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Colectomy

(Other names: Hemicolectomy, partial colectomy, or segmental resection) A colectomy is a surgical procedure used to treat colon cancer.

The surgery involves removing a portion of the colon, or large intestine, usually about one-third to one-fourth of it. The surgeon will typically remove the portion of the colon that appears cancerous, as well as another small portion on either side of the cancerous part and some nearby lymph nodes. The remaining parts of the colon are then attached to each other.

A colectomy can be done in two ways. The traditional procedure is an open colectomy, in which a long incision is made on your abdomen to give the surgeon adequate access to the colon. The newer form of colectomy is a laparoscopic-assisted colectomy, in which only small incisions are made, and a tiny camera is inserted into one of the incisions to help the surgeon see the area being worked on. This may be an option for earlier stage cancers.

Hospital Stay: Hospital Stay: 5 days
Duration: Duration: 2-3 hrs
Cost Estimate: Cost Estimate: 3500 USD - 9500 USD These are indicative prices in Indian Hospitals

A colectomy is usually performed if colon cancer is caught in its earlier stages. Sometimes even when the cancer has progressed beyond the early stages, a more extensive colectomy can be an option.
Your health care provider will recommend a colectomy if your medical team has been determined that this surgery will give you the best chance of survival.

  • Bowel obstruction
  • Colon cancer
  • Crohn’s disease
  • Ulcerative colitis
  • Severe bleeding from the colon that can’t be controlled
  • Diverticulitis
  • Preventive surgery – Colectomy may be an option for people with inherited genetic conditions that increase colon cancer risk, such as familial adenomatous polyposis or Lynch syndrome.

Risks of the procedure

Colectomy is generally regarded as a fairly safe procedure, and there are rarely any major complications from it. Still, as with any surgery, it carries some possible risks. Be sure to discuss any concerns with your health care provider before the procedure.

Some possible risks of a colectomy include:

  • Internal bleeding
  • Infection
  • Hernia
  • Scar tissue
  • Blockage of the intestines
  • A leak where the intestines are sewn together
  • Damage to nearby organs

Before the procedure

  • It is important that the bowels be empty when the surgery is performed. You must follow your health care provider’s instructions on dietary changes and liquid intake on the days leading up to surgery.
  • A day or two before the procedure, your health care provider may give you a bowel preparation that includes laxatives and enemas.
  • The day before the procedure, you may be instructed to only drink clear liquids or broth; you may be told not to have any food or beverages at all up to 12 hours before the procedure.
  • Your health care provider may ask you to stop taking certain medications during the week leading up to the surgery.

Based on your medical condition, your health care provider may request other specific preparations.

During the procedure

  • You will receive general anesthesia before the surgery, and you will be completely asleep during the procedure.
  • Your surgeon will make a long cut on your abdomen if performing an open colectomy or several smaller incisions for a laparoscopic-assisted colectomy.
  • The surgeon will use surgical tools to remove the targeted portion of your colon.
  • The two open ends of the colon will be attached.
  • The lymph nodes near the site of the cancer will also be removed at this time. Surgeons often remove at least 12 of these lymph nodes.
  • Once the surgery is complete, the abdominal incision is closed.

After the procedure

A colectomy is a major surgical procedure and you will probably be in the hospital for three to seven days. You’ll likely need to take pain medication for two to three days, and you’ll also receive nutrition from an IV drip. You may be allowed some limited liquids as the colon begins to recover.

After a few days, you should be able to start on solid food again. Your doctor will schedule follow-up appointments to check on your progress. Most people who have a colectomy have a good prognosis and can expect to live a normal life after their recovery.

If surgery involves a colostomy or ileostomy to attach intestine to the outside of abdomen, training is required for care of stoma and how to change the ostomy bag that will collect waste.

Once you leave the hospital, expect a couple of weeks of recovery at home. You may feel weak at first, but eventually your strength will return.

A colectomy is the removal of part of the colon (partial colectomy) or the entire colon (total colectomy), also known as the large intestine. Colectomy can be used to treat a variety of diseases, including removal of colon or rectal cancer or large polyps (growths that arise on the lining of the colon), diverticular disease, inflammatory bowel disease (Crohn’s disease or ulcerative colitis), or bleeding that cannot be stopped. The portion of the colon removed depends on the nature of the disease.

Colon resection can be performed in two ways: conventional open surgery or laparoscopic surgery.

Conventional Open Colectomy
An open colectomy uses a long incision down the center of the abdomen. When this method is required, the recovery period in the hospital is usually, but not always, longer.

Laparoscopic/Minimally Invasive Colectomy
With a laparoscopic or minimally invasive colectomy, the surgeon uses several very small incisions and specialized instruments to perform the operation. The exact same operation is performed on the inside as with an open colectomy. However, there is less pain and recovery is usually faster.

If a colectomy is recommended for a benign, or non-cancerous, growth, it is usually because that growth is symptomatic in some way (bleeding or causing a blockage) or to prevent it from progressing into a cancer. In the case of diverticulitis or inflammatory bowel disease, colectomy is used to remove a segment that is affected by severe inflammation or infection.

When a colectomy is needed to treat a malignant (cancerous) tumor, the surgeon must remove both the tumor and the vascular and lymph structures supplying that portion of the colon. This operation can be curative, depending on the stage of the cancer. Patients who have a colectomy for cancer will meet with a medical oncologist soon after they have recovered from surgery to determine if further treatment such as chemotherapy is required.

While laparoscopic surgery for colon cancer is an established and valuable option, the benefit 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.

The advantages of a laparoscopic colectomy include reduced postoperative pain due to a shorter incision and decreased exposure of the intra-abdominal viscera to air, compared to an open colectomy. Additional benefits include shorter hospital stay, smaller surgical scars, and faster return to normal activities including work. The gastrointestinal tract usually recovers more rapidly so patients can resume eating sooner. It is sometimes possible to avoid the need for narcotic pain medicines completely after a laparoscopic colectomy.

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. A laparoscope is a tiny telescope connected to a video camera. It is placed through the cannula to allow the surgeon to see a magnified, lighted view of the internal organs on a high-definition monitor. Up to four more ports are inserted to allow the surgeon and an assistant to use specialized instruments to work inside the abdomen.

The segment of the colon to be removed is then freed from the attachments to other organs and/or the abdominal wall. The blood vessels supplying only that segment are then sealed with a specially designed energy device and divided. One of the cannula incisions is then enlarged slightly and the segment of colon is then extracted out of the abdomen. The two remaining ends of the colon are then reconnected, either with a surgical stapler or sutures.

When open surgery is indicated or recommended, the same principles are applied, but the surgeon works with traditional handheld instruments through a larger, single incision.

Not every patient is eligible for laparoscopic colectomy. This depends on the type of disease affecting the patient and the training of the surgeon. Several other factors are considered including the patient’s body type and overall health, previous operations on the abdomen resulting in scar tissue, history of bleeding problems and pregnancy.

An ileostomy or colostomy is when a portion of the small intestine or colon is brought out to the skin through a surgical opening the abdominal wall. Instead of eliminating with a bowel movement, intestinal waste passes into a specially fitted low-profile appliance, also known as a pouching system or a bag. Whether or not a patient will require a stoma depends on the nature of their disease. Temporary and even permanent ileostomies are sometimes required after certain operations for inflammatory bowel disease, and for some rectal cancer operations. If the rectal cancer involves or is close to the anal sphincter mechanism, a permanent colostomy could be required. Patients who may require a stoma work closely with a team of highly experienced enterostomal nurses to learn how to manage their stoma. Patients with stomas are able to live healthy, active lives and enjoy all of the activities they used to do before they had a stoma.

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 to the surgical floor to spend the rest of his or her stay at the University of Chicago Medicine. Post-operative pain is kept at a manageable level by providing a combination of medicines that have been found to reduce the need and frequency of narcotic pain medications. Narcotic pain medications are often necessary but do slow recovery of the gastrointestinal tract.

The patient is kept on IV fluid initially and can often start taking liquids and even solids foods as soon as they feel hungry or thirsty. Within the University of Chicago Section of Colon and Rectal Surgery, we advise patients to self-regulate their oral intake during recovery and slow down or stop if they have nausea or feel full. The gastrointestinal tract does not always start functioning again all at once, and the time it takes for normal digestion to resume can be variable. Walking and minimizing narcotic pain medications will speed this process.

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.

The long-term effects of colectomy depend on the amount of the colon removed. If a part of the colon is removed, patients may notice little change in their bowel function or frequency of bowel movements. 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

The potential complications after colectomy include bleeding and infection, injury to nearby structures including the intestines, the bladder, blood vessels, and the ureter (a tube that carries urine from the kidney to the bladder). It is always possible that a leak can occur where the intestines were reconnected (the anastomosis). Blood clots can occur in the veins, and these can travel to the lungs. Hernia at the surgical incisions or bowel obstruction from internal scar tissue can also occur, even years later.

It is important to thoroughly understand the operation and the reason for it. 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. Prior to the surgery, ask the surgeon about the volume and number of cases annually performed, the complexity of these cases, and their own overall complication rate.

It is generally recommended that patients with Stage 3 colon cancer undergo chemotherapy after surgery. Patients with Stage 2 or 3 rectal cancer are usually recommended to undergo a combination of chemotherapy and radiation before surgery. These patients will receive more treatment with chemotherapy after the operation. Several studies have shown that this treatment approach reduces the chance of cancer recurrence.

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