Colectomy

What is a colectomy?

A colectomy is a type of surgery used to treat diseases of the colon (also called the bowel or large intestine). The diseased or damaged part of the colon is removed. Then the remaining ends of the colon are attached to each other.

In some cases, a lot, or even all, of the colon is removed. Then an opening to the outside of the body (stoma) is needed to pass stool. The stoma is a hole made in the skin over your belly (abdomen). The intestine is attached to the stoma. Stool then goes into a bag that sticks to the skin around the stoma. This is called a colostomy. Depending on your diagnosis, it may be lifelong (permanent).

A colostomy might also be needed for just a short time to let your colon heal after surgery. Then a second surgery is done a few months later to reconnect the bowel.

A colectomy can be done in 2 ways:

  • Open colectomy. The surgery is done by making a long, vertical cut (incision) on your belly.

  • Laparoscopic-assisted colectomy. The surgery is done through many small incisions made in the skin over your belly. A tiny video camera is put into 1 of the incisions so the surgeon can see inside your body. Long, thin tools are put in the other incisions and used to do the surgery. People often have less pain and recover faster because of the small incisions.

Why might I need a colectomy?

This surgery can be used to treat inflammatory bowel disease, ulcerative colitis, Crohn's disease, and diverticulitis. Colectomy is also used to treat cancer.

When treating cancer, the surgeon will remove the part of the colon that has cancer in it. A small piece of colon on either side of the cancer is also removed. Nearby lymph nodes are often taken out, too, so they can be checked for cancer.

What are the risks of a colectomy?

All surgery has risks. Your healthcare provider will discuss them with you before the surgery. Ask questions if you have concerns. Risks of a colectomy include:

  • Reactions to anesthesia

  • Pneumonia

  • Blood clots in the legs or lungs

  • Internal bleeding

  • Infection at the incision or inside the belly

  • Hernia

  • Scar tissue (adhesions) in the stomach, which can block the intestines

  • Leaking where the intestines are sewn together

  • Damage to nearby organs

How do I get ready for a colectomy?

Before a colectomy, a complete workup will be done by your healthcare team. This is done to learn more about the extent of bowel disease or cancer. It's needed to plan your surgery. It may include X-rays, scans, blood tests, and an EKG. A colonoscopy might be done. This allows the surgeon to look at the inside of your colon and rectum. It's done with a flexible, tube-like scope that has a tiny light and video camera on the end.

Here's what to expect before surgery:

  • Your bowels must be empty before the surgery. You'll need change what you eat and drink for a few days before surgery.

  • You may also need to do bowel prep 1 to 2 days before surgery. This may include a laxative and enemas to clean out your bowel.

  • Be sure follow any instructions you're given about not eating or drinking before surgery.

  • You may need to stop taking some of your medicines in the week before the surgery. This includes blood thinners. Be sure to tell your providers about all the medicines you take, including over-the-counter drugs, vitamins, herbs, supplements, marijuana, and street drugs.

  • You may be asked to shower with a special soap before your surgery. You might also be given antibiotics to help prevent infection.

Your healthcare provider may give you other instructions. Ask questions about anything you're not sure about.

What happens during a colectomy?

Here is what to expect during surgery:

  • You'll be given general anesthesia for the surgery. These drugs make you sleep and not feel pain during surgery.

  • The skin over your belly will be cleaned and hair there may be clipped or shaved.

  • For an open colectomy, the surgeon will make a long cut (incision) on your stomach. For a laparoscopic-assisted colectomy, several small incisions will be made.

  • The diseased part of your colon will be removed.

  • The 2 open ends of the colon will be sewn together. Or an opening to the outside of your body (stoma) will be made.

  • If you have cancer, lymph nodes near it will be removed. Surgeons often take out at least 12 of these lymph nodes.

  • Once the surgery is done, the incision is closed.

What happens after a colectomy?

You will wake up on a stretcher in a recovery room. You'll stay there until you're fully awake, alert, and breathing well. You'll be hooked up to machines that watch your vital signs (such as your heart rate and blood pressure). Then you'll be taken to a hospital room. You'll likely be in the hospital for 3 to 7 days.

You'll need to take pain medicine for several days. It's important to control your pain so you can cough, take deep breaths, and get out of bed as you recover. You may be allowed some liquids as your colon begins to work again.

After a few days, or sometimes even the same day, you may be able to eat some solid food. You will be asked to follow a low-residue, low-fiber diet for a few weeks to decrease the amount of stool passing through your bowel as it heals. A dietician will talk with you about this.

Before leaving the hospital, make sure you know what problems or side effects to watch for. Your healthcare provider will schedule follow-up appointments to check on your progress.

If you have a colostomy, an ostomy nurse will work with you as you learn how to take care of it.

When to call the doctor

Talk with your healthcare provider about problems you should watch for. Call right away if you have any of the following:

  • Fever of 100.4°F (38°C) or higher, or as advised by your healthcare provider

  • Chills

  • Cough or shortness of breath

  • Fast, irregular heartbeat

  • New chest pain

  • Signs of infection around the incision, such as redness, drainage, warmth, and pain

  • Drainage from the incision site

  • Incision opens up or the edges pull apart

  • Any abnormal bleeding or bleeding that soaks the bandage

  • Trouble passing urine or changes in how your urine looks or smells

  • No bowel movement for 2 or more days

  • Swelling in your hand, arm, or chest that gets worse or isn't getting better a week or 2 after surgery

  • Pain, redness, swelling, or warmth in an arm or leg

Know what problems to watch for and when you need to call your healthcare provider. Also be sure you know what number to call to get help after office hours and on weekends and holidays.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure

  • The reason you are having the test or procedure

  • What results to expect and what they mean

  • The risks and benefits of the test or procedure

  • What the possible side effects or complications are

  • When and where you are to have the test or procedure

  • Who will do the test or procedure and what that person’s qualifications are

  • What would happen if you did not have the test or procedure

  • Any alternative tests or procedures to think about

  • When and how you will get the results

  • Who to call after the test or procedure if you have questions or problems

  • How much you will have to pay for the test or procedure

Online Medical Reviewer: Jen Lehrer MD
Online Medical Reviewer: Kimberly Stump-Sutliff RN MSN AOCNS
Online Medical Reviewer: Raymond Kent Turley BSN MSN RN
Date Last Reviewed: 2/1/2021
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