Colectomy

A colectomy is the removal of part or all of the colon, also known as the large intestine. Colectomy is used as a treatment for a variety of diseases, including colon or rectal cancer, large polyps (growths that arise on the lining of the colon), diverticular disease, inflammatory bowel disease (Crohn’s disease or ulcerative colitis), or intestinal bleeding that cannot be stopped. The portion of the colon removed depends on the nature of the disease.

Colon resection can be performed in two ways: conventional open surgery or laparoscopic surgery.

Conventional Open Colectomy: An open colectomy uses a long incision down the center of the abdomen. When this method is required, the recovery period in the hospital is usually, but not always, longer.

Laparoscopic/Minimally Invasive Colectomy: With a laparoscopic or minimally invasive colectomy, the surgeon uses several very small incisions and specialized instruments to perform the operation. The exact same operation is performed on the inside as with an open colectomy. However, there is less pain and recovery is usually faster. Surgeons at UChicago Medicine have extensive expertise in performing advanced laparoscopic colectomy.

Benefits

If a colectomy is recommended for a benign, or non-cancerous growth, it is usually because that growth is symptomatic in some way (bleeding or causing a blockage) or to prevent it from progressing into a cancer. In the case of diverticulitis or inflammatory bowel disease, colectomy is used to remove a segment that is affected by severe inflammation or infection.

When a colectomy is needed to treat a malignant (cancerous) tumor, the surgeon must remove both the tumor and the vascular and lymph structures supplying that portion of the colon. This operation can be curative, depending on the stage of the cancer. Patients who have a colectomy for cancer will meet with a medical oncologist soon after they have recovered from surgery to determine if further treatment such as chemotherapy is required.

Risks

The potential complications after colectomy include bleeding and infection, injury to nearby structures including the intestines, the bladder, blood vessels and the ureter (a tube that carries urine from the kidney to the bladder). It is always possible that a leak can occur where the intestines were reconnected (the anastomosis). Blood clots can occur in the veins, and these can travel to the lungs. Hernia at the surgical incisions or bowel obstruction from internal scar tissue can also occur, even years later.

While laparoscopic surgery for colon cancer is an established and valuable option, the benefit of laparoscopy in rectal cancer surgery is still under investigation. Our surgeons are involved in the largest multicenter trial investigation on the use of laparoscopy for rectal cancer.

The advantages of a laparoscopic colectomy include reduced postoperative pain due to a shorter incision and decreased exposure of the intra-abdominal viscera to air, compared to an open colectomy. Additional benefits include a shorter hospital stay, smaller surgical scars and a faster return to your normal activities. The gastrointestinal tract usually recovers more rapidly so patients can resume eating sooner. It is sometimes possible to completely avoid the need for narcotic pain medicines after a laparoscopic colectomy.

Is laparoscopic colectomy right for me?

Not every patient is eligible for laparoscopic colectomy. This depends on the type of disease affecting the patient and the training of the surgeon. Several other factors are considered including the patient’s body type and overall health, previous operations on the abdomen resulting in scar tissue, history of bleeding problems and pregnancy.

During a laparoscopic colectomy, the surgeon enters the abdomen by placing a cannula or port (narrow tube-like instrument) into the abdomen through a small incision measuring less than half an inch. Carbon dioxide (CO2) gas is pumped into the abdomen through the port to create more space inside the abdomen. A laparoscope is a tiny telescope connected to a video camera. It is placed through the cannula to allow the surgeon to see a magnified, lighted view of the internal organs on a high-definition monitor. Up to four more ports are inserted to allow the surgeon to use specialized instruments to work inside the abdomen.

The segment of the colon to be removed is then freed from the attachments to other organs and/or the abdominal wall. The blood vessels supplying only that segment are then sealed with a specially designed energy device and divided. One of the cannula incisions is then enlarged slightly and the segment of colon is then extracted through the abdomen. The two remaining ends of the colon are then reconnected, either with a surgical stapler or sutures.

When open surgery is indicated or recommended, the same principles are applied, but the surgeon works with traditional handheld instruments through a larger, single incision.

An ileostomy or colostomy is when a portion of the small intestine or colon is brought out to the skin through a surgical opening through the abdominal wall. Instead of eliminating with a bowel movement, intestinal waste passes into a specially fitted low-profile appliance, also known as a pouching system or a bag. Whether or not a patient will require a stoma depends on the nature of their disease. Temporary and even permanent ileostomies are sometimes required after certain operations for inflammatory bowel disease, and for some rectal cancer operations. If the rectal cancer involves or is close to the anal sphincter mechanism, a permanent colostomy could be required. Patients who may require a stoma work closely with a team of highly experienced enterostomal nurses to learn how to manage their stoma. Patients with stomas are able to live healthy, active lives and enjoy all of the activities they used to do before they had a stoma.

After an open or laparoscopic colectomy, the patient will be connected to IV fluids to maintain hydration. During the initial time of recovery, the patient wakes up from anesthesia while in the recovery room. The patient is then transferred to the surgical floor to spend the rest of his or her stay at UChicago Medicine. Post-operative pain is kept at a manageable level by providing a combination of medicines that have been found to reduce the need and frequency of narcotic pain medications. Narcotic pain medications are often necessary, but slow recovery of the gastrointestinal tract.

The patient is kept on IV fluid initially and can often start taking liquids and even solid foods as soon as they feel hungry or thirsty. We advise patients to self-regulate their oral intake during recovery and slow down or stop if they have nausea or feel full. The gastrointestinal tract does not always start functioning again all at once, and the time it takes for normal digestion to resume can vary. Walking and minimizing narcotic pain medications will speed this process.

For the first six weeks after surgery, we recommend a low residue diet, which is a low fiber diet that is designed to reduce the amount and frequency of stools and to extend the time spent digesting the food itself. This is to avoid unnecessary trauma to the healing intestinal reconnection.

The long-term effects of colectomy depend on the amount of the colon removed. If a part of the colon is removed, patients may notice little change in their bowel function or frequency of bowel movements. Even in a situation when the entire colon needs to be removed, as is often the case in ulcerative colitis, the patient will be able to return to his or her normal activities with a good quality of life despite the absence of the entire colon.

It takes approximately two to three weeks to completely resume normal activities. However, we recommend that the patient avoid heavy lifting for approximately six weeks. Depending on the condition for which the surgery was recommended, regular checkups are scheduled either with surgeons, medical oncologists or gastroenterologists at UChicago Medicine.

In cases of colectomy for cancer, very specific guidelines are followed at UChicago Medicine in terms of administration of chemotherapy and/or radiation therapy. It is generally recommended that patients with Stage 3 colon cancer undergo chemotherapy after surgery. A multi-specialty team helps guide every patient through this process, including the coordination of multiple appointments.

Patients with Stage 2 or 3 rectal cancer are usually recommended to undergo a combination of chemotherapy and radiation before surgery. These patients will receive more treatment with chemotherapy after the operation. Several studies have shown that this treatment approach reduces the chance of cancer recurrence.

For inflammatory bowel disease patients, our gastroenterology team is at the forefront of innovation and new treatment modalities. Our surgeons work in close collaboration with them and offer a team approach, if needed, after surgery.