease or ulcerative colitis)
Diverticular disease
Trauma to the colon
Total Colectomy
In a total colectomy, the entire colon is removed. However, either part or all of the rectum is left intact. The outcome of this surgery could take one of a few forms.
An ileostomy may be performed, in which the end of the small intestine is brought through the abdominal wall to make a stoma (a surgical hole made in the body). The stoma is where stool exits the body. An appliance is worn over it and emptied as needed.
In other cases, the healthy end of the small intestine might be connected to the rectum, and stool leaves the body through the anus. A total colectomy might be used for:
IBD
Diverticular disease
Colon cancer
Injuries
Proctocolectomy
In this form of surgery, the rectum is removed along with the colon. With this surgery, a permanent ileostomy will also need to be placed.
This surgery may be used to treat:
IBD
Colon and rectal cancer
Congenital (present at birth) problems affecting the rectum or anus
An injury
Reasons for Colectomy Surgery
A colectomy may be used to treat several diseases or conditions affecting the colon and/or rectum.
One common reason for a colectomy is to treat IBD. In Crohn's disease, part or all of the colon may be removed. If all of the colon is removed, an ileostomy will be placed.
In ulcerative colitis, a total colectomy is always used. Either an ileostomy is placed, or additional surgeries will create a rectum from the last section of the small intestine.
Diverticular disease is another reason for colectomy surgery. Inflamed diverticula (outpouchings of the colon) cause diverticulitis. In most cases, it can be treated without surgery. When surgery is used, the affected section of the colon is removed.
Ischemic colitis is a condition in which blood flow to the colon is cut off or restricted for some reason. It is usually treated medically in the hospital.
However, there are cases of ischemic colitis in which parts of the colon's tissues have begun to die. In that instance, those sections of the colon would be removed with a partial or a hemicolectomy. If there are complications, a total colectomy with an ileostomy might be necessary.
Colon cancer is another reason that a colectomy may be needed. In most cases, only the section of the colon that is affected by colon cancer is removed.
A total colectomy and an ileostomy are rarely used, such as in the case of colon cancer in a person with familial adenomatous polyposis, a hereditary condition that causes hundreds of polyps (growths in the colon lining) that begin as benign but become cancerous.
Preparing for Colectomy Surgery: What Happens Before?
Several things must be done before colectomy surgery. The surgical team will give instructions on what tests and preparations are needed before the procedure. You should ask as many questions as needed to be sure you understand what will happen before, during, and after the surgery.
Tests
Blood tests may be done prior to a colectomy to understand a person's readiness for surgery and to look for any other issues that may be present or could lead to complications. Lung X-rays and other tests may also be done to ensure there are no problems with breathing.
Medications
Some medications may need to be stopped in the days before surgery. This includes any drugs that could increase the risk of bleeding or infection after surgery.
Plan Your Hospital Stay
After colectomy surgery, you may be in the hospital for several days. You will need to plan to be away from home and bring comfort items such as mobile devices, toiletries, and slippers to the hospital.
Preoperative Counseling
The surgical team will be available to answer questions about the surgery. If there will be an ileostomy placed, you will meet with an enterostomal therapy (ET) nurse.
An ET nurse will explain what to expect in the first days and weeks with a new stoma, including how ostomy pouches work. They will also help determine the best location for the stoma based on your lifestyle and the type of clothing you like to wear.
Bowel Prep
Before colectomy surgery, you must drink a special solution or take a series of tablets that help clear all the stool from the colon and rectum. There are several types of preparations, and surgeons will choose the ones they prefer.
Preparation may take place in the day or two before surgery. Usually, nothing to eat or drink is allowed on the morning of surgery or a few hours before the surgery.
What Happens on the Day of Your Colectomy?
On the day of the colectomy, you will go to the hospital at the time requested by the surgical team. It's important to bring a photo ID and your insurance information. The hospital staff will provide several forms for you to review and sign.
You will change into a surgical gown and be prepped for surgery. An intravenous (IV) line will be placed for the administration of fluids as well as medications. Some medications may be given before going into the operating room. Your temperature, blood pressure, and heart rate will all be taken.
Once in the operating room, you will receive general anesthesia to ensure you are not awake during the surgery. The surgical team will then prepare the patient for surgery and monitor breathing, blood pressure, and heart rate throughout the surgery.
What Happens During a Colectomy Procedure?
You will be under general anesthesia for a colectomy and will be asleep the entire time. The surgery may be done laparoscopically or with an open incision. The surgery will take several hours, potentially four or more. Recovery in the hospital will take place over several days.
Laparoscopic Surgery
When possible, laparoscopic surgery (considered minimally invasive surgery) will be used. Several small incisions are made in the abdomen. Specialized tools are passed through those incisions to complete the procedure.
The surgeon will use surgical tools to cut sections of the colon or the entire colon for removal. Healthy colon tissue will be attached back together, called an anastomosis. Or, a stoma will be created for a colostomy or an ileostomy.
Open Surgery
In open surgery, one large incision will be created in the abdomen. The surgeon will complete the colectomy through this incision. The incision will be closed up after the surgery.
Procedure Types
There are many different types of colectomy procedures. Which one is chosen will depend on the reason for the colectomy, the person's health, and the potential for complications or continuation of the condition in the future.
In some cases, an ostomy may be needed temporarily. The ostomy could be reversed later. In others, a colostomy or ileostomy is placed.
The surgeon can tell you which type of procedure you will have. Sometimes, this plan must change or be adjusted during the surgery. Here is some of the terminology that may be used:
Resection: A portion of the colon is removed, and the healthy tissue is reattached together.
Right hemicolectomy: The ascending colon, on the right side of the body, is removed.
Left hemicolectomy: The descending colon, on the left side of the body, is removed.
Subtotal colectomy: The ascending and descending colon are removed, and the sigmoid colon (the last section) is left.
When Is a Stoma Necessary?
A stoma may be necessary if the colon needs time to heal or if the rectum and anus need to be removed. In colon cancer, a permanent stoma isn't usually required. For ulcerative colitis or Crohn's disease, a permanent stoma might be needed and may be planned from the outset of the surgery.
For ulcerative colitis, the ileostomy may be permanent, or there is an option to reverse it after having more specialized surgery to create a J-pouch from the terminal ileum. This procedure creates an artificial pathway for passing stool.
What Are the Risks of Colectomy?
As with any type of surgery, there is the potential for complications with colectomy surgery. One serious complication is bleeding. It is not a common occurrence, but bleeding has the potential to be serious.
Another potential complication during surgery is damage to surrounding organs and tissue. If this damage is found during the surgery, another procedure will be used to repair it.
After surgery, complications that may occur include infections and a leak at the site where the two healthy parts of the intestine were attached (anastomosis).
For a leak at the anastomosis site, more surgery may be needed to repair it. In some cases, a temporary ostomy may be used to allow the bowel to heal.
To avoid infections, antibiotics might be given before or during surgery. You will get instructions and assistance while in the hospital in using breathing treatments to prevent a lung infection and wound care to avoid an infection at the incision site.
Care will be taken to avoid infection, but if one does occur, treatment with antibiotics may be started.
How Long Does Recovery Take?
A colectomy is a major surgery. Recovery may take up to six weeks. Activity is usually ramped up slowly, such as returning to driving, household tasks, and work or school, as recovery continues.
Immediately after surgery, you will spend several days in the hospital receiving pain management and getting started on eating solid foods. You will also be shown how to care for incisions, especially when they are left open to heal. Those incisions will need to be packed with gauze and changed regularly.
Diet may initially consist of liquids and then move to solids as the bowel returns to normal functioning. You will be given directions on diet when you return home. The goal is to return to a regular, healthful diet as soon as possible.
Pain management in the hospital may be given intravenously. At home, oral pain medications, both prescription and over-the-counter (OTC), may be used until they are no longer needed.
What’s the Long-Term Outlook After a Colectomy?
Most people recover well from the surgery itself and won't experience any complications.
For the long-term outlook, the reason that the surgery is done in the first place may be the more important factor. Some conditions may require more treatment after surgery.
For example, Crohn's disease and ulcerative colitis will need to be managed even after surgery. This will mean regular appointments with healthcare providers, prescription or OTC medication, and monitoring for inflammation through endoscopic procedures and blood and stool tests.
Surgery for colon cancer may be followed by radiation and/or chemotherapy. You will need to follow up with your healthcare providers to monitor for recurrence of the cancer or other complications.
When to Contact a Healthcare Provider
After coming home from colectomy surgery, you should contact a healthcare provider if you experience any signs of a complication, such as:
Redness, swelling, heat, or oozing of pus or other fluid at the incision site or sites
Not having any bowel movements (constipation)
Pain in the abdomen, especially if it becomes severe
Fever, vomiting, or other signs of being unwell
Summary
A colectomy is a major abdominal surgery. It will require a stay of several days in the hospital and then several weeks of recovery at home. There is the potential for infection, bleeding, and damage to other organs, but the healthcare team will take steps to make the recovery process as event-free as possible.
Most people recover and return to work or school several weeks after the surgery. However, some people may need ongoing monitoring and care for any underlying conditions.
Read the original article on Verywell Health.
