Colectomy: what is it?

Colectomy refers to surgery to remove all or part of a diseased or damaged colon. This is a treatment option for people with colon cancer and may also include removal of nearby lymph nodes.

Colon Cancer can start polyps in the large intestine or inside the rectum. Screening can lead to the early detection of these polyps, and early detection can lead to complete recovery.

However, if cancer cells grow and spread throughout a person’s body, they have “metastasized” creating a more serious condition.

In 2021, colon cancer will represent approximately 8.7% of all cancer deaths in the United States.

This article explains what to expect before, during, and after the procedure. It also examines the risks, complications, and more.

Health professionals tend to treat colon cancer using a type of surgery called a colectomy.

If the cancer is not at a very early stage and a surgeon cannot remove it without cutting the abdominal wall, they may perform a colectomy.

There is Several types of the colectomy procedure, including:

  • partial or subtotal colectomy
  • total colectomy
  • hemicolectomy
  • total proctocolectomy

Stoma

In some cases, a surgeon will need to create a stoma, which contains part of the intestine to allow feces and other wastes to exit the body.

A colostomy bag is attached to the stoma to collect feces.

Learn more about colostomy bags here.

Before any surgery, a person will undergo tests, discuss and receive advice.

Tests

Before surgery, a person will undergo various tests and exams, which may include:

A surgeon will need to know the person’s entire medical history, including current illnesses or past serious illnesses. They may also need to discuss symptoms, home remedies, or medications.

A healthcare professional may advise people who smoke to try to quit smoking before their operation to reduce the risk of lung infections after surgery.

Medicines

The surgeon will explain the pain relievers to use after the procedure and how to care for the incision. Their advice will include how to reduce or change medications that may impact recovery, anesthetic response, or blood clotting.

They may also prescribe antibiotics and other medications to be taken before surgery to cleanse the intestines.

Typically, a healthcare practitioner will advise a person to refrain from eating. 4 hours before surgery, although they can consume clear fluids up to 2 hours before the procedure.

The healthcare professional will also advise that the person leave valuables such as jewelry at home.

On the day of surgery, someone will need to bring certain items to the hospital or medical center. These may include:

  • a list of all prescription drugs, over-the-counter drugs, herbal remedies, and other supplements they are using
  • their insurance and identification information
  • loose and comfortable clothes
  • shoes that do not require bending over to be put on
  • an advance health directive

Discussion with the anesthesiologist on the day of surgery should include the following:

  • any allergy of the person
  • any pre-existing health conditions they have
  • all the loose teeth they have
  • all the details about their alcohol or drug use

Colectomies take place under general anesthesia. They can be either laparoscopic-assisted or open surgery.

Laparoscopic-assisted surgery

During laparoscopic colectomy, a surgeon will insert tiny openings or flexible tubes through incisions in the abdomen. They will insert lights and other surgical tools through these ports or tubes.

They can then remove the diseased or damaged part of the colon and either sew the two ends together or create a stoma.

Open surgery

In open colectomy, a surgeon will access the colon through an incision in the abdomen and remove the section of the colon that is diseased or damaged. They can also remove some of the surrounding healthy tissue.

They will then sew or staple the ends together, known as an anastomosis, or create a stoma.

If the procedure is for the treatment of cancer, the surgeon may also remove some of the lymph nodes near the colon for a microscopic examination to look for cancer.

Types of procedure

The procedures that take place during colectomy surgery depend on the amount of colon to be removed.

They include:

  • Sigmoidectomy: This refers to the removal of the sigmoid colon, which is the curved part of the descending colon that connects to the rectum.
  • Right hemicolectomy: This refers to the removal of the right or ascending colon.
  • Left hemicolectomy: This refers to the removal of the left or descending colon.
  • Segmental resection: This refers to the removal of short segments of the colon.
  • Total colectomy: This refers to the removal of the entire colon. A surgeon will then attach the small intestine to the rectum.
  • Low anterior resections: This refers to the removal of the upper rectum.
  • Transverse colectomy: It refers to the removal of the midgut or transverse colon.
  • Abdominal perineal resection: This refers to the removal of the rectum, anus, and sigmoid colon and the attachment of a permanent colostomy.
  • Total proctocolectomy: This is the removal of all or part of the colon and rectum.

When is an ostomy necessary?

An ostomy may be needed if the surgeon cannot sew or staple the two separate ends of the bowel together. Instead, in a procedure called a colostomy, they will attach a bag to collect feces to an opening on the outside of the body.

The stoma may be temporary and the surgeon can remove it surgically after the lower colon heals. During the second surgery, they will reattach the colon inside the body. However, the stoma can be permanent.

People should discuss the potential benefits, risks, and complications of colectomy with a healthcare professional.

Risks and complications that are commonly associated with colectomy include:

  • leaking colon contents into the abdomen
  • infections
  • pneumonia and other lung problems
  • blood clots in the veins or lungs
  • postoperative bleeding
  • gastrointestinal fistula or unusual connection between two parts of the body
  • organ or tissue adhesions
  • stroke or heart attack
  • death

When to seek medical advice

People should ask a healthcare professional when to seek medical advice or care after surgery.

In general, they should see a doctor immediately if they have any of the following symptoms:

  • nausea continues
  • vomiting
  • leakage or drainage from the wound
  • severe pain
  • abdominal cramps
  • fever
  • a bad smell or drainage from the incision
  • increased swelling or redness around or above the incision
  • blood in stool
  • a swollen abdomen
  • no bowel movements for 2 to 3 days

Most people stay in the hospital for 3-4 days after open or laparoscopic-assisted colectomy, unless there are complications.

People who have vomiting, nausea, or an inability to urinate may need to stay in the hospital longer.

After a first bowel movement after surgery, usually within 3 to 4 days, a person can resume their normal diet.

Many people return to normal activities 1 to 2 weeks after laparoscopic-assisted surgery and 2 to 3 weeks after open surgery.

People should avoid engaging in strenuous activities, exercising, and lifting anything over 10 pounds for 4-6 weeks after colectomy surgery.

A healthcare professional may prescribe chemotherapy or radiation therapy after surgery to reduce the risk of further disease.

A the person’s outlook after a colectomy depends on several factors, including:

  • the severity or extent of their disease or damage to the colon
  • the amount of colon and surrounding tissue removed by the surgeon
  • any complications that occurred during or after surgery
  • the general state of health of the person
  • the person’s age

A study of people who had colectomy for ulcerative colitis found that 84% reported an improvement in their quality of life after the procedure.

In the same study, 81% of people experienced symptoms after colectomy, such as reduced body image, depression, anxiety, sexual dysfunction, and reduced work productivity.

Colectomy refers to a type of surgery to remove all or part of a diseased or damaged colon.

Most people spend a few days in the hospital after having a colectomy, but can resume most non-strenuous activities within 1 to 4 weeks.

Some people may need to use a colostomy bag.


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