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Total Abdominal Colectomy Basic Surgical Steps

(Also Called 'Total Abdominal Colectomy, Pediatric')

What is a laparoscopic total abdominal colectomy?

Total abdominal colectomy

Figure 1: Total abdominal colectomy removes all of the large intestine (area shaded in diagonal lines)

A laparoscopic total abdominal colectomy is an operation that removes the large intestine. (Please see figure 1)

The surgery is used to treat:

  • Inflammatory conditions of the intestine, such as Crohn's disease and ulcerative colitis
  • Familial polyposis, an inherited (hereditary) condition in which hundreds to thousands of polyps (small growths) form throughout the entire length of the large intestine
  • Severe, chronic constipation

The term "laparoscopic" refers to a type of surgery called laparoscopy. Laparoscopy enables the surgeon to complete the surgery through very small "keyhole" incisions in the abdomen. A laparoscope, a small, telescope-like instrument, is placed through a small incision near the bellybutton.

What happens during the surgery?

There are three main steps to this surgery.

Abdomen incisions

Figure 2: Laparoscopic surgery is performed through 4 or 5 small incisions in the abdomen

Step 1: Positioning the laparoscope

Once you are under anesthesia, the surgeon will make a small cut (about 1/2 inch) near the bellybutton. A laparoscope will be inserted into the abdomen through this incision. Images taken by the laparoscope will be projected onto video monitors placed near the operating table.

Once the laparoscope is in place, the surgeon will make 4 or 5 more "keyhole" incisions in the abdomen (figure 2). Surgical instruments will be placed through these incisions to complete the surgery.

Step 2: Dividing the sigmoid colon and rectum

The colon is a large organ (about 5 feet long) that starts at the end of the small intestine (ileum) and ends at the rectum. The last section of the large intestine is called the sigmoid colon, which joins with the rectum. (Please refer to figure 1.) Your surgeon will carefully free the colon in sections, starting with the rectum and sigmoid colon, moving from the descending (left) colon to the ascending (right) colon. The main blood vessels (arteries) that supply blood to the colon will be carefully cut and closed throughout the surgery.

Once the sigmoid colon has been freed from the rectum, the surgeon will free the "splenic flexure," a bend in the colon that lies just below the spleen. Throughout the procedure, the surgeon will use a paddle-like instrument to hold loops of the intestine up and out of the way. Next, the surgeon will free the right colon from the ileum. At this time, your surgeon will identify the part of the ileum that will be rejoined with the rectum.

Lastly, your surgeon will pass a snare-like instrument over the colon to make sure that all of the attachments to the tissue have been cut. Once this is complete, he or she will enlarge one of the incision sites and pull the colon out of the abdominal cavity.

Anastomosis

Figure 3: The open ends of the ileum and rectum are rejoined. The open ends of the ileum and rectum are rejoined.

Step 3: Rejoining the ileum and rectum

Next, your surgeon will rejoin the rectum and ileum. This rejoining is called an "anastomosis." A circular stapler with an anvil-shaped head and center post and rod will be used to make the anastomosis. First, the anvil-shaped end of the stapler (the end with the post) is passed into the ileum and stitched into place. The post will extend beyond the cut end of the ileum. To complete the anastomosis, the rod of the circular stapler is passed into the rectum, connected with the center post, then closed and "fired" to join the ileum with the rectum. This is called an ileorectal anastomosis (IRA). As an alternative to the IRA, some patients may require the creation of a reservoir from the small intestine. This reservoir is called an ileal pouch anal anastomosis (IPAA). (If you are having an IPAA, your nurse will give you more information about the procedure. The operation is finished by rinsing out the abdominal cavity and checking the anastomosis for leaks. Finally, all of the keyhole incisions in the abdomen will be stitched or taped closed.

Recovering at home

You will be encouraged to increase your activity level steadily once you are home. Walking is great exercise! Walking will help your general recovery by strengthening your muscles, keeping your blood circulating to prevent blood clots and helping your lungs remain clear. If you are fit and did regular exercise before surgery, you may resume exercising when you feel comfortable. There are only two things you are not permitted to do for six weeks after surgery: lift or push anything over 30 pounds or do abdominal exercises such as sit-ups.

You will be sent home on a soft diet, which means you can eat most everything except raw fruits and vegetables. You should eat this diet until your post-surgical check-up. If the diet is making you constipated, please call our office for advice.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 5/29/2008...#4671


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