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Colectomy -- Open Surgery

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(Total Colectomy; Partial Colectomy; Colon Removal)

Definition

This is an operation 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 your colon is removed. In a total colectomy, your entire colon is removed.
Colon
colectomy colon
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Reasons for Procedure

A colectomy may be performed 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

Possible Complications

If you are planning to have a colectomy, your doctor will review a list of possible complications, which may include:
  • Damage to other organs or structures
  • Infection
  • Bleeding
  • Hernia forming at the incision site
  • Blood clots
  • Complications from general anesthesia
Factors that may increase the risk of complications include:
  • Having neurological, heart, or lung conditions
  • Increased age
  • Obesity
  • Smoking
  • Previous abdominal surgery
  • Infection

What to Expect

Prior to Procedure

Your doctor may do the following:
  • Physical exam
  • Blood tests
  • Imaging tests such as ultrasound, barium x-ray, CT scan, and MRI scan
  • Colonoscopy with biopsy samples—visual exam and removal of tissue inside the large intestine using a flexible tube with a camera on the end
Leading up to your procedure:
  • Talk to your doctor about your current medicines. Certain medicines may need to be stopped before the procedure, such as:
    • Ibuprofen or other anti-inflammatory drugs
    • Blood-thinning medications
    • Anti-platelet medications
  • Drink plenty of water.
  • Follow a special diet, if advised by your doctor.
  • You will likely be given laxatives and other medicines to help clean out your bowels.
  • Take antibiotics, if prescribed by your doctor.
  • Shower the night before the procedure using antibacterial soap.
  • Arrange to have someone drive you to and from the procedure and for help at home.
  • The night before, eat a light meal or drink clear liquids as directed. Do not eat or drink anything after midnight unless told otherwise by your doctor.
  • Wear comfortable clothing.

Anesthesia

You will receive general anesthesia. You will be asleep.

Description of Procedure

A single, long incision will be made in the abdomen. The section of colon will be removed through the incision. When possible, the colon on either side of the removed section will be sewn together.
In a total colectomy, a colostomy or ileostomy will need to be formed. This will create a path for waste to leave your body. A small opening called a stoma will be made in the front of your abdominal wall. The open end of your intestine will be attached at the stoma. The stoma may be either temporary or permanent. This part of the procedure may also be done if your intestine needs time to heal and rest.
Colostomy Pouch
colostomy pouch
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The surgeon will close the muscles and skin of the abdomen with stitches or staples. A sterile dressing will be placed over the incision areas.

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 or more

How Much Will It Hurt?

Anesthesia is given to prevent pain during the surgery. Pain is common during recovery. You will receive medication to help manage pain.

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
  • 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 encouraged to practice deep breathing to help open your lungs.
At Home
After your procedure, be sure to follow your doctor's instructions.
If you have a colostomy:
After your procedure, be sure to follow your doctor's instructions.
If you have a colostomy:
  • You will need to take it easy for 1-2 months.
  • You will be taught how to care for the stoma site and change the ostomy bag .
  • Slowly progress from a clear liquid diet, to a bland, low-fiber diet. You will slowly advance to a regular diet.
  • Inform your physicians and pharmacist that you cannot take medicines that are considered time-released or time-sustained.
  • Do not use laxatives, because post-colostomy stools are usually quite liquid.
  • Drink plenty of fluids, since extra fluids will be lost in your stool.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Be sure to follow your doctor’s instructions .

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Nausea and/or vomiting that you cannot control with the medications you were given after surgery, or which persist for more than two days after discharge from the hospital
  • Pain that you cannot control with the medications you have been given
  • Pain, burning, urgency or frequency of urination; blood in the urine
  • Cough, shortness of breath, or chest pain
  • Fatigue or other new symptoms
  • Lightheadedness
  • Pain or swelling in your feet, calves, or legs
  • Bloody or black stools
  • Diarrhea
  • Lack of stool in the colostomy bag
  • Severe abdominal pain
  • Bleeding from the stoma
In case of an emergency, call for medical help right away.

RESOURCES

American Society of Colon and Rectal Surgeons http://www.fascrs.org

National Cancer Institute http://www.cancer.gov

CANADIAN RESOURCES

The Canadian Association for Enterostomal Therapy http://www.caet.ca

Colorectal Cancer Association of Canada http://www.colorectal-cancer.ca

References

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.

Crohn’s disease. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/#treat . Updated January 18, 2011. Accessed May 28, 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.

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 May 28, 2013.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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