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Colorectal Resection by Editorial Staff and Contributors

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

Definition

A colorectal resection is a surgery to remove a section of the large intestine. It is done to remove injured or diseased parts of the colon.

Reasons for Procedure

This surgery is performed to treat a variety of conditions, including the following:

Colorectal cancer
Diverticular disease —small pouches form in the wall of the colon
Inflammatory intestinal diseases (eg, colitis , Crohn’s disease )
Intestinal blockage
Trauma to the intestine
Precancerous polyps, especially those seen in familial polyposis
A hole in the bowel wall or dead piece of bowel
Bleeding from the colon

For colon cancer, the goal is to remove all of the cancer. If you have a precancerous condition, then you may have prevented the development of cancer. If you had surgery due to other conditions, a successful operation will alleviate or improve your symptoms.

Possible Complications

If you are planning to have a resection, your doctor will review a list of possible complications, which may include:

Damage to other organs or structures
Infection
Bleeding
Hernia forming at the incision site
Blood clots
Complications from general anesthesia
Intestinal obstruction due to development of scar tissue

Some factors that may increase the risk of complications include:

Having neurological, heart, or lung conditions
Age: older than 70 years
Obesity
Smoking
Previous abdominal surgery or radiation therapy
Infection
Diabetes

What to Expect

Prior to Procedure

Your doctor will likely do the following:

Physical exam
Blood tests
Ultrasound exam of the abdomen—a test that uses sound waves to visualize the inside of the abdomen
X-ray exam of the abdomen, after swallowing a barium drink and/or receiving a barium enema
CT scan —a type of x-ray that uses a computer to make pictures of the inside of the body
MRI scan —a test that uses magnetic waves to make pictures of the inside of the body
Colonoscopy with biopsy samples—visual exam and removal of tissue inside of the large intestine with a flexible tube that is attached to a light and a viewing device

Leading up to your procedure:

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Aspirin or other anti-inflammatory drugs
- Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
Drink eight, 8-ounce glasses of fluid daily.
Your doctor may give you a special diet for several days before surgery.
Wear comfortable clothing.
Your colon must be completely cleaned out before the procedure. A number of cleansing methods may be used. This may include enemas, laxatives, and a clear-liquid diet. You may be asked to drink a large container of solution. It will aid in the complete emptying of the colon. This preparation may start several days before the procedure.
Your doctor may give you antibiotics. It is important to take them.
You will usually be asked to stay on clear liquids after the bowel is cleaned out. Do not eat or drink anything after midnight before your procedure.
You may need to shower the night before your procedure using antibacterial soap.
Arrange for a ride to and from the hospital.
Arrange for help at home for the first days after your procedure.

Anesthesia

General anesthesia will be used. You will be asleep.

Description of Procedure

The operation may be done either using a laparoscope or using standard open techniques. This description focuses on a standard open approach.

The doctor will make a cut in the skin over the area of intestine that needs to be removed. The cuts will pass through skin and muscle to reach the inside of the abdomen. The intestine will be clamped on either side of the piece that is to be removed. The intestine next to each clamp will be cut. The diseased portion of intestine will then be removed. The two loose ends of intestine will be sewn together. Some soft tubes may be left in the abdomen to drain any accumulating fluids.

If the procedure was done as an emergency, or if the doctor decides that the intestines need time to rest and heal, you may require a colostomy. In this procedure, an artificial opening will be created in your abdomen, called a stoma. One or both ends of the intestine will be attached to the stoma. This allows waste material (feces) to exit your intestine through the stoma. It collects in a pouch called an ostomy bag. A colostomy may be left in place for several months while your intestine heals.

When your intestine has healed properly, you will undergo another operation. The ends of the intestine will be rejoined. If the majority of your large intestine has been removed, you may require a permanent colostomy.

Colostomy

The muscles and skin of the abdomen will be closed. Stitches or staples may be used. A sterile dressing will be applied. If you have a colostomy, an ostomy bag will be attached to collect feces.

Immediately After Procedure

The removed tissue will be sent to a lab to be examined. You will be moved to a recovery room. There, you will be monitored for any negative reactions to the surgery or anesthesia

How Long Will It Take?

About 1-4 hours

How Much Will It Hurt?

The anesthesia will prevent pain during the procedure. Medicine may be given to help manage any pain after the procedure.

Average Hospital Stay

The usual length of stay is 5-7 days. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

At the Hospital

You may need antibiotics. You may also need medicine for nausea and pain.
You may require a nasogastric (NG) tube for a few days. The tube enters through your nose and goes to your stomach. It is used to help decompress your bowel.
Your intestine will require some time to heal before it will function properly again. At first, you will get nutrition through an IV (needle in your hand). As you improve, you will be slowly advanced through liquid and soft diets to a regular diet.
If you had a colostomy or ileostomy, a pouch will be attached on the outside of your body. Waste material will be collected in it. You will receive instructions about diet and activity. During the first few days after surgery, you may be restricted from eating.
You will wear boots or special socks to help prevent blood clots.
You will be asked to walk often after surgery.
You may be asked to use an incentive spirometer, to breathe deeply, and to cough frequently. This will improve lung function.
Your incision will be examined often for signs of infection.

At Home

Be sure to follow your doctor’s instructions .

If you have a colostomy:

You will need to take it easy for 1-2 months.
A specialized nurse will teach you how to care for the stoma site and change the ostomy bag .
Ask your doctor about when it is safe to shower, bathe, or soak in water.
You will progress from a clear liquid, to a bland, low-fiber diet, to your regular diet after about 6-8 weeks.
Alert your physicians and pharmacist that you cannot take medicines that are considered time-released or time-sustained.
Do not use laxatives, because postcolostomy stools are usually quite liquid.
Drink eight, 8-ounce glasses of liquid daily as extra fluids will be lost in your stool.
You will need to practice good skin care of the area around the stoma. This will help to prevent inflammation and infection.
You may wish to join a support group or seek counseling to help you adjust to your colostomy.

Call Your Doctor

If any of the following occur, call your doctor:

Redness, swelling, increasing pain, excessive bleeding, warmth, drainage, or bulging at the incision site
Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
Severe abdominal pain
Signs of infection, including fever and chills
Cough, shortness of breath, or chest pain
Pain and/or swelling in your feet, calves, or legs
Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
Blood in your stool or black, tarry stools
Diarrhea
Feeling weak or dizzy
If you had a colostomy created:
- Not collecting stool in the ostomy pouch
- The skin around the stoma appears irritated, moist, red, swollen, or develops sores

In case of an emergency, call for medical help right away.

RESOURCES:

American Cancer Society http://www.cancer.org/
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) http://www.niddk.nih.gov/

CANADIAN RESOURCES:

Canadian Society of Colon and Rectal Surgeons http://www.colon-rectalsurgery.org/
Health Canada http://www.hc-sc.gc.ca/

References:

American Gastroenterological Association website. Available at: http://www.gastro.org/wmspage.cfm?parm1=2 .
National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ .

Last reviewed November 2012 by Daus Mahnke, MD

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