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Colectomy—Laparoscopic Surgery by Krisha McCoy, MS

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

Definition

This is a procedure to remove all or part of the colon. The colon, or large intestine, is the lower part of the intestines. In a partial colectomy, only part of the colon is removed. In a total colectomy, all of the colon is removed.

Colon

Reasons for Procedure

A colectomy may be done to treat a variety of conditions, including:

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

Possible Complications

If you are planning to have a colectomy, 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

Factors that may increase the risk of complications include:

Neurological, heart, or lung conditions
Age: older than 70 years
Obesity
Smoking
Previous abdominal surgery
Infection

What to Expect

Prior to Procedure

Your doctor may 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
Barium X-ray —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 and biopsy —exam and removal of tissue inside the large intestine using a flexible tube with a camera on the end

Leading up to your procedure:

Talk to your doctor about your current medicines. Certain medicines may need to be stopped before the procedure, such as:
- Aspirin or other anti-inflammatory drugs for up to one week before surgery
- Blood-thinning drugs (eg, warfarin [Coumadin])
- Clopidogrel (Plavix)
Drink at least eight, 8-ounce glasses of water daily.
If recommended by your doctor:
- Follow a special diet.
- Take laxatives.
- Take antibiotics.
- Shower the night before the procedure using antibacterial soap.
Arrange to have someone drive you home and to help you at home.
The night before, eat a light meal or drink clear liquids. Do not eat or drink anything after midnight unless told otherwise by your doctor.

Anesthesia

You will receive general anesthesia . You will be asleep.

Description of Procedure

The doctor will make small incisions in the abdomen. She will then insert instruments through these incisions . The section of colon will then be removed through these small openings. The doctor may then sew together the two parts of the colon. In some cases, the doctor may need to switch to open surgery . This involves making a larger incision.

If all of your colon is removed, a colostomy or ileostomy will be done. This will create a path for waste to leave the body. The doctor will make a small opening, called a stoma, in the front of the abdominal wall. The open end of your intestine will be attached at the stoma. The stoma may be either temporary or permanent. This procedure may also be done if your intestine needs time to heal.

Colostomy Pouch

Stitches or staples will be used to close the area. A bandage will be placed over the incisions.

Immediately After Procedure

You will be taken to the recovery room.

How Long Will It Take

1- 4 hours or more

How Much Will It Hurt?

You will have pain after the surgery. Your doctor will give you pain medicine.

Average Hospital Stay

The hospital stay is 5-6 days. You may need to stay longer if you have complications.

Post-procedure Care

At the Hospital

The hospital staff will:

Give you instructions about diet and activity if you have a stoma and a bag to collect waste. During the first few days after surgery, you may be restricted from eating.
Instruct you to wear boots or special socks to prevent blood clots in your legs.
Encourage you to do deep breathing to help prevent pneumonia.

At Home

If you have a colostomy:

Limit activity for 1-2 months.
A nurse will teach you how to care for the stoma site and change the ostomy bag.
Slowly progress from a clear liquid diet, to a bland, low-fiber diet. You will slowly advance to a regular diet.
Tell your doctor and pharmacist that you cannot take medicines that are time-released or time-sustained.
Do not take laxatives.
Drink eight, 8-ounce glasses of fluid every day. Extra fluid will be lost in your stool.
Ask your doctor about when it is safe to shower, bathe, or soak in water.
Follow your doctor’s instructions.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
Nausea and/or vomiting that you cannot control with the medicines you were given, or that lasts for more than two days
Pain that you cannot control with the medicines you have been given
Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
Cough, shortness of breath, or chest pain
Joint pain, fatigue, stiffness, rash, or other new symptoms
Feeling weak or dizzy
Pain or swelling in your feet, calves, or legs
Bloody or black stools
Diarrhea
Lack of stool in the colostomy bag
Severe abdominal pain
Bleeding from the stoma
Not collecting stool in the ostomy pouch

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

RESOURCES:

American Cancer Society http://www.cancer.org/
American Society of Colon and Rectal Surgeons http://www.fascrs.org/
National Cancer Institute http://www.cancer.gov/

CANADIAN RESOURCES:

The Canadian Association for Enterostomal Therapy http://www.caet.ca/
Colorectal Cancer Association of Canada http://www.colorectal-cancer.ca/

References:

Alves A, Panis Y, Mathieu P, et al. Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study. Archives of Surgery. 2005;140:278-283.
A patient guide to colostomy care. Northwestern Memorial Hospital website. Available at: http://www.nmh.org/nmh/patientinformation/patientguidecolostomycare.htm . Accessed July 16, 2008.
Dictionary of cancer terms. National Cancer Institute website. Available at: http://www.cancer.gov/dictionary/ . Accessed July 16, 2008.
Feo CV, Zerbinati A, Giacometti M, et al. The ideal length of hospital stay in the surgical treatment of colorectal cancer. Ann Ital Chir. 2002;73:13-16.
Perioperative management. American Society of Colon and Rectal Surgeons website. Available at: http://www.fascrs.org/displaycommon.cfm?an=1&subarticlenbr=127 . Accessed September 24, 2005.
What is the treatment for Crohn’s disease? National Digestive Diseases Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/#treat . Accessed July 16, 2008.

Last reviewed November 2012 by Marcin Chwistek, MD

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