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Colectomy—Open Surgery by Krisha McCoy, MS

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

Definition

This is an operation 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 your colon is removed. In a total colectomy, all of your colon is removed.

Colon

Reasons for Procedure

A colectomy may be performed to treat a variety of conditions, including the following:

Colorectal 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, especially those seen in 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:

Having neurological, heart, or lung conditions
Age: older than 70 years
Obesity
Smoking
Previous abdominal surgery
Active 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 with biopsy samples—visual 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 such as warfarin (Coumadin)
- clopidogrel (Plavix)
Drink at least eight, 8-ounce glasses of water daily.
Follow a special diet, if recommended by your doctor.
You will likely be given laxatives and other medicines to help clean out your bowels.
Take antibiotics, if prescribed by your doctor.
You may need to shower the night before your procedure, using antibacterial soap.
Arrange to have someone drive you to and from the procedure and for help at home.
The night before, eat a light meal or drink clear liquids as directed. Do not eat or drink anything after midnight unless told otherwise by your doctor.
Wear comfortable clothing.

Anesthesia

You will receive general anesthesia for the surgery. You will be asleep.

Description of Procedure

The surgeon will make a single, long incision in the abdomen. She will remove the section of colon through the incision. When possible, the colon on either side of the removed section will be sewn together.

In a total colectomy, a colostomy or ileostomy will need to be formed. This will create a path for waste to leave your body. Your doctor will make a small opening, called a stoma, in the front of your abdominal wall. The open end of your intestine will be attached at the stoma. The stoma may be either temporary or permanent. This part of the procedure may also be done if your intestine needs time to heal and rest.

Colostomy Pouch

The surgeon will close the muscles and skin of the abdomen with stitches or staples. A sterile dressing will be placed over the incision areas.

Immediately After Procedure

The removed tissue will be sent to a lab for examination. You will be taken to the recovery room and monitored.

How Long Will It Take

About 1- 4 hours or more

How Much Will It Hurt?

Anesthesia is given to prevent pain during the surgery. Pain is common during recovery. You will receive medicine to help manage pain.

Average Hospital Stay

This procedure is done in a hospital setting. The usual length of stay is 5-6 days. Your doctor may choose to keep you longer, however, if complications arise.

Post-procedure Care

At the Hospital

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 encouraged to practice deep breathing to help open your lungs.

At Home

After your procedure, 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 .
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.
Be sure to 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 after surgery, or which persist for more than two days after discharge from the hospital
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 911 .

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 October 2009 by Daus Mahnke, MD

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