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Colectomy -- Laparoscopic Surgery

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Colectomy—Laparoscopic Surgery

(Total Colectomy; Partial Colectomy; Colon Removal)

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
colectomy colon
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Reasons for Procedure

A colectomy may be done to treat a variety of conditions, including:
  • Colorectal cancer
  • Inflammatory intestinal diseases such as colitis and Crohn’s disease
  • Intestinal blockage
  • Trauma to the intestine
  • Diverticular disease —small pouches in the wall of the colon
  • Precancerous polyps, especially those seen in familial polyposis
  • A hole in the bowel wall, or a 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
  • Increased age
  • Obesity
  • Smoking
  • Previous abdominal surgery
  • Infection

What to Expect

Prior to Procedure

Your doctor may do the following:
  • Physical exam
  • Blood tests
  • Imaging tests such as ultrasound, barium x-ray, CT scan, and MRI scan
  • 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:
    • Ibuprofen or other anti-inflammatory drugs
    • Blood-thinning medications
    • Anti-platelet medications
  • Drink plenty of water.
  • 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

Small incisions will be made in the abdomen. Instruments will be inserted through these incisions. The section of colon will then be removed through these small openings. The two parts of the colon may then be sewn together. In some cases, the doctor may need to switch to open surgery . This involves making a larger incision.
In a total colectomy, a colostomy or ileostomy will need to be formed. This will create a path for waste to leave your body. A small opening called a stoma will be made 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
colostomy pouch
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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 medication.

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:
If you have a colostomy:
  • Limit activity for 1-2 months.
  • You will be taught 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.
  • Inform your physicians and pharmacist that you cannot take medicines that are considered time-released or time-sustained.
  • Do not take laxatives.
  • Drink plenty of fluid, since 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 medications you were given, or that lasts for more than two days
  • Pain that you cannot control with the medications you have been given
  • Pain, burning, urgency or frequency of urination; blood in the urine
  • Cough, shortness of breath, or chest pain
  • Fatigue or other new symptoms
  • Lightheadedness
  • 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
In case of an emergency, call for medical help right away.

RESOURCES

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.

Crohn’s disease. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/#treat . Updated January 18, 2011. Accessed May 28, 2013.

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.

A patient guide to colostomy care. Northwestern Memorial Hospital website. Available at: http://www.nmh.org/ccurl/580/761/colostomy-care-guide-09-07.pdf. Published September 2007. Accessed May 28, 2013.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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