Generality

Colectomy is the surgical operation of removing the entire colon or just one part of it.

Performed with a traditional surgery or laparoscopy, colectomy allows the treatment or prevention of various morbid conditions affecting the large intestine.

Resection of the affected colon during a colectomy.

Image taken from: www.obesitysurgeryassociates.com

In addition to total colectomy and subtotal colectomy (ie part of the colon), there are also hemicolectomy (which eliminates either only the right or only the left colon) and proctocolectomy (with which the colon and rectum are removed together).

Colectomy requires special preparation and is performed under local anesthesia.

At the end of the procedure, the patient is fed for a few days parenterally and is generally hospitalized for about a week.

What is colectomy?

Colectomy is the surgical procedure aimed at the total or partial removal of the intestine tract called the colon .

Obviously, during each colectomy the recanalization of the intestine must also be practiced, in order to allow again the transit (and therefore also the expulsion) of the feces.

WHERE IS THE COLON? BRIEF RECALL OF INTESTINAL ANATOMY

The intestine is the portion of the digestive system between the pylorus and the anal orifice. From the anatomical point of view, it is divided into two main sectors: the small intestine, also called small intestine, and the large intestine, also called large intestine .

The small intestine is the first section; it starts at the level of the pyloric valve, which separates it from the stomach, and ends at the level of the ileocecal valve, located on the border of the large intestine. The small intestine consists of three sections (the duodenum, the fast and the ileum), is about 7 meters long and has an average diameter of 4 centimeters.

The large intestine is the terminal tract of the intestine and of the digestive system. It starts from the ileocecal valve and ends at the anus; consists of 6 sections (cecum, ascending colon, transverse colon, descending colon, sigma and rectum), is about 2 meters long and has an average diameter of 7 centimeters (hence the name of large intestine).

MAIN TYPES OF COLECTOMY

Depending on the amount of colon removed, colectomy assumes a different specific denomination; this name refers to the portion of large intestine removed.

Therefore, the following types of colectomy exist:

  • Total colectomy, which consists in removing the entire colon.
  • Subtotal colectomy, which consists in the removal of one or more parts of the colon.
  • Hemicolectomy, which consists in removing the right or left portion of the colon
  • Proctocolectomy, which consists of the double removal of colon and rectum.

When you run

Colectomy is practiced to prevent or treat certain morbid conditions that can arise in the colon.

These morbid conditions consist of:

  • Colon cancer . The more the malignant tumor of the colon is at an advanced stage, the larger the portion of the intestine removed. In cases of very serious malignancies, a total colectomy is also used.
  • Crohn's disease and ulcerative colitis . They are two autoimmune diseases, belonging to the category of so-called inflammatory bowel diseases. Characterized by disorders of the alvo and abdominal pain, Crohn's disease and ulcerative colitis require colectomy when the planned drug therapies have not produced satisfactory results or when, during a control colonoscopy, precancerous cells have been found.
  • Diverticulitis . Diverticulitis requires colectomy when drug therapy and the adoption of a healthy lifestyle have not produced the desired results.
  • Bowel obstruction . If the occlusion is severe, a total colectomy may also be necessary.
  • Persistent intestinal hemorrhage . When the intestinal blood loss is severe and does not indicate improvement, the use of partial colectomy may be the only therapeutic solution. The removed intestinal area is obviously the bleeding one.
  • Intestinal polyps . Intestinal polyps are benign tumors, which, however, can in some cases turn into malignant formations. To prevent this complication, a partial colectomy can be used, through which the intestinal region presided over by the polyps is eliminated.

risks

Like any surgical operation, colectomy can also lead to complications, such as:

  • Internal bleeding
  • Infections
  • Formation of blood clots in the veins (deep vein thrombosis) or in the lungs (pulmonary embolism)
  • Stroke or heart attack during the operation
  • Allergic reaction to anesthetic drugs or sedatives used during surgery

Furthermore, since the surgeon modifies a vital organ, surrounded by other equally delicate structures, the risk of:

  • An injury to the damage of the bladder or small intestine caused by surgical instrumentation.
  • A problem of fecal transit . This occurs due to a defect in intestinal recanalization.

Preparation

Colectomy is a surgical procedure that involves general anesthesia . Therefore, before its execution, the individual must be subjected to the following clinical controls:

  • Accurate physical examination
  • Complete blood analysis
  • Electrocardiogram
  • Evaluation of clinical history (diseases suffered in the past, possible allergies to anesthetic drugs, medicines taken at the time of checks, etc.).

If there are no contraindications of any kind, the operating surgeon (or a member of his staff) will explain the methods of intervention, the possible risks, the pre- and post-operative recommendations and, finally, the recovery times.

The main pre- and post-operative recommendations:

  • Before colectomy, suspend any treatment based on antiplatelet agents (aspirin), anticoagulants (warfarin) and anti-inflammatory drugs (NSAIDs), because these drugs, by reducing the coagulation capacity of the blood, predispose to serious bleeding.
  • On the day of the procedure, appear at full fast from at least the previous evening and with the intestine empty and possibly clean . To empty the intestine, the doctor generally recommends a laxative solution to be taken several hours before the operation, while antibiotics are used to clean the intestine.
  • After the surgery, be assisted by a trusted person .

EMERGENCY COLECTOMY

Sometimes, colectomy can be an emergency intervention (for example in the case of acute intestinal obstruction). In such circumstances, there is no time to stick to certain precautions, such as bowel emptying or pre-operative fasting.

Procedure

Colectomy can be performed with a traditional surgery (also called " open-air") or with a laparoscopic surgery (or laparoscopy operation ).

Before anesthetizing the patient, this is connected to various devices that will measure, for the entire duration of the operation, its vital parameters (blood pressure, heart rate, blood oxygenation, etc.).

TRADITIONAL COLECTOMY

During "open" colectomy, the surgeon makes an incision of several centimeters at the abdominal level and, from the opening thus created, removes the diseased colon (all or only a part, depending on the needs) and carries out the recanalization.

Scheme of a permanent colostomy. Image taken from: lifescript.com

After recanalization, the large abdominal incision is closed with stitches.

LAPAROSCOPIC COLECTOMY

During laparoscopic colectomy, the surgeon performs (still on the abdomen) small incisions of about one centimeter, through which he introduces the surgical instrumentation (laparoscope etc.) with which he extracts from his abdominal site the tract of colon to intervene on. Once the diseased areas have been removed and the recanalization has been carried out, it reinserts the modified colon into the original site and sews up the small incisions.

INTESTINAL RECANALIZATION

Depending on the type of colectomy and the size of the colon removed, the surgeon can recanalize the remaining intestine in various ways.

  • It can reconnect the remaining parts of the colon with sutures and thus re-establish a stool passage very similar to the normal one. In these cases, there is the danger that, over time, the sutures will become loose.
  • It can connect the remaining colon to an opening on the abdomen ( colostomy ); this opening is connected to a stool collection bag. Depending on the case, the colostomy may be temporary or permanent.
  • In the case of proctocolectomy (removal of colon and rectum), it can join the small intestine to the anus.

TRADITIONAL COLECTOMY AND LAPAROSCOPIC COLECTOMY COMPARED

The "open" colectomy is certainly more invasive and requires longer recovery times than the laparoscopic colectomy. However, it allows the surgeon to operate more accurately.

In fact, with laparoscopic surgery, the risk of injuring organs adjacent to the colon (bladder, small intestine, etc.) is not negligible.

Post-operative phase

Once the colectomy is completed, a period of hospitalization is foreseen for a maximum of one week. During this period, medical personnel monitor the condition of the patient and his intestine at regular intervals.

Generally, until admission is complete, feeding takes place intravenously ( parenteral feeding ), as the intestine has not yet healed enough to digest and absorb solid foods.

At discharge, it is likely that the patient will still feel pain and feel particularly tired. Both are normal sensations, which tend to resolve over time.

It is a good idea to undergo periodic medical check-ups and contact your doctor at the slightest appearance of abdominal discomfort, blood in the stool, etc.

If a colostomy has been performed, medical personnel will teach the patient (or caregiver) how to change the stool collection bag.

Results

The results of a colectomy depend on how severe the condition that required its execution is. In fact, the more severe the intestinal problems are, the fewer the long-term benefits that a colectomy can provide.