Colectomy—Open Surgery Overview

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 © 2009 Nucleus Medical Media, Inc.

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 © 2009 Nucleus Medical Media, Inc.

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 .

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.