AMERICAN COLLEGE OF SURGEONS • DIVISION OF EDUCATION Colectomy Surgical Removal of the Colon Digestive System The Condition Possible surgical risks include temporary A colectomy is the removal of a section problems with the intestine that may of the large intestine (colon) or bowel. require a stoma; leakage from the colon Transverse This operation is done to treat diseases into the abdomen; lung problems including Colon of the bowel, including Crohn’s disease pneumonia; infection of the wound, and ulcerative colitis; and colon cancer. blood, or urinary system; blood clots in the veins or lung; bleeding; fi stula; or death. Common Symptoms Risk of not having an operation—Your Ascending Descending ● Symptoms may include diarrhea, symptoms may continue or worsen, and Colon Colon constipation, abdominal cramps, your disease or cancer may spread. nausea, fever, chills, weakness, or loss of appetite and/or weight loss, or bleeding. Sigmoid Colon ● There may be no symptoms. This is Expectations Rectum why screening is essential.* Before your operation— Evaluation Anus may include a colonoscopy, blood work, urinalysis, chest X-ray, or CAT Scan (CT) Treatment Options of the abdomen.1 Your surgeon and Surgical Procedure anesthesia provider will discuss your Patient Education health history, home medications, and This educational information is Open colectomy—An incision is made postoperative pain control options. to help you be better informed in the abdomen and the section of the diseased colon is removed. The two The day of your operation—You will about your operation and not eat for 4 hours but may drink clear empower you with the skills and divided ends of the colon are sutured (sewn) or stapled together in an liquids up to 2 hours before the operation. knowledge needed to actively Medication to clean out your intestines participate in your care. anastomosis. If the colon cannot be sewn back together, it is brought up through and an antibiotic may be started the day the abdomen to form a colostomy. before. Most often you will take your Keeping You normal medication with a sip of water. Laparoscopic colectomy—A light, Informed camera, and instruments are inserted Your recovery—The average length through small holes in the abdomen to of stay is 3 to 4 days for a laparoscopic Information that will help you 2 remove the diseased colon or tumor. or open colectomy. The time from further understand your operation your fi rst bowel movement to eating and your role in healing. Nonsurgical Procedure normally is also about 3 to 4 days. Education is provided on: Some diseases of the colon are treated Call your surgeon if you have continued with antibiotics, steroids, or drugs nausea, vomiting, leakage from the wound, Colectomy Overview ......................1 that aff ect the immune system. blood in the stool, severe pain, stomach Condition, Symptoms, Tests .........2 cramping, chills, or a high fever (over 101°F Treatment Options….. ....................3 or 38.3°C), odor or increased drainage Risks of These Procedures .............4 Benefits and Risks from your incision, a swollen abdomen Preparation or no bowel movements for 3 days. and Expectations .............................5 of Your Operation Your Recovery B e n e fi t s — Removal of diseased or and Discharge ....................................6 cancerous sections of the intestine Pain Control.............................................7 will relieve your symptoms and can reduce your risk of dying from cancer. Glossary/References ........................8 *See ACS colonoscopy resource: facs.org/~/media/ les/education/patient%20ed/colonoscopy.ashx This first page is an overview. For more detailed information, review the entire document. AMERICAN COLLEGE OF SURGEONS • SURGICAL PATIENT EDUCATION • www.facs.org/patienteducation The Condition, Symptoms, Colectomy and Diagnostic Tests SAMPLE Sigmoid Colectomy (Sigmoidectomy) Segmental Resection Part or all of the sigmoid colon is removed. One or more short segments of the colon are removed. The descending colon is then reconnected to the rectum. The remaining ends of the colon are reconnected. The Condition The Procedure Symptoms There are diff erent types of conditions and There are diff erent procedures to treat The most common symptoms are: diseases that may aff ect the intestines: diseases of the bowel and intestines: ● Diarrhea, constipation, abdominal ● Infl ammatory bowel diseases include ● A colectomy is an operation to cramps, nausea, loss of ulcerative colitis and Crohn’s disease. remove a part of the intestine (bowel) appetite, or weight loss that is diseased. The name of the Fever, chills, or weakness ● Ulcerative colitis presents as ulcers ● (tiny open sores) in the inner layer procedure depends on what section of the colon and includes bloody of the intestine is removed. diarrhea and abdominal pain.3 ● Right hemicolectomy is the removal Common Tests of the ascending (right) colon. ● Crohn’s disease is the infl ammation of History and Physical Exam the entire lining of the digestive tract, ● Left hemicolectomy is the removal You will be given a physical exam and 4 with 15% of cases in the colon only. of the descending (left) colon. asked about you and your family’s This usually presents with continual Sigmoidectomy is the removal of complete medical history, including 5 ● diarrhea and abdominal pain. the lower part of the colon which symptoms, pain, and stomach problems. ● Diverticulitis is an infl ammation or is connected to the rectum. infection of small, bulging pouches Additional Tests (see Glossary) ● Low anterior resection is the removal (diverticula) located in the colon. of the upper part of the rectum. Other tests may include: Colorectal polyp is any growth on ● ● Segmental resection is the removal ● Blood tests the lining of the colon or rectum. of only a short piece of the colon. ● Urinalysis ● Colorectal cancer is a malignant ● Abdominal perineal resection is ● Digital rectal exam (cancerous) tumor in the colon or rectum. the removal of the sigmoid colon, rectum and anus and construction ● Abdominal X-ray Parts of the Colon of a permanent colostomy. ● Abdominal ultrasound Transverse ● Total colectomy is when the entire ● Colonoscopy Colon colon is removed and the small ● Computerized tomography (CT) scan intestine is connected to the rectum. ● Electrocardiogram (ECG)—for patients ● Total proctocolectomy is the removal of over 45 or if high risk of heart problems the rectum and all or part of the colon. Ascending Descending Colon Colon Sigmoid Colon 2 AMERICAN COLLEGE OF SURGEONS • SURGICAL PATIENT EDUCATION • www.facs.org/patienteducation Surgical and Colectomy Nonsurgical Treatment Stoma Interior Keeping You Laparoscopic Repair Informed Conversion Your surgeon may need to convert from a laparoscopic colectomy to an open colectomy. This may be needed due to:9 Abdominal • Adhesions from Stoma Surface prior surgery • Bleeding • Obesity • Inability to see important structures • Presence of a large tumor • Inability to complete the operation Patients whose operations were converted from abdomen is then inflated with carbon dioxide, laparoscopic to an Surgical Treatment which allows the surgeon to see the intestines open colectomy did not have adverse short- or A colectomy can be done by open or and organs clearly. Small instruments inserted long-term effects.9 In a laparoscopic repair. The type of operation through the ports are used to remove diseased large study with over will depend on the condition, size of the colon or a tumor. If the colon cannot be sewn 41,585 patients having a diseased area or tumor, and location. back together, the ends of the intestine are colectomy, laparoscopy Your health, age, anesthesia risk, and the joined together or a stoma is created. was successfully surgeon’s expertise are also important. Benefits of Laparoscopic Colectomy performed while Open Colectomy Benefits include less scarring, earlier 2,508 (5.8%) patients return of colon function, less pain, and required conversion to An incision is made in the abdomen and the 10 6 an open procedure. diseased section of the colon is removed. shorter hospital stays. There has been no The healthy parts of the colon are then difference between laparoscopic and open 7 stitched or stapled together (anastomosis). colectomy for 5-year cancer survival rates. If the colon cannot be sutured back New studies using enhanced recovery together, the colon is brought up through protocols with the laparoscopic approach an opening on the abdominal wall (stoma) are showing decreasing complications, 8 to form an ostomy. Waste will empty hospital stay, and decreasing readmissions. through the ostomy into a pouch that is fixed around the stoma on the abdomen. Non-Surgical Treatment Laparoscopic Colectomy Some diseases of the intestines may be Several small incisions are made in the treated with medication. Depending on the abdomen. Ports or hollow tubes are inserted stage of cancer, radiation and chemotherapy into the openings. Surgical tools and a lighted may also be part of the treatment plan. scope are placed through the ports. The 3 Colectomy Risks of These Procedures SAMPLE Risks Based on the ACS Risk Calculator* Partial Colectomy with Anastomosis Procedure from the ACS Risk Calculator – March 5, 2019 Average Patient Risks Keeping You Informed Percentage Pneumonia: 2.6% Stopping smoking before your operation and taking deep Infection in the lungs breaths plus getting up and walking after can help prevent pneumonia. Heart complication: 1.1% Problems with your heart or lungs can sometimes be Heart attack or sudden stopping of the heart worsened by general anesthesia. Your anesthesia provider will take your history and suggest the best option for you. Wound Infection 10.7% Antibiotics are generally given before the surgery. You may be asked to use special soap before and after your surgery. Urinary tract infection: 1.9% A Foley catheter may remain in the bladder a few days Infection of the bladder or kidneys after surgery to drain the urine. Adequate fluid intake and catheter care decrease the risk of bladder infection. Blood clot: 2% Longer surgery and bed rest increase the risk.