Frequently Asked Questions About Colectomy (Colon Resection)
- What is colectomy (colon resection)?
- What are the benefits of colectomy?
- What happens during a colectomy?
- Is laparoscopic colectomy right for me?
- What happens after colon resection surgery?
- What other treatments will I need in addition to colectomy?
- What are the complications and risks associated with colectomy?
Q. What is a colectomy?
A. A colectomy is the removal of part or all of the colon depending on the nature of the disease. It is used to treat a variety of diseases, including:
- Adenomatous polyps: growths that arise from the mucosa (the inside lining of the colon)
- Diverticular disease: when pouches in the wall of the colon extend outward
- Inflammatory bowel disease: either Crohn’s disease or ulcerative colitis
- Cancer of the colon and rectum
This surgery on the large intestine can be performed in two ways: conventional open surgery or laparoscopic surgery.
Conventional Open Colectomy
Most conventional open colectomies require a long incision down the center of the abdomen. The average hospital stay is five to eight days or longer depending on the time necessary for bowel activity to return and for the patient to tolerate taking anything by mouth.
Laparoscopic/Minimally Invasive Colectomy
Laparoscopic colectomies, also called minimally invasive colectomy, enable the surgeon to perform the operation through small incisions (usually less than one inch in length). Although the exact same operation is performed on the inside of the abdomen as an open surgery, with a laparoscopic procedure, the recovery is often faster and the cosmetic results are significantly better. Here at the University of Chicago Medicine, we have been performing advanced laparoscopic colorectal surgery since 2002. Our surgeons have performed more than a thousand of these procedures.
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Q. What are the benefits of colectomy?
A. When a colectomy is needed to treat benign, non-cancerous disease, it is usually performed to either prevent cancer progression or to stop bleeding (as is the case with adenomatous polyps) or to remove a segment that is affected by severe inflammatory or infectious problems (as is the case with diverticulitis and inflammatory bowel disease).
When a colectomy is needed to treat malignant (cancerous) disease, the goal and benefits resulting from the surgery include radical resection (removal) of the cancer with surgical cure and improved quality of life. While laparoscopic surgery for colon cancer is a well established and valuable option, the role of laparoscopy in rectal cancer surgery is still under investigation. Our surgeons at the University of Chicago Medicine are involved in the largest multicenter trial investigation on the use of laparoscopy for rectal cancer.
Added Benefits of the Minimally Invasive Approach
The advantages of a laparoscopic colectomy include reduced postoperative pain due to a shorter incision and decreased exposure of the intraabdominal viscera to air, compared to an open colectomy. Additional benefits of minimally invasive colectomy include:
- Shorter hospital stay
- Quicker ability to resume eating solid foods
- Reduced requirement for narcotic pain medicine
- Smaller post-surgical scars that are placed in less-visible areas
- Faster return to normal activities
At the University of Chicago Medicine, our surgeons are able to recommend and perform laparoscopic colectomies in the vast majority of all the abdominal operations of the colon and rectum.
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Q. What happens during a colectomy?
A. 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 and to enable the surgeon to better view tissue. The laparoscope, a tiny telescope connected to a video camera, is placed through the cannula to allow the surgeon to see a magnified, lighted view of the internal organs on a TV monitor. Up to four additional cannulas are inserted to allow surgeons to use special instruments to work inside the abdomen.
The segment of the colon to be removed is then excluded from the body’s circulation system by dividing the feeding vessels with special instruments. The colon is freed from the attachments to other organs and/or the abdominal wall. The portion of the colon is removed through one of the small cannula incisions or in some cases, a brand new incision is created in an area that is not visible even when the patient is wearing a swimsuit.
When open surgery is indicated or recommended, the same principles are applied, but the surgeon works with his hands through a larger, single incision.
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Q. Is laparoscopic colectomy right for me?
A. Not every patient is eligible for laparoscopic colectomy. This depends considerably on the type of disease affecting the patient, how much of the colon needs to be removed and the experience of the surgeon. Additionally, several factors are also considered in recommending a laparoscopic operation, including: the patient’s body type, previous operations on the abdomen resulting in scar tissue, history of bleeding problems and pregnancy.
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Q. What happens after colon resection surgery?
A. 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 from to the surgical floor to spend the rest of his or her stay at the University of Chicago Medicine. Postoperative pain is managed with an IV pain pump controlled by the patient. However, the pump is timed so that the patient will not be able to administer an excessive dose of narcotics.
The patient is kept on an IV fluid and should not eat by mouth for the first few days until intestinal function resumes. Following this, the patient is started on a liquid diet which is then followed by a soft diet. The patient is then sent home after he or she is able to tolerate a regular diet.
For the first six weeks after the 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. No feeding tubes are needed after a colectomy unless the patient is also affected by conditions that limit the ability to absorb nutrients.
The long-term effects of colectomy depend on the amount of the colon removed. 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 the University of Chicago Medicine.
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Q. What other treatments will I need in addition to colectomy?
A. In cases of colectomy for cancer, very specific guidelines are followed at the University of Chicago Medicine in terms of administration of chemotherapy and/or radiation therapy. It is generally recommended that patients with stage III colon cancer undergo chemotherapy after surgery. Currently, a prospective randomized trial sponsored by the American College of Surgeons Oncology Group (ACOSOG) is studying patients with stage II colon cancer with markers of high risk of occurrence and the need for chemotherapy in these patients. Our surgeons are actively enrolling patients in this study.
For rectal cancer, chemotherapy and radiation therapy are recommended for patients that have stage II or III disease. These patients are usually recommended to undergo combined treatment before surgery. Several studies have shown that providing treatment before the surgery increases the chance of cancer eradication.
For inflammatory bowel disease patients, our Section of Gastroenterology 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.
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Q. What are the complications and risks associated with colectomy?
A. The potential complications after colectomy include:
- Bleeding
- Infection
- Injury to other organs, blood vessels, the ureter (the structure that carries urine from the kidneys to the bladder) and the urinary bladder
- A leak from the connection that is made between the two ends of the intestine
- Blood clots in the veins of the leg or the abdomen
- Hernia
- Obstruction of the bowel
It is important to thoroughly understand the operation and the reason for it. Prior to the surgery, ask the surgeon about the volume and number of cases annually performed, the complexity of these cases, the overall complication rate and/or success rate for malignant and benign disease.
Additionally, ask about the availability of clinical trials for a specific disease. Clinical trials will allow the patient to have access to groundbreaking new technology, drugs and protocols that could potentially make a difference between a successful surgical treatment and recurrence of the disease.
For an operation like a colectomy, it is important to find a surgeon that has had specific training in this field and extensive experience in handling complex colorectal problems. Furthermore, in complex benign and malignant colorectal diseases, a team approach offers the benefit of multiple experts working together with the patient’s best interest in mind. The University of Chicago Medicine provides patients with multidisciplinary, state-of-the-art care that can improve long-term outcomes. Our colon and rectal surgeons are highly trained in laparoscopy and are actively involved in national clinical trials and teaching courses.
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