Colectomy (Bowel Resection Surgery)

Procedure Details

How do you prepare for a colectomy?

Health screening

Before scheduling a colectomy, your healthcare team will evaluate your fitness for surgery. In addition to a physical exam and health history, this may include:

• Blood tests.
• X-ray.
• Electrocardiogram (EKG) test.
• Urinalysis.
• Colonoscopy.

Pre-operative counseling

Your healthcare team will want to make sure you understand everything about the procedure before you sign your consent. They’ll counsel you about:

• Surgical risks.
• Living with a colostomy, if you’re going to have one.
• Options for pain management.

Bowel prep

When you have surgery on your bowels, it’s important for them to be empty. You’ll need to prepare for this a couple of days in advance. Your healthcare provider may ask you to:

• Consume only a clear liquid diet.
• Fast before the procedure (no food or drinks).
• Take a laxative or enema to clear out your bowels, like polyethylene glycol (Miralax®). These bowel preparations come with their own specific instructions.

What happens when you have a colectomy?

The specifics of your colectomy surgery will depend on the type of operation you’re having and the surgical method being used. The operation will follow a general pattern, though.

General procedure

In general, you can expect your provider to:

1. Put you to sleep under general anesthesia.
2. Make one or more incisions in your abdomen (belly area).
3. Carefully separate and remove the affected colon tissue.
4. Connect the healthy bowel ends using staples or sutures, or
5. Create a stoma and redirect your bowel end to the stoma.
6. Close your abdominal incisions.

Open vs. laparoscopic/robotic surgery

Your surgeon may perform your colectomy by traditional open surgery or by minimally-invasive laparoscopic surgery.

• Open surgery means opening up your abdominal cavity through one long incision. This method provides the easiest access to your organs and may be necessary when your case is more complicated, or if you are having emergency surgery.
• Laparoscopic surgery is performed through several small incisions, using the aid of a tiny video camera called a laparoscope. If you have a laparoscopic/robotic colectomy, your surgeon will begin with a single small incision, which is used to place the laparoscope. They'll pump gas through the incision to inflate your abdominal cavity for better visibility, then place the camera, which will project your organs onto a video screen. One or more additional small incisions will give your surgeon access to your colon with special tools.

Colon resection variations

You may need all or only part of your colon removed. Operations to remove different sections of the colon have different names.

Total colectomy

A total colectomy removes your entire colon. This is the majority of your large intestine. It begins at the end of your small intestine and ends at your rectum, the tail end of the large intestine that leads into the anal canal.

Partial / subtotal colectomy

A subtotal or partial colectomy removes a portion of your colon. Your operation may go by a more specific name that references the section of your colon that's being removed. For example:

• Sigmoid colectomy. A sigmoid colectomy, or sigmoidectomy, removes the last section of your colon, known as the sigmoid colon. This is the part that connects to your rectum.
• Hemicolectomy. A hemicolectomy removes one side of your colon. A left-side hemicolectomy removes your descending colon, the section that travels downward on the left. This is in the latter half of your colon. A right-side hemicolectomy removes your ascending colon, the section that travels upward on the right side. This is roughly the first half of your colon.
• Proctocolectomy. A proctocolectomy removes part or all of the colon and the rectum with it. “Procto” means rectum. (A total proctocolectomy removes the entire colon and rectum.)

Anastomosis or ostomy

After your bowels have been resected, your surgeon may be able to join the severed ends right away. Or, they might have to wait and join them in another surgery later on. Sometimes they're not able to reconnect your bowels together. Your colectomy will end with one of these procedures:

• Anastomosis. Anastomosis means the two ends of your bowels are joined together, making your intestines whole again. Many if not most colectomies end this way.
• Colostomy / Ileostomy. If your bowels can’t be reconnected at the time of your colectomy, your surgeon will create a stoma in your abdominal wall. They’ll redirect the upper portion of your intestines to the stoma. If your colectomy removed the first part of your colon that connected to your small intestine, the end of your small intestine will be redirected to your stoma. This is called an ileostomy, after the ileum — the last part of the small intestine. If your colectomy removed a section from the middle or end of your colon, the upper part of your colon will be redirected to your stoma in a colostomy. These operations may be temporary or permanent.
• Ileal pouch. If you had a total proctocolectomy and your entire colon and rectum were removed, you might be a candidate for an ileaoanal anastomosis. That means your ileum can be connected directly to your anus, with the addition of an ileal pouch. The pouch is an internal alternative to a colostomy or ileostomy bag. Your surgeon creates the pouch out of the ileum, to serve as a reservoir to store waste as your rectum once did. This procedure often occurs in follow-up surgeries, but sometimes it can be done as part of your proctocolectomy surgery.

What happens after colectomy surgery?

You’ll spend a few days recovering in the hospital before you’re discharged. It might be two days or up to a week, depending on what kind of operation you had and how you are doing. During this time, you’ll be:

• Monitored for any signs of complications from the procedure.
• Gradually weaned from your pain medication.
• Fed with a liquid diet or soft diet.
• Waiting for your bowels to begin functioning again.

You’ll also receive counseling on how to take care of yourself when you get home. This may include:

• Wound care.
• Ostomy care.
• Dietary advice.