Colectomy (Bowel Resection Surgery)

Overview

What is a colectomy?

A colectomy is a type of bowel resection (removal) surgery. During the procedure, a surgeon removes some or all of the colon.

What is the colon?

The colon is another name for the large intestine. Some healthcare providers call it the large bowel.

The colon looks like a long, winding tube. It wraps from one side of your belly to the other, making a square-like shape. It stretches about 5 feet in length.

The colon is a digestive organ. It starts where the small intestine (ileum) ends, and goes across the belly to end at the rectum. It helps your body digest food. The process works like this:

  1. Food enters the colon from the small intestine.
  2. As food moves through the colon, water slowly gets absorbed.
  3. Digested food waste heads to the rectum as stool.
  4. Stool exits the body through the anus when you poop.

Why is a colectomy performed?

Surgeons perform colectomy to remove colon tissue that doesn’t work correctly. Many problems can stop the colon from working as it should, including:

  • Inflamed tissues due to conditions such as inflammatory bowel disease or diverticulitis.
  • Infection caused by a cut or hole in the colon wall
  • Blockage that stops food or gas from passing through the colon.
  • Disease that damages colon tissue.
  • Cancer in the colon.

Who needs a colectomy?

In some cases, your provider may recommend colectomy surgery as the best way to treat a disease, such as colon cancer. Other times, providers consider colectomy when less-invasive treatment options, such as medication, don’t control your symptoms.

Less commonly, surgeons may need to perform a colectomy to remove a blockage or stop bleeding in your colon. These problems may lead to a potentially serious infection if left untreated. If you have a colon blockage or bleeding, your care team may need to make quick decisions to protect your health.

Colectomy surgery can treat:

Procedure Details

What is a total colectomy?

Healthcare providers have specific names for colectomy surgeries based on the section of the colon removed during a procedure. During a total colectomy, a surgeon removes the entire colon.

What is a partial colectomy?

Partial colectomy describes any colectomy surgery that involves removing one part of the large intestine.

Types of partial colectomy surgery include:

  • Hemicolectomy: A surgeon removes the left or right side of the colon.
  • Proctocolectomy: A surgeon removes some or all of the colon plus the rectum.
  • Sigmoidectomy: This procedure involves removing the bottom section of the colon. This portion, the sigmoid colon, joins with the rectum. Providers may also call this surgery a sigmoid colectomy.

What is a laparoscopic colectomy?

Surgeons can perform colectomy surgery using open (traditional) or laparoscopic (minimally invasive) techniques:

  • Open surgery: A surgeon makes one or more long incisions to access, remove and repair the affected colon tissues.
  • Laparoscopic colectomy: A surgeon makes several tiny incisions. They guide advanced, flexible tools (with a camera at the tip) through these incisions. The camera displays magnified images from inside your body onto a video monitor near the operating table. These techniques and tools allow the surgeon to remove and repair tissues precisely.

How is a colectomy performed?

The specifics of your colectomy surgery depend on the details and severity of your case. Your provider will give you specific instructions to prepare for surgery. You may need to drink a special liquid to empty your bowel before surgery and take antibiotic pills to help prevent infection.

For colectomy surgery, you lie on your back on an operating table. This “table” feels more like a hospital bed. Its design helps the operating team easily position you and makes surgery safer.

In general, you can expect your provider to:

  1. Put you to sleep using general anesthesia, so you’re safe and unaware during the operation.
  2. Make one or more incisions in your abdomen (belly area).
  3. Carefully separate and remove the affected colon tissue.
  4. Connect healthy bowel ends using staples or sutures.
  5. Close abdominal incisions.

What’s the difference between a colectomy vs. a colostomy?

Not all colectomy surgeries require a colostomy. If your surgeon can reconnect both ends of healthy colon tissue, you may experience few or no changes to how your body digests food.

Sometimes, the colon can’t be put back together right away (or at all). In that case, your surgeon will create a colostomy.

During a colostomy procedure, a surgeon:

  1. Makes an opening (called a stoma) in the abdominal wall.
  2. Connects the healthy end of the colon to the stoma.
  3. Connects a plastic bag (called a colostomy bag) to this opening.

This waterproof bag collects waste from the digestive tract. You will need to empty this bag throughout the day.

Are colostomy bags permanent?

Not always. Many people only need a colostomy for a short time while their colon tissue heals. During a second operation, your surgeon reconnects the colon and removes the colostomy bag. But in certain situations, a colostomy is permanent.

The thought of having a colostomy bag (and how it could change your life) can be unnerving. Before your surgery, ask your provider whether you may need a colostomy. Many hospitals have specially trained nurses who can teach you how to care for a colostomy bag, should you need one.

How long is colectomy surgery?

Colectomy surgery may take as little as one hour or longer than four hours. Much depends on what the surgery entails, including how much colon tissue your provider needs to remove.

Risks / Benefits

What are the potential risks or complications of colectomy?

Complications are generally rare. But they can happen after any surgery. Following your provider’s guidance as closely as possible can reduce these risks.

Possible complications of colectomy include:

  • Bleeding.
  • Infection.
  • Blood clots.
  • Leak where the colon tissues get reconnected.
  • Injury to nearby organs, such as the small intestine or bladder.

Recovery and Outlook

What can I expect after colectomy surgery?

You may stay in the hospital for two to four days after colectomy surgery. If you have a minimally invasive procedure, you may have a shorter hospital stay.

In some cases, your surgeon may place a catheter (long, thin tube) in your bladder during surgery. This catheter collects urine into an attached bag. If you need a urinary catheter, your provider will likely place it after you go to sleep for surgery and remove it before you leave the hospital.

What does colectomy recovery look like?

Recovery from colectomy surgery looks different for everyone. A lot depends on why you needed a colectomy and what the procedure involved.

Before you go home from the hospital, your provider will explain how surgery may impact what you can eat or how your body gets rid of waste (poop). Recovery may include minor or big changes in how your body functions. These changes may be temporary (for a short time) or permanent (lifelong).

Your provider will give you clear instructions for how to take care of yourself during your recovery. They will guide you in:

  • Managing any pain you feel.
  • Caring for your incision.
  • Caring for a colostomy bag (if you have one).
  • Making healthy food choices to avoid stressing your digestive system while your body heals.
  • Watching out for warning signs of possible complications, such as infection.
  • Doing the right activities – you may have to limit how much you lift or carry for a while as you heal.

Be open with your provider about any questions you have, before and after surgery. They understand many of the common concerns people have about colectomy surgery. And they can provide tips that may ease your mind.

Your provider will encourage you to take it easy right after surgery. Try to be extra gentle with yourself in the first few days after you get home. Getting up to walk around is good for you. But don’t do too much, too soon. Your provider can help you understand exactly what that looks like for you.

Many people get back to most of their usual routines two weeks after surgery. Ask your provider if you need to take extra precautions before resuming any particular activities, such as showers, work, driving or sex.

What can I eat after a colectomy?

Your provider may recommend sticking to a low-fiber diet for up to one month after surgery. Low-fiber foods include white pasta and bread. These foods create less work for your colon while it’s trying to heal.

Your provider may also recommend you increase how much water you drink every day. You will likely meet with a dietitian or other nutrition expert after surgery. This provider can help you make smart diet choices that are best for your body.

When to Call the Doctor

When should I call the doctor?

Your healthcare provider will explain what signs you should watch out for after your surgery.

Call your provider anytime you have concerns, especially if you have:

  • Redness, swelling or foul odor near the incision site.
  • Any pain (especially around your belly) that gets worse over time.
  • No bowel movements for two to three days after surgery.
  • Fever.
  • Throwing up.

What questions should I ask my healthcare provider?

If your provider has recommended you have a colectomy, you may want to ask:

  • How comfortable and experienced are you with performing this procedure?
  • Do you plan to use a laparoscopic or open approach to surgery? Why do you recommend that approach?
  • How should I prepare for surgery?
  • What should I expect during my recovery? When can I expect to feel like my normal self?
  • What are the main risks and complications of this procedure?
  • Will this surgery change how I eat or use the bathroom?
  • Do I have other options that may treat my problem?

A note from Cleveland Clinic

While colectomy is major surgery, it is largely safe and effective. Recent medical advances may help you get back to your usual routines faster than you expect. If you’re concerned about the potential of needing a colostomy, reach out to your provider. They can answer any questions or concerns you have about how a colostomy bag may affect your life. You may not need one at all. But if you do, you should know that having a colostomy bag doesn’t have to stop you from living a full, active and happy life.

Last reviewed by a Cleveland Clinic medical professional on 12/04/2020.

References

  • American College of Surgeons. Colectomy. (https://www.facs.org/-/media/files/education/patient-ed/colectomy.ashx) Accessed 12/10/2020.
  • American Society of Colon & Rectal Surgeons. The Colon: What It Is, What It Does and Why It Is Important. (https://fascrs.org/patients/diseases-and-conditions/a-z/the-colon-what-it-is,-what-it-does) Accessed 12/10/2020.
  • American Society of Colon & Rectal Surgeons. Ulcerative Colitis. (https://fascrs.org/patients/diseases-and-conditions/a-z/ulcerative-colitis) Accessed 12/10/2020.
  • Society of American Gastrointestinal and Endoscopic Surgeons. Colon Resection Surgery Patient Information. (https://www.sages.org/publications/patient-information/patient-information-for-laparoscopic-colon-resection-from-sages/) Accessed 12/10/2020.
  • Crohn’s & Colitis Foundation. Small and Large Bowel Resection. (https://www.crohnscolitisfoundation.org/what-is-crohns-disease/treatment/surgery/small-large-bowel-resection) Accessed 12/10/2020.

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