Colectomy Surgery

A colectomy or colon resection surgery is a surgical procedure that may help treat a range of conditions affecting the colon (large intestine). This procedure involves removing all or part of the colon to help treat conditions that noninvasive procedures cannot treat so that the digestive system can continue to function correctly.

Why Is a Colectomy Performed?

Your healthcare provider may recommend colectomy surgery if they believe it will help improve your quality of life and chances of survival. They will also provide information you need to know before, during and after surgery. The following conditions may require colectomy:

Colorectal cancer – when cells in the colon or rectum grow out of control.
Colorectal polyps – abnormal growths in the rectum or large intestine.
Diverticular disease – the inflammation of the diverticula, small pouches that form along the large intestine walls.
Inflammatory bowel disease (IBD) – an umbrella term for the chronic GI inflammatory conditions Crohn's disease and ulcerative colitis. About seven million people worldwide have this condition.

What Is a Partial Colectomy?

Partial colectomy means only a part of the colon is removed. Other types of colectomies include:

Colectomy Type	Part/s Removed
Hemicolectomy surgery: Right colectomy surgery Left colectomy surgery	Left or right of the colon.
Abdominal perineal resection	Sigmoid colon (end of the colon), rectum and anus
Segmental resection	A small part of the intestine
Low anterior resection	Uppermost part of the rectum
Sigmoidectomy	Sigmoid colon

What Is a Total Colectomy?

Total colectomy surgery involves removing the colon from the small intestine’s lowest part (ileum) to the rectum. After this, the remaining end of the small intestine is connected to the rectum. On the other hand, total proctocolectomy involves removing the rectum and leaving the anus intact.

What Happens Before a Colectomy?

Your medical team will evaluate your overall health before a colectomy to help them plan your surgery. You will undergo blood tests, X-rays and electrocardiogram (ECG) to check your heart and a colonoscopy to view your colon and rectum. Follow all your healthcare provider’s instructions on preparing for the surgery, which may include:

Stopping certain medications a week before surgery
Changing the food and drink you consume days before colectomy
Using enemas and laxatives to clean your bowel one to two days before your procedure
Drinking clear liquids or broth the day before colectomy Not drinking or eating anything for up to 12 hours before surgery

What Happens During a Colectomy?

You will be given general anesthesia before the colectomy so you stay asleep and pain-free during surgery. A colectomy may be performed laparoscopically or with open surgery, depending on which surgery you will have. The entire procedure may take up to four hours.

A laparoscopic colectomy surgery generally follows these steps:

The surgeon makes several small incisions in the belly area.
A laparoscope will be inserted through one of the incisions. The laparoscope is a thin, flexible tube equipped with a camera and lighting at one end.
Other surgical instruments will be inserted through the other incisions.
Your surgeon may need to make another cut on the belly so they can put their hand inside to remove the diseased part of the colon.
A harmless gas will expand your belly, making it easier for the surgeon to examine and operate on the surgical area.
Your surgeon will locate and remove the part of the large intestine that will be removed. Some lymph nodes may be extracted if needed.

An open colectomy surgery generally follows these procedures:

A single long incision will be made in the belly or abdomen.
Belly organs will be examined for any problems.
Your surgeon will locate and remove the part of the large intestine that will be removed. Some lymph nodes may be extracted if needed.

The next steps in either open or laparoscopic surgery include:

Anastomosis – connecting the remaining healthy parts of the large intestine.
Colostomy – this procedure is done if there is not enough healthy colon to stitch together. The surgeon will create an opening called a stoma through the belly skin. The colon will be attached to the belly’s outer wall. The stool will pass through the stoma into a drainage bag outside the body. Colostomy may be short-term or permanent.

What Happens After a Colectomy?

You may need to stay in the hospital for several days after the colectomy. Patients who have a larger amount of intestines removed or those who have developed complications may need to stay longer. Your doctor may allow you to drink water by the second or third day. Follow your doctor’s instructions on how to care for yourself at home to help you heal properly, including wound care, diet, physical activity and when to call the doctor.

You may experience the following as you recover. Keep in mind your doctor’s instructions on how to cope with some discomfort:

Pain when you sneeze, cough or move suddenly. This may last for a few weeks.
Hard stools, diarrhea or no bowel movement at all.
Problems with your colostomy.

Recovery varies for each patient depending on their overall health before surgery, type of colectomy, post-surgery complications and other factors. Some patients can recover fully and return to most of the activities they enjoyed before surgery, such as sports, hiking and other activities. Some patients may need to take certain medications long-term for other digestive-related conditions. Your doctor will work closely with you to determine a long-term recovery plan to help you live a better life down the road.