Colectomy
(Colon Removal)

Colon

• The colon’s function is to help absorb water and thicken your stool. The rectum (the last portion of your colon) helps to hold stool and assist with defecation (having a bowel movement.)
• A colectomy is removal of a portion of the large intestine (colon)
• The most common reasons for colon removal (partial or complete) is diverticulitis, large polyps or cancer, or inflammatory bowel disease.

Diverticulitis

• Diverticulosis is a common condition in which holes in the muscle layer of the wall of the colon develop. This is thought to be related to our Western diet (low fiber, high fat and red meat).
• The holes in this layer allow the intact inner layer (mucosa) to pouch out. This result in “pockets” with a thin wall compared to normal colon. 
• These diverticula almost always only cause symptoms in your sigmoid colon, even if you have diverticula in other portions of your colon. This is because the opening is narrow here, and the wall is thick, which leads to the areas of highest pressure. 
• Sometimes these pockets do not cause any symptoms, and are often found at routine colonoscopy.
• If you have diverticulosis, a high-fiber diet (or a fiber supplement such as Metamucil) and increased water intake is recommended. You do not need to avoid nuts or seeds. This was disproven many years ago.

• Diverticula can bleed; or they can perforate, leading to inflammation of the colon, called diverticulitis.

• Diverticulitis can be managed without surgery often. Bowel rest and antibiotics during an acute flare can treat this. Taking a fiber supplement, increasing water intake, increasing activity, losing weight if you are overweight, and avoiding smoking can all decrease your risk of future episodes.
• Sometimes, the perforation can lead to leakage of bacteria and stool into your abdomen, which can form abscesses (pockets of infection), or severe illness leading to emergent surgery.
• If you have had a complicated episode (perforation), or if you have had repeated non-complicated episodes, you are often referred to a surgeon to discuss removal of this portion of your colon.
• You can also develop chronic issues (chronic pain, fistulas, or strictures) that will only resolve with surgery.
• A sigmoid colectomy (removal of the sigmoid colon) is discussed either to treat acute or chronic issues, or to prevent future episodes.

Cancer (or large polyps)

• Colorectal cancer is the third most common type of cancer in the United States
• Colorectal cancer typically begins as a polyps which grows slowly and eventually turn into cancer. This is why screening colonoscopies are recommended to remove polyps when they are small, to prevent their progression to cancer and/or to discover colon cancer at an early stage, as this cancer almost always does not cause symptoms until it is very large.
• When large polyps (that cannot be removed endoscopically, or are suspected to harbor cancer), or colorectal cancer is found, you will be referred to a surgeon to discuss removal of a portion of your colon.
• You will likely have imaging and blood tests first to help determine if the cancer has spread. 
• The blood supply, and lymphatic drainage of the colon is contained in mesentery, which is a fatty sheet that connects to your colon. 
• Once colon cancer begins to spread, it typically will spread to lymph nodes in its mesentery, and then to the liver, or lungs.
• Removal of the colon and the mesentery around it (including blood vessels and lymph nodes), is essential to both treat and stage your cancer (determine if the cancer has spread)
• Depending on your cancer (stage and location), you may need additional treatments. Radiation and/or chemotherapy may be recommended. Your surgeon can discuss this with you further at your visit, and will refer you to these specialists if needed.

Inflammatory Bowel Disease

• Ulcerative colitis, or Crohn’s disease are the two types of IBD
• Diarrhea, cramping, blood in stools and weight loss are common with this
• Is often treated by a gastroenterologist with medications, and monitored
• Part or all of your colon may be involved and surgery can be considered based on the severity of inflammation and response to medications. 
• If you develop complications such as perforation, you may need surgery.

Surgery (Colectomy)

• Common operation with low-moderate risk

• Can be done laparoscopically or open
• Some operations may be recommended to be done open for various reasons, your surgeon will discuss these options with you.
• The portion needing to be removed will be discussed with you at your consultation
• Right hemicolectomy is removal of the ascending (or right) colon.
• Left hemicolectomy is removal of the descending (or left) portion of your colon
• Sigmoidectomy is removal of the sigmoid colon (left lower portion before your rectum)
• Low anterior resection is removal of the upper/mid rectum
• Abdominoperineal resection is removal of the enture rectum and anus with creation of a permanent colostomy
• Total colectomy is removal of the entire colon

Laparoscopic partial colectomy

• 4 small incisions with hollow tubes placed to use instruments and a lighted camera
• Carbon dioxide is used to make space between your organs to work with small instruments
• The colon is mobilized away from other structures
• Part of your colon, and its mesentery (with blood vessels and lymph nodes) is removed through an incision about 5cm in size. This is your largest incision. 
• The remaining ends of your colon are re-attached together (called an “anastomosis”). This is done with a stapler and/or sutures.

• Bleeding, infection, damage to surrounding structures
• Anastomotic leak (where your colon is reattached)
• Uncommonly, you may need a “stoma”; where a portion of your bowel is brought through the skin; which empties into a bag. This is rarely permanent. If this is a possibility during your operation, your surgeon will discuss this during your consultation   
• Conversion to open procedure (large incision) 
• Anesthesia-related risks (heart, lung complications and blood clots)
• Your risk of complications depends on your overall health and the reason for your colectomy.

Preparing for your surgery

• You will be given instructions for a bowel prep prior to surgery
• Nothing to eat or drink after midnight the night before your surgery
• You may take am meds (you will be told which ones to take/hold) with a sip of water in the am
• If you smoke; quitting smoking before surgery can decrease your risk of respiratory complications and infections after surgery.

When to Call

• Severe or worsening uncontrolled pain
• A fever >101.3
• Continuous vomiting
• Foul smelling drainage, redness or continued bleeding from an incision sites
• Chest pain or trouble breathing (call 911 or go to the ER)
• Any questions or concerns