Colectomy

The colectomy is performed to prevent and treat various diseases of the colon, which are as mentioned below:

• Obstruction in the bowel – Colon may get blocked or obstructed which leads to an emergency situation. The patient may require partial or total colectomy surgery depending on the blockage level.
• Uncontrolled bleeding – In some people there may be bleeding from the colon, which will need an immediate colectomy to get rid of the affected part.
• Crohn's disease – This is an inflammatory bowel disease, which may require surgery or colectomy, if the symptoms are not cured by medications. Removing the affected portion of the colon may provide temporary relief from the severe signs and symptoms of Crohn's disease. Colectomy is also useful if any precancerous changes are seen during an examination test of the colon.
• Colon cancer – In the early stage of cancer detection, only a small part of the colon is affected and removed. But in later stages, as cancer grows and spreads, a large part of the colon or the entire colon may be removed. This depends on the size of cancer affected area.
• Ulcerative colitis – It is also one of the inflammatory bowel diseases, which may require surgery or colectomy, if the symptoms are not cured by medicines. Removing the affected portion of the colon may provide temporary relief from the severe signs and symptoms of ulcerative colitis. Colectomy is also useful if any precancerous changes are seen during an examination test of the colon.
• Diverticulitis – This is also an inflammatory disease affecting the diverticulum (a part of the colon). The doctor may recommend a partial colectomy surgery if the diverticulitis recurs or if there are severe complications from the diverticulitis.
• Preventive surgery – If a patient is at an increased chance of getting colon cancer from the multiple colon polyps (precancerous), then the doctors might advise to get the entire colon resected (total colectomy) to prevent colon cancer in future. Also getting a colectomy done is recommended for people who have inherited genetic colon cancers e.g. Lynch syndrome or familial adenomatous polyposis.
• Colon tumor (no involvement of rectum)
• Colonic inertia or severe constipation
• Rectal prolapse
• Large colon polyps which are difficult to be removed by colonoscopy.
• Bowel incontinence
• Volvulus i.e. the abnormally twisted bowel.
• Intussusception i.e. a condition where one part of the intestine slides into the other part of the intestine.

The complications associated with the colectomy depends upon the condition of the patient and the type of colectomy a patient undergoes. Some of the complications related to this surgical procedure are as mentioned below:

Risks associated with any surgery are as follows:

• Heavy bleeding
• Infections e.g. pneumonia
• Cardiac arrest

After waking up from the effect of general anesthesia patients might face some of the following problems:

• Nausea
• Vomiting
• Uneasiness
• Dizziness
• Breathing difficulty
• A temporary state of confusion
• A feeling of cold or shivering
• Allergic reactions to the medicine given during the colectomy procedure.

Complications related to the colectomy:

• Injury in the surrounding organs to the colon such as urinary bladder and small intestine.
• Tear in the suturing, done to connect the remaining parts of the digestive tract.
• Infection at the surgical site
• Bleeding from the colon or abdomen.
• Leakage of the waste or stool from the suturing between the rectum and the small intestine, leading to abscess and infection.
• Scarring of the tissue between the rectum and the small intestine leading to obstruction or blockage of the intestine.
• Opening of the wound, known as dehiscence.
• Skin irritation in some patients.

The doctor will discuss the colectomy procedure, along with its benefits and risks, with the patient in detail. Some points to be taken into consideration are as mentioned:

Before the procedure:

• The doctor takes a complete medical history and physical examination test before performing the surgical procedure. The patient may be asked about the age and weight of the patient, any past surgeries, allergies to any medicines, previous personal history and family history of heart attacks. In the physical examination, the doctor examines the patient very carefully for any other concerning signs and symptoms.
• The doctor also advises some tests such as some blood investigations, before the surgery
• If a patient is diabetic, the patient is advised to ask the doctor if he/she should continue taking insulin before the procedure or not. The patient is also asked to inform the doctor about any past allergies or surgeries, if any.
• The patient is advised to quit smoking, avoid alcohol, avoid drinking or eating anything after midnight or one night before the bypass surgery.
• The patient is advised to empty the urinary bladder and bowel, before the test.
• Antibiotics are advised before the surgery in order to suppress the naturally present bacteria from the colon and also to avoid any infections.
• The patient has to remove or avoid any jewelry, eyeglasses, hairpins, electronic gadgets or any metal objects and is asked to change into a hospital gown, during the procedure
• The surgical procedure needs hospitalization and hence, the patient should be prepared for that

During the procedure:

The vital signs of the patient are checked. The pulse rate and the amount of oxygen in the blood is checked through a pulse oximeter. A blood pressure cuff is tied on the arm of the patient to monitor the blood pressure. An antibiotic medicine is then given to the patient through the vein in the arm.

The patient is then taken to the operation theatre and made to lie on the operation table. General anesthesia is given to the patient to prevent from feeling any pain during the surgery. When the patient is unconscious, a breathing tube may be put in the mouth and attached to the ventilator on the other end. This helps the patient to breathe normally during and even after the surgery (for some time).

The colectomy procedure can then be performed in two ways, as mentioned below.

• Open colectomy – In this procedure, a large incision is made on the abdomen of the patient to reach the colon. The surgeon then uses special surgical tools to cut the affected part or entire affected colon, depending upon the severity of the problem.
• Laparoscopic colectomy –
  • This type of laparoscopic procedure is known as a minimally invasive colectomy. In this type of surgical procedure, the surgeon makes 4 to 5 (length of a quarter inch) small incisions on the abdomen of the patient.
  • Through one incision, a small camera is put inside to see clearly and through the other incisions, surgical tools are put to work on the affected part. The aforementioned small camera is attached to a big screen outside in the operating room for the surgeon to see how to proceed with the surgery.
  • The affected colon or a part of the colon is then separated from the normal tissue. It is taken out through another small incision made. The surgeon then works on the colon repair outside the patient’s body.
  • When the repair is done, the colon is put back into its normal position.
  • If the large part or entire colon is extracted, then the surgeon needs to connect the remaining parts of the digestive tract together for the elimination of the waste properly through the rectum.
  • The surgeons can also alternatively, connect the small intestine or colon to an opening in the abdomen. This will make the waste elimination from the body through the opening in the abdomen. The patient would be asked to wear a bag outside that abdomen opening to collect stool. This can either be a temporary or permanent procedure, depending upon the parts affected inside the body.
  • In some cases, if the rectum and the colon both are affected, then the surgeon might have to remove the rectum and the colon from the patient’s body. in such cases, the surgeon attaches a small pouch-like part of the small intestine to the anus. This will help to excrete waste from the body.

After the procedure:

After the surgery, the patient is shifted in the recovery room, wherein, he/she is kept under continuous monitoring and observation. The vital signs e.g. pulse rate, body temperature, oxygen levels or breathing rate, and heart rate, are monitored continuously.

The patient will remain on the ventilator for some time until the condition of the patient is completely stable and he is able to breathe on his own. The patient is usually discharged once the bowel movements are regained and if any complications do not appear.

Initially, the patient is unable to digest solid food and hence, the doctors advise a liquid diet through the veins (IV). Slowly the patient would be asked to start taking liquids from the mouth. Once the intestine recovers fully, the patient is able to digest the solid food items properly.

For a few weeks, it would be difficult for the patient to return to normal activities due to the weakness. However eventually, the patient can return to the workplace after consulting the doctor.

In the case of excretion of waste through an abdominal opening, the nurse informs the steps to take care of the bag (ostomy bag) of waste, properly at home.

The recovery after the laparoscopic colectomy takes lesser time as compared to the open colectomy surgery. Regular follow-ups are necessary to keep a close check on the treatment progression and also in case colon cancers and medical care continues for a very long time. After the full recovery, the patient is able to eat and drink normally. If the patient faces constipation after going home, the doctor should be informed immediately.