Colectomy is a surgical procedure that involves the removal of all or part of a diseased or injured colon. It is a treatment choice for colon cancer patients, and it can require the removal of surrounding lymph nodes as well.
Colon cancer may begin from polyps in the large intestine or inside the rectum. Early detection of these polyps can be achieved by screening, and early detection can result in a complete cure.
As cancer cells expand and spread around a person’s body, they are said to have “metastasized,” implying that the disease has progressed to a more severe stage.
Colon cancer is expected to account for 8.7% of all cancer deaths in the United States by 2021.
What to expect before, during, and after the procedure is covered in this article. It also considers dangers, complications, and other factors.
Colectomy is a form of surgery used by healthcare practitioners to treat colon cancer.
A colectomy operation may be used if the cancer is not in an early stage and a surgeon cannot remove it without cutting through the abdominal wall.
Colectomy can be done in a variety of ways, including:
- partial or subtotal colectomy
- total colectomy
- total proctocolectomy
A surgeon may need to build a permanent or temporary stoma to contain a portion of the intestine and allow faeces and other waste to leave the body in some cases.
A colostomy bag is attached to the stoma to collect the faecal material.
Reasons for colectomy
Colectomy may be recommended by a healthcare provider for a variety of bowel-related medical conditions, including:
A healthcare professional will take a person’s medical history and conduct a physical examination before determining whether or not a surgical procedure is necessary.
In most cases, they may also do a colonoscopy. This includes inspecting the colon with a light and camera attached to a thin tube. A manual rectal exam can also be performed.
What happens before the operation?
An individual may undergo some tests, have some conversations, and obtain some advice prior to any surgical procedure.
Tests and Examinations
An individual will undergo a variety of tests and examinations prior to surgery, which may include:
A surgeon will require the patient’s complete medical history, including any current or previous severe illnesses. Symptoms, home remedies, and medicines may also be discussed.
To reduce the risk of lung infections after surgery, a healthcare professional can encourage smokers to try to quit smoking before their procedure.
After the operation, the surgeon will discuss which pain killers to take and how to care for the incision. They’ll tell you how to reduce or modify any drugs that could affect your recovery, anaesthetic response, or blood clotting.
They can also prescribe antibiotics and other medicines to help clear the intestines before surgery.
On the day of surgery
A healthcare professional will usually advise a person to avoid eating for 4 hours before surgery, though clear fluids can be consumed up to 2 hours before the operation.
The healthcare provider will also encourage the patient to leave valuables at home, such as watches.
An individual will need to carry such things to the hospital or medical centre on the day of surgery. This may include the following:
- a list of all prescription medications, over-the-counter medications, herbal remedies, and other supplements they are using
- their insurance information and identification
- comfortable, loose-fitting clothing
- shoes that do not require bending over to put on
- an advance health directive
The following points should be discussed with the anaesthetist on the day of surgery:
- any allergies the person has
- any preexisting health conditions they have
- any loose teeth they have
- any details on their alcohol or drug use
Colectomies are performed under sedation. They can be performed laparoscopically or openly.
A surgeon will insert tiny flexible ports or tubes through incisions in the abdomen during laparoscopic colectomy. They’ll use these ports or tubes to insert lights and other surgical instruments.
They may then either stitch the two ends together or establish a stoma by removing the diseased or damaged part of the colon.
Open surgical options
In an open colectomy, a surgeon enters the colon through an incision in the abdomen and removes the diseased or injured part of the colon. They can also remove some of the healthy tissue in the region.
The ends will then be stitched or stapled together, known as anastomosis, or a stoma will be formed.
The surgeon may also remove several lymph nodes near the colon for microscopic examination to check for cancer if the operation is for cancer treatment.
Types of procedures
The procedures performed during colectomy surgery are determined by how much of the colon must be removed.
They are as follows:
- Sigmoidectomy: This refers to the removal of the sigmoid colon, which is the curved portion of the descending colon that connects to the rectum.
- Right hemicolectomy: This refers to the removal of the right, or ascending, colon.
- Left hemicolectomy: This refers to the removal of the left, or descending, colon.
- Segmental resection: This refers to the removal of short segments of the colon.
- Total colectomy: This refers to the removal of the entire colon. A surgeon will then attach the small intestine to the rectum.
- Low anterior resections: This refers to the removal of the upper rectum.
- Transverse colectomy: This refers to the removal of the middle bowel, or the transverse colon.
- Abdominal perineal resection: This refers to the removal of the rectum, anus, and sigmoid colon and the attachment of permanent colostomy.
- Total proctocolectomy: This refers to the removal of all or part of the colon and the rectum.
When is a stoma necessary?
If the surgeon is unable to stitch or staple the two separated ends of the intestine together, a stoma may be required. Instead, they would use a colostomy procedure to tie a bag to an opening on the outside of the body to collect faeces.
The stoma may be temporary, and the surgeon could remove it surgically once the lower colon has healed. The colon will be reattached inside the body during the second operation. The stoma, on the other hand, may be permanent.
Colectomy should be discussed with a healthcare practitioner to determine the possible advantages, dangers, and complications.
The following are some of the most common risks and complications associated with colectomy:
- leakage of the colon contents into the abdomen
- pneumonia and other lung problems
- blood clots in veins or the lungs
- postoperative bleeding
- gastrointestinal fistula, or an unusual connection between two body parts
- organ or tissue adhesions
- stroke or heart attack
When to seek medical advice
When seeking medical advice or treatment after surgery, people should consult with a healthcare professional.
If they experience any of the following symptoms, they can seek medical help right away:
- continued nausea
- leakage or drainage from the wound
- severe pain
- abdominal cramping
- a bad smell or drainage coming from the incision
- increased swelling or flushing around or over the incision
- blood in the stool
- a swollen abdomen
- no bowel movements for 2–3 days
If there are complications, most people remain in the hospital for 3–4 days following laparoscopic-assisted or open colectomies.
If you have nausea, vomiting, or are unable to move urine, you will need to stay in the hospital for a longer period of time.
After 3–4 days, when a person has their first bowel movement after surgery, they will resume regular eating habits.
Many patients resume their normal activities one to two weeks after laparoscopic surgery and two to three weeks after open surgery.
For 4–6 weeks after colectomy surgery, people should stop strenuous sports, working out, and lifting something heavier than 10 pounds.
Several factors influence a person’s prognosis following colectomy surgery, including:
- the severity or extent of their colon disease or damage
- how much of the colon and surrounding tissues the surgeon removed
- any complications that occurred during or after surgery
- the person’s overall health
- the person’s age
One study found that 84 percent of people who had a colectomy for ulcerative colitis showed an improvement in their quality of life after the procedure.
Colectomy is a form of surgery that involves removing all or part of a diseased or damaged colon.
After a few days in the hospital, most people are able to resume most non-strengthening activities within 1–4 weeks.
A colostomy bag may be needed in some cases.
- Brown, C., et al. (2015). Long-term outcomes of colectomy surgery among patients with ulcerative colitis.
- What to know about colectomy https://www.medicalnewstoday.com/articles/colectomy?
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- Proctocolectomy and colectomy. (n.d.).
- Strand, N., et al. (2019). Colectomy: Surgical removal of the colon.
- Surgery for colon cancer. (2020).
- What is a stoma? (n.d.).