What is a laparoscopic total abdominal colectomy?
A laparoscopic total abdominal colectomy is an operation that removes the large intestine. (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
Fig 1: Total abdominal colectomy removes all of the large intestine (area shaded in diagonal lines).
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 navel.
What happens during the surgery?
There are three main steps to this surgery.
Step 1: Positioning the laparoscope
Once you are under anesthesia, the surgeon will make a small cut (about 1/2 inch) near the navel. 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 3- 5 more "keyhole" incisions in the abdomen (see figure 2). The number and position of these incisions depend upon the build of the patient, surgeon preference and difficulty of the operation. Surgical instruments will be placed through these incisions to complete the surgery.
Fig 2: Laparoscopic surgery is performed through 4 or 5 small incisions in the abdomen.
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, called the sigmoid colon, joins with the rectum. (See figure 1.) Your surgeon will carefully free the colon in sections, these include the rectum and sigmoid colon, the descending (left) colon and the ascending (right) colon. The surgeon will also free the "splenic flexure," a bend in the colon that lies just below the spleen and the "hepatic flexure," the corresponding bend that lies under the liver. Throughout the procedure, the surgeon will use a paddle-like instrument to hold loops of the intestine up and out of the way. The main blood vessels (arteries) that supply blood to the colon will be carefully tied and divided throughout the surgery.
Next, the surgeon will identify the part of the ileum (small bowel) that will be rejoined with the rectum. Lastly, your surgeon will 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.
Step 3: Rejoining the ileum and rectum
After dividing the colon at the predetermined positions, your surgeon will rejoin the rectum and ileum. This rejoining is called an "anastomosis" And this may be made with stitches or by using a stapler. If a stapling technique is chosen by the surgeon, a circular stapler with an anvil-shaped head and center post and rod will usually 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.
Fig 3: The open ends of the ileum and rectum are rejoined.
Recovering at home
You will be encouraged to steadily increase your activity level 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 remain on 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