Colectomy is a surgical procedure to remove all or part of your colon. Your colon, also called your large intestine, is a long tube-like organ at the end of your digestive tract.
Colectomy is used to treat and prevent diseases and conditions that affect the colon, such as:
- Bleeding that can’t be controlled. Severe bleeding from the colon may require surgery to remove the affected portion of the colon
- Bowel obstruction. A blocked colon is an emergency that may require total or partial colectomy, depending on the situation
- Colon cancer. Early-stage cancers may require only a small section of the colon to be removed during colectomy. Cancers at a later stage may require more of the colon to be removed
- Crohn’s disease. If medications aren’t helping you, removing the affected part of your colon may offer temporary relief from signs and symptoms. Colectomy may also be an option if precancerous changes are found during a test to examine the colon (colonoscopy)
- Ulcerative colitis. Your doctor may recommend total colectomy if medications aren’t helping to control your signs and symptoms. Colectomy may also be an option if precancerous changes are found during a colonoscopy
- Diverticulitis. Your doctor may recommend surgery to remove the affected portion of the colon if your diverticulitis recurs or if you experience complications
- Preventive surgery. If you have a very high risk of colon cancer due to the formation of multiple precancerous colon polyps, you may choose to undergo total colectomy to prevent cancer in the future. Colectomy may be an option for people with inherited genetic conditions that increase colon cancer risk, such as familial adenomatous polyposis or Lynch syndrome
There are various types of colectomy operations:
- Total colectomy involves removing the entire colon
- Partial colectomy involves removing part of the colon and may also be called subtotal colectomy
- Hemicolectomy involves removing the right or left portion of the colon
- Proctocolectomy involves removing both the colon and rectum
Colectomy surgery usually requires other procedures to reattach the remaining portions of the digestive system and permit waste to leave the body.
Colon surgery may be performed in two ways:
- Open colectomy. Open surgery involves making a longer incision in your abdomen to access your colon. Your surgeon uses surgical tools to free your colon from the surrounding tissue and cuts out either a portion of the colon or the entire colon
- Laparoscopic colectomy. Laparoscopic colectomy, also called minimally invasive colectomy, involves several small incisions in your abdomen. Your surgeon passes a tiny video camera through one incision and special surgical tools through the other incisions. The surgeon watches a video screen in the operating room as the tools are used to free the colon from the surrounding tissue. The colon is then brought out through a small incision in your abdomen. This allows the surgeon to operate on the colon outside of your body. Once repairs are made to the colon, the surgeon re-inserts the colon through the incision. Laparoscopic colectomy may reduce the pain and recovery time after surgery. But not everyone is a candidate for this procedure. Also, in some situations your operation may begin as a laparoscopic colectomy, but circumstances may force your surgical team to convert to an open colectomy
Once the colon has been repaired or removed, your surgeon will reconnect your digestive system to allow your body to expel waste.
Options may include:
- Rejoining the remaining portions of your colon. The surgeon may stitch the remaining portions of your colon together, creating what is called an anastomosis. Stool then leaves your body as before
- Connecting your intestine to an opening created in your abdomen. The surgeon may attach your colon (colostomy) or small intestine (ileostomy) to an opening created in your abdomen. This allows waste to leave your body through the opening (stoma). You may wear a bag on the outside of the stoma to collect stool. This can be permanent or temporary
- Connecting your small intestine to your anus. After removing both the colon and the rectum (proctocolectomy), the surgeon may use a portion of your small intestine to create a pouch that is attached to your anus (ileoanal anastomosis). This allows you to expel waste normally, though you may have several watery bowel movements each day. As part of this procedure, you may undergo a temporary ileostomy