Surgical Procedures: Colectomy
What is a colectomy and how is it performed?
A colectomy is surgery to remove either all or part of the colon. It can also be called a large bowel resection. In some cases a colostomy is needed after colectomy. A colostomy is an opening to the outside of the body that excretes stool into a bag. In some cases, the cut parts of the colon will be reattached so that bowel movements can happen and no colostomy is needed.
A colectomy may be used to treat:
- Cancers of the colon.
- Precancerous polyps.
- Cases of an inherited genetic mutation where colectomy may stop colon cancer from developing.
- Bowel obstruction.
- Infection or bleeding.
- Crohn’s disease.
- Volvulus (twisted intestines).
- Ulcerative colitis.
- Intussusception (When the intestine folds into itself).
There are many types of colectomy:
- Total colectomy: Removal of the whole colon.
- Partial colectomy: Removal of part of the colon.
- Hemicolectomy: Removal of the right or left side of the colon.
- Total proctocolectomy: Removal of the colon and the rectum. The rectum is the part of the colon that attaches to the anus. The small intestine may be attached to the anus to allow stool to be excreted normally. For some, a temporary ileostomy (opening to the outside of the body for stool removal) may be needed.
- Abdominal perineal resection: Removal of the sigmoid colon (part of the colon that attaches to the rectum), rectum and anus. A permanent colostomy is needed after this surgery.
- Segmental resection: Removal of a small part of affected colon.
- Low anterior resection: Removal of the uppermost part of the rectum.
- Sigmoidectomy: Removal of the lowest part of the colon.
A colectomy can be done using a laparoscopic or open technique.
- Laparoscopic colectomy: A probe with a lighted camera and other surgical tools are put into the abdomen through many small incisions.
- Open colectomy: A large abdominal incision is made to do the surgery.
What are the risks associated with a colectomy?
As with any surgery, there are risks and possible side effects. These can be:
- Reaction to anesthesia. (Anesthesia is the medication you are given to help you sleep through the surgery, not remember it and to manage pain. Reactions can include wheezing, rash, swelling and low blood pressure.)
- Blood clots.
- Damage to nearby organs like the bladder, ureter, blood vessels and/or small intestines.
- Incisional hernia (This is when tissue in the belly pushes through the muscle. It can look like a lump, and can be painful or tender when touched.)
- Adhesion/scar tissue formation (An adhesion is scar tissue that joins 2 pieces of tissue that should not be joined. They are often painless and do not need treatment. Serious cases can cause a blockage in the bowel or limit blood flow.)
- Your incision opening/coming apart.
- Issues with your colostomy, such as infection and leaking.
- Bowel obstruction. (This is a blockage in the bowel that can limit digestion or the removal of stool.)
- Anastomotic leaks. (This is a leak in the area reconnecting the bowel and fluid leaks into the body.)
What is recovery like?
Recovery from a colectomy will depend on the extent of the procedure have had. How long you need to stay in the hospital will depend on the surgery you had and the time needed for recovery.
You will be told how to care for your surgical incisions and stoma (if present) and will be given any other instructions before leaving the hospital. Full instructions on caring for the stoma (if present) will be given to you by a specially trained stoma nurse/therapist.
Your medical team will discuss with you the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention and/or other conditions.
Your provider will tell you what you should and should not do when you go home. This will often include:
- Do not lift anything over a certain weight, no climbing and no strenuous activity until you are told that you can.
- Change your diet as instructed. You may be asked to eat a low-residue (low fiber) diet after surgery.
- Drink 8 to 10 glasses of water per day unless otherwise instructed.
- Avoid straining to have a bowel movement.
- Do not drive while taking narcotic pain medication.
- Often, you can return to work in 2-3 weeks, depending on your type of job.
- Speak with your healthcare team about showering, submerging your surgical incisions in water, diet, sexual activity and stoma care.
What will I need at home?
- Thermometer to check for fever, which can be a sign of infection.
- Loose clothes and underwear.
- Incision and stoma care supplies. These are supplied by the hospital, your healthcare team or the stoma nurse/therapist.
When to call your doctor?
- Fever. Ask your provider at what temperature you should call them.
- Signs of infection, which include redness, bleeding, odor or drainage at the incision.
- Any new or worsening pain.
- Belly pain and/or swelling.
- No bowel movement for 2-3 days after surgery.
How can I care for myself?
You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.
Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.
There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.
Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.
- Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.
This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.
Mayo Clinic. Colectomy. 2018. Found at: http://www.mayoclinic.org/tests-procedures/colectomy/home/ovc-20157031
Large Bowel Resection. Found at: http://www.healthline.com/health/large-bowel-resection
The University of Chicago Medicine. Frequently Asked Questions About Colectomy (Colon Resection). Found at: http://www.uchospitals.edu/specialties/colorectal/services/colectomy.html#P75_10158
American College of Surgeons. Colectomy Surgical Removal of the Colon. 2015. Found at: https://www.facs.org/~/media/files/education/patient%20ed/2015%20colectomy%20brochure%20final.ashx