Colectomy

Generality

Colectomy is the surgical operation of removing the entire colon or part of it only.
Executable with a traditional surgery or laparoscopy, colectomy allows to cure or prevent various morbid conditions affecting the large intestine.

Resection of the diseased colon tract during a colectomy.

Image taken from: www.obesitysurgeryassociates.com

In addition to total colectomy and subtotal colectomy (i.e. of a part of the colon), there are also "hemicolectomy (with which only the right colon or only the left colon is removed) and proctocolectomy (with which the colon and rectum are removed. together).
Colectomy surgery requires special preparation and is performed under local anesthesia.
At the end of the procedure, the patient is injected for a few days and usually remains hospitalized for about a week.

What is a colectomy?

Colectomy is surgery aimed at the total or partial removal of the intestinal tract called the colon.
Obviously, during each colectomy the recanalization of the intestine must also be practiced, in order to allow the transit (therefore also the expulsion) of the faeces again.

WHERE IS THE COLON FOUND? BRIEF RECALL OF THE 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 the small intestine, and the large intestine, also called the large intestine.

The small intestine is the first tract; it begins at the pyloric valve, which separates it from the stomach, and ends at the ileocecal valve, located on the border with the large intestine. The small intestine is made up of three sections (the duodenum, the jejunum 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 digestive system. It begins at the ileocecal valve and ends at the anus; it 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, the colectomy takes on a different specific name; this name refers to the portion of the large intestine removed.
Therefore, the following types of colectomy exist:

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

When you do

Colectomy is performed to prevent or treat certain morbid conditions that can arise in the colon.
These morbid conditions consist of:

• Colon cancer. The more advanced the colon cancer is, the larger the portion of the intestine is removed. In cases of very severe malignant neoplasms, 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 alvus and abdominal pain, Crohn's disease and ulcerative colitis require colectomy when the prescribed drug therapies have not produced satisfactory results or when precancerous cells have been found during a control colonoscopy.
• 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 bleeding. When intestinal blood loss is severe and shows no improvement, partial colectomy may be the only therapeutic solution. The intestinal area removed is obviously the bleeding one.
• Intestinal polyps. Intestinal polyps are benign tumors, which, however, in some cases can turn into malignant formations. To prevent this complication, a partial colectomy can be used, through which the intestinal region presided over by polyps is eliminated.

Risks

Like any surgical operation, colectomy can also involve 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 the surgery

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

• An injury to the bladder or small intestine caused by surgical instruments.
• A faecal transit problem. 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 to be operated on must be subjected to the following clinical checks:

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

If no contraindications of any kind emerge, the operating surgeon (or a member of his staff) will illustrate the procedures, the possible risks, the pre- and post-operative recommendations and, finally, the recovery times.

The main pre- and post-operative recommendations:

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

COLECTOMY D "EMERGENCY

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

Procedure

Colectomy can be performed with a traditional surgery (also called "open") or with a laparoscopic surgery (or laparoscopic surgery).
Before anesthetizing the patient, this is connected to various devices that will measure, for the duration of the operation, his vital parameters (blood pressure, heart rate, blood oxygenation, etc.).

TRADITIONAL COLECTOMY

During the "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.

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

After recanalization, he closes the large abdominal incision with sutures.

LAPAROSCOPIC COLECTOMY

During laparoscopic colectomy, the surgeon makes (always 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 section of colon to be operated on. once the diseased areas have been removed and the recanalization carried out, he reinserts the modified colon in its original location and stitches 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 via sutures and thus re-establish a passage for the stool very similar to the normal one. In these cases, there is a danger that the sutures will loosen over time.
• It can connect the remaining part of the colon to an "opening in the abdomen" (colostomy); this opening is connected to a collection bag for feces. Depending on the case, the colostomy can be temporary or permanent.
• In the case of proctocolectomy (removal of the colon and rectum), it can join the small intestine to the anus.

COMPARISON OF TRADITIONAL COLECTOMY AND LAPAROSCOPIC COLECTOMY

The "open" colectomy surgery is certainly more invasive and requires longer recovery times, compared to the laparoscopic colectomy operation. However, it allows the surgeon to operate with greater precision.
By means of laparoscopic surgery, in fact, the risk of damaging the organs adjacent to the colon (bladder, small intestine, etc.) is by no means negligible.

Post-operative phase

At the end of the colectomy, there is a period of hospitalization lasting a maximum of one week. During this period, the medical staff monitors the condition of the patient and his intestines at regular intervals.
Generally, until the end of hospitalization, the feeding takes place intravenously (parenteral feeding), as the intestine has not yet healed sufficiently to be able to digest and absorb solid foods.
After discharge, the patient is likely to still feel pain and feel particularly tired. Both are normal sensations, which tend to resolve over time.
It is good to undergo periodic medical checks and contact your doctor at the slightest appearance of abdominal discomfort, blood in the stool, etc.

If a colostomy has been performed, medical staff 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 it to be performed. In fact, the more severe the intestinal problems, the less long-term benefits a colectomy can provide.