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Colectomy -- Open Surgery

Definition

This is a procedure to remove all or part of the colon. The colon, or large intestine, is the lower part of the intestinal tract. 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:

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.

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—You will be asleep during the procedure.

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 2 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
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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 will be in a recovery room while the nursing staff monitors your breathing, pulse, and heart rate. Recovery may include:

  • Medications to control pain and nausea
  • Antibiotics to prevent an infection
  • Walking as soon as you are able
  • A nasogastric tube placed through your nose and into your stomach to decompress your intestines
  • IV nutrition while your intestine heals
  • Compression stockings to prevent blood clots
  • Ostomy care
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

Recovery may take 1-2 months. A specialized nurse will teach you how to care for the stoma site and change the ostomy bag. You will progress from a clear liquid, to a bland, low-fiber diet, to your regular diet after about 6-8 weeks. You will need to alter your activities during your recovery. You will be able to slowly return to normal activity once your doctor clears you to do so.

Call Your Doctor

Contact your doctor if your recovery is not progressing as expected or you develop complications, such as:

  • 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
  • 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 emergency medical services right away.

Revision Information

  • American Cancer Society

    http://www.cancer.org

  • National Institute of Diabetes and Digestive and Kidney Diseases

    http://www.niddk.nih.gov

  • Canadian Society of Colon and Rectal Surgeons

    http://cscrs.ca

  • Health Canada

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

  • 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 September 6, 2016.

  • Alves A, Panis Y, Mathieu P, et al. Postoperative mortality and morbidity in French patients undergoing colorectal surgery: Results of a prospective multicenter study. Arch Surg. 2005;140(3):278-283.

  • Colorectal cancer. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003096-pdf.pdf. Accessed September 6, 2016.

  • Colorectal cancer. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T113642/Colorectal-cancer. Updated August 18, 2016. Accessed October 10, 2016.

  • Crohn disease in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114217/Crohn-disease-in-adults. Updated September 7, 2016. Accessed October 10, 2016.

  • Crohn’s disease. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/crohns-disease/Pages/overview.aspx. Accessed September 6, 2016.

  • Diverticulitis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T113975/Diverticulitis. Updated December 21, 2015. Accessed October 10, 2016.

  • 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(1):13-16.

  • Ulcerative colitis. EBSCO DynaMed Plus website. Available at: http://www.ebscohost.com/dynamed. Updated September 28, 2016. Accessed October 10, 2016.