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Colectomy -- Open Surgery

(Total Colectomy; Partial Colectomy; Colon Removal)

Definition

This is a procedure to remove all or part of the colon. The colon, or large intestine, is the lower part of the intestines. In a partial colectomy, only part of the colon is removed. In a total colectomy, all of the colon is removed.
Colon
colectomy colon
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Reasons for Procedure

A colectomy may be done to treat a variety of conditions, including:
  • Colorectal cancer
  • Inflammatory intestinal diseases such as colitis and Crohn’s disease
  • Intestinal blockage
  • Trauma to the intestine
  • Diverticular disease —small pouches in the wall of the colon
  • Precancerous polyps, especially those seen in familial polyposis
  • A hole in the bowel wall, or a dead piece of bowel
  • Bleeding from the colon
For colon cancer, the goal is to remove all of the cancer. If you have a precancerous condition, then you may have prevented the development of cancer. If you had surgery due to other conditions, a successful operation will alleviate or improve your symptoms.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • Damage to other organs or structures
  • Infection
  • Bleeding
  • Hernia forming at the incision site
  • Blood clots
  • Complications from general anesthesia
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

What to Expect

Prior to Procedure

Your doctor will likely do a physical exam and recommend blood tests.
Imaging tests take pictures of internal body structures. Imaging tests include:
Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure, like:
  • Anti-inflammatory drugs
  • Blood thinners
  • Antiplatelets
Your doctor may recommend preparation several days in advance of your procedure. This may include:
  • A special diet.
  • Your colon must be completely cleaned out. A number of cleansing methods may be used. This may include enemas, laxatives, and a clear-liquid diet. You may be asked to drink a large container of solution. It will aid in the complete emptying of the colon. This preparation may start several days before the procedure.
  • Antibiotics. It is important to take them as directed.
  • A shower the night before your procedure using antibacterial soap.
  • Wearing comfortable clothing.
  • Arranging for a ride to and from the hospital.
  • Arranging for help at home for the first days after your procedure.

Anesthesia

General anesthesia will be used. You will be asleep.

Description of Procedure

Partial Colectomy
A single, long incision will be made in the abdomen. The diseased portion of intestine will then be removed through the incision. The two loose ends of intestine will be sewn together. Some soft tubes may be left in the abdomen to drain any accumulating fluids.
Stitches or staples will be used to close the area. A bandage will be placed over the incisions.
Total Colectomy
In a total colectomy, the entire colon will be removed through the incision. In some cases, the last part of the small intestine, called the ileum, is then connected to the rectum. A small pouch is made from the ileum to store stool. This pouch mimics the function of the rectum and preserves anal function.
Stitches or staples will be used to close the area. A bandage will be placed over the incisions.
Colostomy
With either procedure, you may need a colostomy or ileostomy. In this procedure, an artificial opening will be created in your abdomen, called a stoma. One or both ends of the intestine will be attached to the stoma. This allows feces to exit your intestine through the stoma. It collects in a pouch called an ostomy bag. A colostomy may be temporary or permanent.
A temporary colostomy allows the intestine to rest and heal. When your intestine has healed properly, you will undergo another operation to rejoin the ends of the intestine.
Colostomy Pouch
colostomy pouch
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Immediately After Procedure

The removed tissue will be sent to a lab for examination. You will be taken to the recovery room and monitored.

How Long Will It Take

About 1-4 hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

This procedure is done in a hospital setting. The usual length of stay is 5-6 days. Your doctor may choose to keep you longer if complications occur.

Post-procedure Care

At the Hospital
  • You may need antibiotics. You may also need medication for nausea and pain.
  • You may require a nasogastric (NG) tube for a few days. The tube enters through your nose and goes to your stomach. It is used to help decompress your intestines.
  • Your intestine will require some time to heal before it will function properly again. At first, you will get nutrition through an IV. As you improve, you will be slowly advanced through liquid and soft diets to a regular diet.
  • If you had a colostomy or ileostomy, a pouch will be attached on the outside of your body. Waste material will be collected in it. You will receive instructions about diet and activity. During the first few days after surgery, you may be restricted from eating.
  • You will wear boots or special socks to help prevent blood clots.
  • You will be asked to walk often after surgery.
  • You may be asked to use an incentive spirometer, to breathe deeply, and to cough frequently. This will improve lung function.
  • Your incision will be examined often for signs of infection.
Preventing Infection
During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chance of infection, such as:
  • Washing your hands often and reminding your healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
At Home
If you have a colostomy:
If you have a colostomy:
  • You will need to take it easy for 1-2 months.
  • A specialized nurse will teach you how to care for the stoma site and change the ostomy bag .
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • You will progress from a clear liquid, to a bland, low-fiber diet, to your regular diet after about 6-8 weeks.
  • Alert your physicians and pharmacist that you cannot take medications that are considered time-released or time-sustained.
  • Do not use laxatives, because postcolostomy stools are usually quite liquid.
  • Drink plenty of liquid daily as extra fluids will be lost in your stool.
  • You will need to practice good skin care of the area around the stoma. This will help to prevent inflammation and infection.
  • You may wish to join a support group or seek counseling to help you adjust to your colostomy.

Call Your Doctor

Call your doctor if any of the following occurs:
  • Redness, swelling, increasing pain, excessive bleeding, warmth, drainage, or bulging at the incision site
  • Nausea and/or vomiting that you cannot control with the medications you were given after surgery
  • Severe abdominal pain
  • Signs of infection, including fever and chills
  • Cough, shortness of breath, or chest pain
  • Pain and/or swelling in your feet, calves, or legs
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
  • Not passing any stool
  • Blood in your stool, or black, tarry stools
  • Diarrhea
  • Feeling weak or lightheaded
If you had a colostomy created, call your doctor if any of the following occurs:
  • Not collecting stool in the ostomy pouch
  • The skin around the stoma appears irritated, moist, red, swollen, or develops sores
If you think you have an emergency, call for medical help right away.

RESOURCES

American Cancer Society http://www.cancer.org

National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov

CANADIAN RESOURCES

Canadian Society of Colon and Rectal Surgeons http://cscrs.ca

Health Canada http://www.hc-sc.gc.ca

References

A patient guide to colostomy care. Northwestern Memorial Hospital website. Available at: http://www.nmh.org/ccurl/580/761/colostomy-care-guide-09-07.pdf. Published September 2007. Accessed June 27, 2013.

Alves A, Panis Y, Mathieu P, et al. Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study. Archives of Surgery. 2005;140:278-283.

Colorectal cancer. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003096-pdf.pdf. Accessed June 27, 2013.

Colorectal cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 12, 2013. Accessed June 27, 2013.

Colorectal cancer prevention and treatment. American Gastroenterological Association website. Available at: http://www.gastro.org/patient-center/digestive-conditions/colorectal-cancer. Updated June 2013. Accessed June 27, 2013.

Crohn’s disease. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/crohns. Updated January 18, 2011. Accessed June 27, 2013.

Diverticulitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 13, 2013. Accessed June 27, 2013.

Feo CV, Zerbinati A, Giacometti M, et al. The ideal length of hospital stay in the surgical treatment of colorectal cancer. Ann Ital Chir. 2002;73:13-16.

Inflammatory bowel disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Accessed June 27, 2013.

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