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Colectomy

A colectomy is the removal of a section of the large intestine (colon) or bowel. This operation is done to treat diseases of the bowel, including Crohn’s disease and ulcerative colitis, and colon cancer.

Colectomy

Common Symptoms

  • Symptoms may include diarrhea, constipation, abdominal cramps, nausea, fever, chills, weakness, or loss of appetite and/or weight loss, or bleeding.
  • There may be no symptoms. This is why colon cancer screening is essential.

Treatment Options

Surgical Procedure

  • Open colectomy—An incision is made in the abdomen and the section of the diseased colon is removed. The two divided ends of the colon are sutured (sewn) or stapled together in an anastomosis. If the colon cannot be sewn back together, it is brought up through the abdomen to form a colostomy.
  • Laparoscopic colectomy—A light, camera, and instruments are inserted through small holes in the abdomen to remove the diseased colon or tumor.

Nonsurgical Procedure

Some diseases of the colon are treated with antibiotics, steroids, or drugs that affect the immune system.

Benefits and Risks of Your Operation

Benefits—Removal of diseased or cancerous sections of the intestine will relieve your symptoms and can reduce your risk of dying from cancer.

Possible surgical risks include temporary problems with the intestine that may require a stoma; leakage from the colon into the abdomen; lung problems including pneumonia; infection of the wound, blood, or urinary system; blood clots in the veins or lung; bleeding; fistula; or death.

Risk of not having an operation—Your symptoms may continue or worsen, and your disease or cancer may spread.

Expectations

Before your operation—Evaluation may include a colonoscopy, blood work, urinalysis, chest X-ray, or CAT Scan (CT) of the abdomen.1 Your surgeon and anesthesia provider will discuss your health history, home medications, and postoperative pain control options. Addressing risk factors such as smoking, alcohol use, anemia, and nutrition has been shown to improve patient outcomes and should be discussed at the pre-operative visit.2

The day of your operation—You may not eat for 4 hours but may drink clear liquids up to 2 hours before the surgery. Most often you will take your normal medication with a sip of water. Your surgical team will advise you if you need to clean your bowels with laxatives or enemas 1-2 days before surgery.4

Your recovery—The average length of stay is 3 to 4 days for a laparoscopic or open colectomy.5 The time from your first bowel movement to eating normally is also about 3 to 4 days. Call your surgeon if you have continued nausea, vomiting, leakage from the wound, blood in the stool, severe pain, stomach cramping, chills, or a high fever (over 101°F or 38.3°C), odor or increased drainage from your incision, a swollen abdomen or no bowel movements for 3 days.

Call your surgeon if you have continued nausea, vomiting, leakage from the wound, blood in the stool, severe pain, stomach cramping, chills, or a high fever (over 101°F or 38.3°C), odor or increased drainage from your incision, a swollen abdomen or no bowel movements for 3 days.

Keeping You Informed

Colorectal cancer is the third leading cause of cancer-related deaths in men and in women. The lifetime risk of developing colorectal cancer is about 1 in 23 (4.3%) for men and 1 in 25 (4.0%) for women. The American Cancer Society recommends that people at average risk of colorectal cancer start regular screening at age 45.

The Condition

There are different types of conditions and diseases that may affect the intestines:

  • Inflammatory bowel diseases include ulcerative colitis and Crohn’s Disease.
  • Ulcerative colitis is a chronic disease that presents as ulcers (tiny open sores) in the inner layer of the colon and includes bloody diarrhea and abdominal pain.6
  • Crohn’s disease is an inflammatory bowel disease (IBD) of the entire
    lining of the digestive tract, from the mouth to the anus. Most cases affect the anus to the small intestine.7
  • Diverticulitis is an inflammation or infection of small, bulging pouches
    (diverticula) located in the colon.
  • Colorectal polyp is any growth on the lining of the colon or rectum.
  • Colorectal cancer is a malignant (cancerous) tumor in the colon or rectum.
The Procedure

There are different procedures to treat diseases of the bowel and intestines:

  • A colectomy is an operation to remove a part of the intestine (bowel) that is diseased. The name of the procedure depends on what section of the intestine is removed.
  • Right hemicolectomy is the removal of the ascending (right) colon and is the most common type of colectomy (41.9%).
  • Left hemicolectomy is the removal of the descending (left) colon.
  • Sigmoidectomy is the removal of the lower part of the colon which is connected to the rectum.
  • Low anterior resection is the removal of the upper part of the rectum.
  • Segmental resection is the removal of only a short piece of the colon.
  • Abdominal perineal resection is the removal of the sigmoid colon, rectum and anus and construction of a permanent colostomy.
  • Total colectomy is when the entire colon is removed and the small intestine is connected to the rectum.
  • Total proctocolectomy is the removal of the rectum and all or part of the colon.
Common Tests

You will be given a physical exam and asked about you and your family’s complete medical history, including symptoms, pain, and stomach problems.

Other tests may include:

  • Blood tests
  • Urinalysis
  • Digital rectal exam
  • Abdominal X-ray
  • Abdominal ultrasound
  • Colonoscopy
  • Computerized tomography (CT) scan
  • Electrocardiogram (ECG)—for patients over 45 or if high risk of heart problems
laproscopic-repair-graphic-.png

Keeping You Informed

Conversion

Your surgeon may need to convert from a laparoscopic colectomy to an open colectomy. This may be needed due to:9

  • Adhesions from prior surgery
  • Bleeding
  • Obesity
  • Inability to see important structures
  • Presence of a large tumor
  • Inability to complete the operation

For patients having a laparoscopic colectomy, conversion occurs at a rate of 14.3%. The complications and length of hospital stay are longer when you are changed to an open procedure. There is no difference in the long term survival rate.8 The right colectomy is the most common type and has the lowest conversion rate while Proctectomy has the highest rate of conversion to an open procedure.10

Length of Stay

You may stay in the hospital for about 2 nights after a laparoscopic repair or longer after an open colectomy.5 You may have a catheter in place in your bladder to measure and drain your urine for a few days. Severe nausea, vomiting, or the inability to pass urine may result in a longer stay.

Risks of this Procedure
Partial Colectomy with Anastomosis Procedure from the ACS Risk Calculator – April 25, 2022

Risks

Average Patient Percentage

Keeping You Informed

Pneumonia: Infection in the lungs

Open: 2.8%

Laparoscopy: 0.8%

Stopping smoking before your operation and taking deep breaths plus getting up and walking after can help prevent pneumonia.

Heart complication: Heart attack or sudden stopping of the heart

Open: 1.3%

Laparoscopy: 0.4%

Problems with your heart or lungs can sometimes be worsened by general anesthesia. Your anesthesia provider will take your history and suggest the best option for you.

Wound Infection

Open: 9.8%

Laparoscopy: 4.1

Antibiotics are generally given before the surgery. You may be asked to use special soap before and after your surgery.

Urinary tract infection: Infection of the bladder or kidneys

Open: 1.7%

Laparoscopy: 1.0%

A Foley catheter may remain in the bladder a few days after surgery to drain the urine. Adequate fluid intake and catheter care decrease the risk of bladder infection.

Blood clot: A clot in the legs that can travel to the lung

Open: 2.3%

Laparoscopy: 0.9%

Longer surgery and bed rest increase the risk. Getting up, walking 5 to 6 times/day, and wearing support stockings reduce the risk.

Renal (kidney) failure: Kidneys no longer function in making urine and/or cleaning the blood of toxins

Open: 1.3%

Laparoscopy: 0.4%

Pre-existing renal insufficiency, fluid imbalance, Type 1 diabetes, over 65 years of age, antibiotics, and other medications may increase the risk.

Return to surgery

Open: 6.4%

Laparoscopy: 3.1%

Bleeding or a bowel leakage may cause a return to surgery. Your surgical and anesthesia team is prepared to reduce all risks of return to surgery.

Death

Open: 1.8%

Laparoscopy: 0.3%

Your surgical team will review for possible complications and be prepared to decrease all risks.

Discharge to nursing or rehabilitation facility

Open: 9.8%

Laparoscopy: 2.2%

Risk of anastomotic leak: A leak from the connection that is made between two ends of the intestine

Open: 4.0%

Laparoscopy: 1.9%

Increased age, emergency surgery, obesity, the use of steroids for inflammation and chemotherapy, and radiation as well as smoking and alcohol before surgery may increase the risk.11

Ileus

Open: 21.1%

Laparoscopy: 7.2%

An ileus after surgery is an absence of bowel function for more than 3 days. Walking soon after surgery and limiting the use of Opioid pain medication can reduce the possibility of ileus.12

*1% means that 1 of 100 people will have this complication

The ACS Surgical Risk Calculator estimates the risk of an unfavorable outcome. Data is from a large number of patients who had a surgical procedure similar to this one. If you are healthy with no health problems, your risks may be below average. If you smoke, are obese, or have other health conditions, then your risk may be higher. This information is not intended to replace the advice of a doctor or health care provider. To check your risks, go to the ACS Risk Calculator at
riskcalculator.facs.org. 

The Day of Your Procedure

Get the details you need about common procedures and know what to expect before you or a loved one has surgery.

Recovery and Discharge

Access resources and information you need to optimize your recovery from surgery.

Safe Pain Management

Your surgical team wants to help you to safely and effectively manage any pain that you may have after surgery.

Surgery FAQ

Answers to common questions surgical patients have before, during, and after a procedure.

Glossary

Advance directives: Documents signed by a competent person giving direction to health care providers about treatment choices.

Anastomosis: The connection of two structures, like two ends of the intestines. Computerized tomography

(CT) scan: A diagnostic test using X-ray and a computer to create a detailed, three-dimensional picture of your abdomen. A CT scan is commonly used to detect abnormalities or disease inside the abdomen.

Electrocardiogram (ECG): Measures the rate and regularity of heartbeats as well as any damage to the heart.

General anesthesia: A treatment with certain medicines that puts you into a deep sleep so you do not feel pain during surgery.

Hematoma: A collection of blood that has leaked into the tissues of the skin or in an organ, resulting from cutting in surgery or the blood’s inability to form a clot.

Ileus: A decreased motor activity of the digestive tract due to nonmechanical causes.

Local anesthesia: The loss of sensation only in the area of the body where an anesthetic drug is applied or injected.

Nasogastric tube: A soft plastic tube inserted in the nose and down to the stomach. It is used to empty the stomach of contents and gases to the rest of the bowel.

Stoma: An artificial opening of the intestine or urinary tract onto the abdominal wall.

Ultrasound: Sound waves are used to determine the location of deep structures in the body. A hand roller is placed on top of clear gel and rolled across the abdomen.

Urinalysis: A visual and chemical examination of the urine, most often used to screen for urinary tract infections and kidney disease.

DISCLAIMER

The American College of Surgeons (ACS) is a scientific and educational association of surgeons that was founded in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice. The ACS endeavors to provide procedure education for prospective patients and those who educate them. It is not intended to take the place of a discussion with a qualified surgeon who is familiar with your situation.  The ACS makes every effort to provide information that is accurate and timely, but makes no guarantee in this regard.

Reviewed 2014 and 2015;
Revised 2019 and 2022 by:
Nancy Strand, RN, MPH
Kathleen Heneghan, RN, PhD, PNP-C
Robert Roland Cima, MD, FACS

References

The information provided in this report is chosen from recent articles based on relevant clinical research or trends. The research below does not represent all that is available for your surgery. Ask your doctor if he or she recommends that you read any additional research.

  1. Tests to Diagnose and stage rectal cancer. https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed April 26, 2022.
  2. Kearney DE, Liska D, Holubar SD. Preoperative instructions and postoperative care in the 21st century. Ann Laparosc Endosc Surg 2019;4:86 | http://dx.doi.org/10.21037/ales.2019.08.02.
  3. Gustafsson UO, Scott MJ, Hubner M, et al. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery
    (ERAS®) Society Recommendations: 2018. World J Surg 2019;43:659-695.
  4. Colectomy: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/colectomy#:~:text=Before%20a%20colectomy%20 you%20will,You%20may%20have%20a%20colonoscopy. Accessed April 25, 2022.
  5. ACS risk calculator: riskcalculator.facs.org accessed April 25, 2022.
  6. What is Ulcerative Colitis? https://www.crohnscolitisfoundation.org/what-is-ulcerative-colitis. Accessed April 21, 2022.
  7. What is Crohn’s Disease? https://www.crohnscolitisfoundation.org/what-is-crohns-disease. Accessed April 21, 2022.
  8. Wei D, Johnston S, Goldstein L, Nagle D. Minimally invasive colectomy is associated with reduced risk of anastomotic leak and other major perioperative complications and reduced hospital resource utilization as compared with open surgery: a retrospective population-based study of comparative effectiveness and trends of surgical approach. Surg Endosc. 2020 Feb. 34 (2):610-621.
  9. Fry RD, Mahmoud NN, Maron DJ, et al. Colon and Rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Saunders Elsevier;2012:1377.
  10. Moghadamyeghaneh Z, Masoomi H, Mills SD, et al. Outcomes of conversion of laparoscopic colorectal surgery to open surgery. JSLS. 2014;18(4): e2014.00230.
  11. Davis, B and Rivadeneira, D. Complications of colorectal anastamosis. Surg Clin N Am. 2013;93:72.
  12. Chapman SJ, EuroSurg Collaborative. Ileus Management International
    (IMAGINE): protocol for a multicentre, observational study of ileus after colorectal surgery. Colorectal Dis. 2018 Jan. 20(1):O17-O25.
  13. Vanhauwaert E, Matthys C, Verdonck L, De Preter V. Low-residue and low-fiber diets in gastrointestinal disease management. Adv Nutr.
    2015;6(6):820-827. Published 2015 Nov 13. doi:10.3945/an.115.009688
  14. Colectomy. https://www.uchicagomedicine.org/conditions-services/colon-rectal-surgery/colectomy. Accessed April 25, 2022.