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Summary

The surgical removal of colon or bowel or large intestine is known as a colectomy. This procedure is generally used to treat colon diseases, such as colon cancer, ulcerative colitis or Crohn’s disease.

Colectomy can be performed by open or laparoscopic methods. Sometimes, additional procedures like colostomy or ileostomy may be required. The common symptoms of bowel cancer include abdominal pain or cramping, change in bowel habits, bleeding and weight loss. The type of surgery depends on the stage of cancer, which requires proper screening before deciding the treatment plan. The procedure aims to relieve symptoms and remove the cancerous part of the colon.

  1. Why is colectomy recommended?
  2. Who can and cannot get colectomy?
  3. What preparations are needed before colectomy?
  4. How is colectomy done?
  5. How to care for yourself after colectomy?
  6. What are the possible complications/risks of colectomy?
  7. When to follow-up with your doctor after a colectomy?

A colectomy may be recommended to treat the following conditions:

  • Colon or rectal cancer
  • Intestinal blockage
  • Inflammatory intestinal diseases like ulcerative colitis and Crohn’s disease
  • Diverticular disease (small pouches in the colon)
  • Precancerous polyps (abnormal tissue growth)
  • Dead tissue in the colon which may occur due to oxygen loss
  • A hole in the colon wall
  • Bleeding from the colon
  • Injury to the colon

The common symptoms of bowel cancer are as follows:

Laparoscopic colectomy may not be done in the following conditions:

  • Obesity
  • Adhesions (scars) from a previous surgery
  • Bleeding
  • When the doctor is not able to see important structures or complete the surgery through the laparoscope
  • When a large tumour is present

In all the abovementioned cases, an open surgery is done.

Before the colectomy, your doctor will do a physical exam and take a medical history for pain, symptoms, and stomach problems. You may also need to undergo a few tests listed below:

Colon cancer is the cancer of the large intestine. The grade of cancer identifies how the cancer cells will behave and the stage of the cancer identifies the spread of the cancer. Knowing the grade and stage of the cancer helps your doctor in deciding the treatment. The grades of bowel cancer are as follows:

  • Grade 1 (low grade): Cancerous cells look similar to normal cells.
  • Grade 2: Cancerous cells look a bit like normal ones.
  • Grade 3: Cancerous cells appear quite abnormal and not like normal cells.
  • Grade 4 (high grade): Cancerous cells look different from normal ones.

There are different ways of staging. One of the commonly used systems is Duke’s staging system, which is mentioned below:

  • Dukes’ A: Cancer is in the inner lining of the bowel or slightly grown into the muscle layer.
  • Dukes’ B: Cancer has spread through the muscle layer of the colon.
  • Dukes’ C: Cancer has grown to minimum one lymph node, which is near to the bowel.
  • Dukes’ D: Cancer has spread to other body parts like liver, lungs, or bones. It is known as advanced bowel cancer.

The following preparation will also be needed before the surgery:

  • You may be asked to stop taking blood thinners a week before the operation.
  • Inform your doctor about all the medicines, vitamins, and nutritional supplements that you consume.
  • Inform your anesthesiologist (a doctor who administers anaesthesia) about any known allergies, heart disease, neurologic disease, stomach problems, lung diseases, endocrine disease, or if you have a history of vomiting and nausea with anaesthesia.
  • Quit smoking before the surgery to reduce the risk of wound or respiratory complications. Read more: Effects of smoking on health
  • You may need to prepare the bowel one to two days before the surgery, which includes using a laxative and enema to empty the bowel. 
  • You may be asked to drink only broth or clear liquids the day before surgery. 
  • Avoid drinking or eating anything for a minimum of 12 hours before the surgery.
  • You will need to make arrangement for someone to take you to the hospital and also bring you back.

Before going for the surgery:

  • Brush your teeth and rinse the mouth with mouthwash.
  • Take a shower and clean the groin area and abdomen by using an anti-bacterial soap.
  • Wear loose, comfortable clothing.
  • Avoid wearing any makeup, nail polish, jewellery, or contact lenses.

Once you reach the hospital, you will be asked to change into a hospital gown and wear a pair of surgical stockings.

Colectomy is performed in the following manner:

  • A nurse may give you medicine to make you relax an hour before going to the operating room.
  • A doctor will place an intravenous (IV) line to provide you with medicines and fluids.
  • A urinary catheter will be inserted in your bladder to drain urine.
  • You will be given general anaesthesia that will put you to sleep during the surgery.

The surgery can be done in the following ways: 

  • Open surgery: In this procedure, your surgeon will make a long cut into your abdomen to remove the diseased part.
  • Laparoscopic (keyhole) surgery: For this surgery, your surgeon will make several small incisions (cuts) in your abdomen. Through one of these cuts, he/she will insert a long tube with a camera (laparoscope) and light to be able to see the inside of your body. Guided by the inserted camera, the surgeon will insert other surgical tools through the rest of the cuts and remove the cancerous part.
  • Robotic surgery: It is relatively a new technique. Some surgeons use a robotic system to help them with laparoscopic or keyhole surgery. Here, the surgeon sees the operation on a magnified screen and controls the arms of the machine to remove the cancer. The robotic machine has four arms, of which one holds the camera and others hold the surgical tools. 

Once the cancerous part is removed using any of the above methods, the surgeon will attach/join the remaining ends of your bowel together, which is called anastomosis.

In some cases, the surgeon may bring the end of the bowel out as an opening on your stomach, which is called a stoma, which may be temporary or permanent. You will have to wear a colostomy or ileostomy bag over the bowel opening to collect the stool that drains from it. If the stoma is temporary, then you may need another operation after a few months to re-join the ends of bowel together. This process is called stoma reversal. A colostomy is the opening of colon onto the surface of the abdomen, while an ileostomy is the opening of the ileum (small bowel) on the surface of the abdomen.

Although partial (hemicolectomy) and total colectomy are commonly performed, other types of colectomy are also done depending on the location of cancer in the colon, as follows: 

  • Left hemicolectomy: In this surgery, the left side of the colon is removed.
  • Transverse colectomy: Here, the transverse colon (the middle part of the colon) is removed.
  • Right hemicolectomy: In this procedure, the right side of the colon is removed.
  • Sigmoid colectomy: The sigmoid colon (sigmoid part of the colon) is removed in this surgery.
  • Subtotal colectomy: In this method, most of the colon is removed. The sigmoid colon is left, which is then joined to the small intestine.

The surgery takes around one to four hours to complete. Here’s what you can expect after colectomy: 

  • You will be moved to a recovery ward where the nurse will closely monitor your breathing, heart rate, and pulse. Soon as your vitals stabilise, you will be shifted to a normal ward. You might be discharged after 3 to 7 days.
  • When you wake up, you will have an IV line attached to your arm to give you fluids for nutrition until your intestine heals.
  • A nasogastric tube (a tube through your nose into the stomach) will be in place to drain fluids collected in your stomach for 24 hours.
  • The urinary catheter will still be in. It will be removed in a few days after the surgery.
  • You will have a tube near the wound to drain accumulated fluid.
  • You will also have an oxygen mask.
  • After 24 to 48 hours, you can start drinking again, beginning with a small amount of water.
  • You will be provided with antibiotics to prevent infection and medicines for nausea and pain.
  • A dressing will be placed over the wounds. 
  • Mostly, dissolvable stitches are used, if not, stitches stay in place for ten days, and the nurse will remove them later.

Once you return to home after the surgery, you should take proper care of yourself in the following manner:

  • Wound care: Avoid soaking in a bathtub until your stitches, staples or Steri-Strips are removed. You may shower within two days after the surgery unless you are advised not to. The Steri-Strips will wear off in seven to 10 days. Scars from the surgery may take four to six weeks to heal. However, avoid going out in the sun or exposing your skin to the sun as it can burn your skin and cause scars to become dark. Also, avoid wearing rough or tight clothes as they may rub on your cuts and cause difficulty in healing. 
  • Pain: You will have to take painkillers for a few days after the surgery.
  • Bowel movements: For the first two weeks, your bowel movements may be looser than usual and more often, until you start eating solid food. Do not strain with bowel movements.
  • Diet: Your doctor will suggest you to take a bland, low-fibre diet for four weeks after the surgery. This will help regulate your bowel movements. Make sure to drink at least eight to 10 glasses of water every day.
  • Activity: You will be able to start regular activities like driving, showering, and walking upstairs in one or two weeks. You may also resume work one to two weeks after surgery in case you have had laparoscopic surgery, and two to three weeks after surgery for open surgery. Avoid lifting heavy objects or doing strenuous activities until four to six weeks after the surgery.

Colectomy alleviates symptoms by removing the cancerous part of the bowel.

When to see the doctor?

Visit or call your doctor immediately if you have the following symptoms:

  • Recurrent vomiting
  • Continuous abdominal pain or swelling in your abdomen
  • Pain that gets worse and does not subside
  • Absence of bowel movement for two to three days after the surgery
  • Fever of more than 38.3oC or 101oF
  • Swelling, bleeding, redness, or bad-smelling discharge from the wound
  • Shortness of breath

The possible risks or complications from colectomy are as follows:

  • Heart complications - these occur in heart patients as a side effect of anaesthesia
  • Pneumonia
  • Wound infection
  • A blood clot in the legs or lungs
  • Urinary tract infection - may occur due to the catheter
  • Kidney failure
  • A bulging of the tissue from the abdominal opening
  • Internal bleeding
  • Scar tissue in the stomach that can block the intestines
  • A leak where the intestines are joined
  • Damage to nearby organs

You will have regular follow up every few months with your doctor to check your progress and, over a period of time, these will become less frequent. Your first follow up appointment will be scheduled within two weeks after the surgery.

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.

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References

  1. Johns Hopkins Medicine [Internet]. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System; Colectomy
  2. Oncolink [Internet]. Philadelphia: Trustees of the University of Pennsylvania; c2018. Colectomy
  3. American Cancer Society [internet]. Atlanta (GA). USA; Colorectal Cancer Signs and Symptoms
  4. Beth Israel Lahey Health: Winchester Hospital [Internet]. Winchester. Maryland. US; Colectomy—Open Surgery.
  5. Cancer Research UK [Internet]. London. UK; Bowel cancer - symptoms
  6. American College of Surgeons [Internet]. Illinois. US; Colectomy
  7. Society of American Gastrointestinal and Endoscopic Surgeons [Internet]. California. US; Colon resection surgery patient information from SAGES
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