Partial Colectomy

Overview

There are several forms of colectomy, such as total colectomy (removal of the whole colon) and partial colectomy (Removal of part of the colon.). Total proctocolectomy (removal of the right or left side of the colon) (Removal of the colon and the rectum.).

A partial colectomy is a form of surgery used to treat disorders of the colon. Cancer, inflammatory illness, and diverticulitis are examples of them. A section of the colon is removed during the procedure. The colon is an extension of the big intestine. When treating cancer, the surgeon will frequently remove the cancerous portion of the colon. He or she will also remove a tiny portion on either side of the cancerous region. He or she will also remove several lymph nodes nearby. The colon's remaining pieces are then joined together. Alternatively, an opening to the exterior of the body (stoma) is formed. This is known as a colostomy.

Is Colectomy a Major Surgery?

The majority of people would agree. While there is no conventional definition of major vs. minor surgery, colectomy requires a lengthy operating time and a recuperation period of up to six weeks, both of which are on the longer side. Furthermore, a colon resection alters the way food passes through your gastrointestinal tract. Some types of colectomy may change the way you use the bathroom in the future.

If the conditions are suitable, colectomy surgery can be performed using minimally invasive techniques. If you qualify for laparoscopic or robotic surgery, your procedure and recuperation time will be reduced. Smaller incisions are used in laparoscopic and robotic surgery than in traditional open surgery, resulting in quicker recovery and less discomfort overall. The type of procedure you get will be determined by your condition.

Difference Between Colectomy & Colostomy

A colectomy is a surgical procedure that removes part or all of your colon. But what happens to the rest of your intestine once the diseased tissue has been removed? That varies based on a number of circumstances. Sometimes the two remaining ends of your intestines can simply be stapled together during the same operation, allowing your digestive tract to work normally. However, this is not always achievable. In this instance, an ostomy — either an ileostomy or a colostomy — may be required. Ileostomy or colostomy can be either temporary or permanent.

Another surgical procedure is an ostomy, which establishes a new conduit for your feces to follow when the typical pathway is blocked. If your system is unable to transport your food waste via your rectum and out through your anus, you will require another route for your stool to exit. A colostomy or ileostomy allows waste to exit your body through a hole in your abdominal wall known as a stoma. To collect excrement, an ostomy bag is attached to the exterior of the stoma.

Not all colectomies necessitate an ostomy, and not all colostomies are permanent. You may only require one for a short time while your intestines heal from the colectomy. Many ostomies can be reversed within a few months, depending on your health. You may need to return to surgery to have the split ends of your intestines rejoined (anastomosis) and your stoma closed. Others may require a permanent ostomy.

What Conditions Does Partial Colectomy Treat?

Many problems can occur that may require part of your colon to be removed.

Conditions commonly treated with colectomy include:

Cancer of the colon. When cancer is discovered in your colon, it is critical to remove the cancerous area of your colon in order to determine the stage of cancer and prevent it from spreading.
Conditions that are precancerous. If a colonoscopy finds changes in your colon that have a high chance of advancing to cancer, your healthcare professional may advise you to have that piece of your colon removed as a preventative measure. If you have a hereditary disorder with a high risk of developing colon cancer, such as familial adenomatous polyposis (FAP) or Lynch syndrome, you may choose for an elective colectomy.
Large bowel obstruction. If your colon is significantly clogged and previous therapies have failed, surgery to remove the obstruction may be necessary. A twist (volvulus) or narrowing (stricture) of the large intestine can produce a blockage.

In persistent and severe cases, colectomy may be used to treat:

Inflammatory bowel disease (IBD). If your colon has been extensively damaged by ulcerative colitis or Crohn's disease, your doctor may recommend a colectomy to treat symptoms.
Diverticulitis. When diverticulitis develops regularly, does not improve with medical treatment, or causes damage to other surrounding organs, a colectomy may be required.
Uncontrollable bleeding. Colon injury and bleeding are tough to treat from the outside. When bleeding cannot be stopped, it becomes risky, and colectomy becomes a safer option.

Contraindications

Colectomy has no absolute contraindications; however, the patient's general medical condition and the justification for surgery should be reviewed on a case-by-case basis.

A patient with significant heart disease with a big polyp in the cecum that cannot be removed colonoscopically is a classic difficult case. The risks and advantages of the surgical operation must be weighed against the expected effects of inaction by the physician. A patient with serious heart illness or who is unable to tolerate anesthesia may be ineligible for surgery. Discussing potential consequences with the patient and his or her family should be standard procedure.

Laparoscopic colectomy has certain relative contraindications in terms of approach. A laparoscopic method may be ruled out due to intra-abdominal adhesions or scar tissue from previous abdominal surgical operations. Furthermore, phlegmon from perforated diverticulitis would make laparoscopic colectomy difficult.

As with all laparoscopic abdominal procedures, the patient's inability to tolerate insufflation is a contraindication for laparoscopic colon resection. Preoperative pulmonary function studies are therefore advised in patients suspected of having breathing difficulties.

The surgeon should also take note of any bleeding disorders or liver problems the patient has. Though not an absolute contraindication, portal hypertension can result in significant bleeding intraoperatively, a dangerous and difficult scenario to control even in the best of circumstances.

Finally, if a 15-cm tumor must be removed or if a tumor is infiltrating the abdominal wall muscle or pelvic attachments, the choice to do laparoscopy may be influenced by the particular surgeon's skill set.

Before the Procedure

A thorough evaluation by your medical team is required prior to undergoing a colectomy. This procedure is used to stage your cancer and arrange your operation. Special X-rays, blood tests, and an EKG may be required. You might need a colonoscopy. This is a surgery that allows you to see within your colon and rectum. It is accomplished using a flexible, illuminated scope and a small video camera.

Before surgery, here's what to expect:

The operation requires that your bowels be emptied. You will need to modify your diet and drink consumption in the days leading up to surgery. Follow all directions from your healthcare team.
Bowel prep may be required 1 to 2 days before the surgery. A laxative and enemas may be used to clear out the colon.
The day before surgery, you may be instructed to drink only clear liquids or broth. You may also be instructed not to eat or drink anything for up to 12 hours before the treatment.
Some medications may need to be discontinued in the week preceding surgery. This includes any blood-thinning medications.

Partial Colectomy Surgery

The specifics of your colectomy surgery will be determined by the kind of procedure and the surgical approach employed. However, the procedure will follow a broad pattern.

General procedure:

In general, you can expect your provider to:

Put you to sleep under general anesthesia.
Make one or more incisions in your abdomen (belly area).
Carefully separate and remove the affected colon tissue.
Connect the healthy bowel ends using staples or sutures, or
Create a stoma and redirect your bowel end to the stoma.
Close your abdominal incisions.

Open vs. laparoscopic/robotic surgery:

Your surgeon may perform a typical open colectomy or a minimally invasive laparoscopic colectomy.

Open surgery: The abdominal cavity is opened up with a single lengthy incision in open surgery. This procedure allows for the most convenient access to your organs and may be required if your condition is more difficult or if you are undergoing emergency surgery.

Laparoscopic and robotic surgery: are conducted through a series of small incisions with the use of a tiny video camera known as a laparoscope. If you are having a laparoscopic/robotic colectomy, the surgeon will start with a single tiny incision to insert the laparoscope. They'll inject gas through the incision to expand your abdominal cavity and project your organs onto a TV screen. One or more further small incisions will allow your surgeon to reach your colon with special instruments through one or more additional minor incisions.

The advantages of laparoscopic surgery are as follows:

Shorter hospital stay (which does not appear to be associated with an increased risk of readmission.
Faster return to activities of daily living.
Lower rate of perioperative complications.
Decreased formation of adhesions, and thus reduced occurrence of intestinal obstruction.

Colon resection variations:

You may need all or part of your colon removed. The operations for removing various parts of the colon have distinct names.

A subtotal or partial colectomy removes a piece of your colon. Your procedure may have a more precise term that refers to the piece of your colon that is being removed. For example:

Sigmoid colectomy: A sigmoid colectomy, also known as a sigmoidectomy, removes the final piece of your colon, known as the sigmoid colon. This is the portion that attaches to your rectum.
Hemicolectomy: A hemicolectomy involves the removal of one side of your colon. The descending colon, which runs downhill on the left, is removed during a left-side hemicolectomy. This is located in the second portion of your colon. The ascending colon, which runs upward on the right side, is removed during a right-side hemicolectomy. This is around half of your colon.
Proctocolectomy: A proctocolectomy involves the removal of a portion of the colon as well as the rectum. "Procto" is Latin for "rectum." (A total proctocolectomy involves the removal of the whole colon and rectum.)

Anastomosis or ostomy:

After your bowels have been resected, your surgeon may be able to immediately reconnect the severed ends. Or they may have to wait and join them later in another procedure. Sometimes they can't reattach your bowels. Your colectomy will end with one of these procedures:

Anastomosis: it occurs when the two ends of your bowels are united, reuniting your intestines. Many, if not the majority, colectomies end in this manner.

Colostomy / Ileostomy: If your bowels are unable to be rejoined during your colectomy, your surgeon will construct a stoma in your abdominal wall. They'll route the top part of your intestines to the stoma. If the initial section of your colon that linked to your small intestine was removed during your colectomy, the end of your small intestine will be rerouted to your stoma. This is known as an ileostomy, after the ileum, the last section of the small intestine. If the colectomy removes a segment of your colon from the middle or end, the upper portion of your colon will be rerouted to your stoma in a colostomy. These procedures might be either temporary or permanent.

Ileal pouch: If you underwent a total proctocolectomy, which removed your whole colon and rectum, you may be a candidate for an ileaoanal anastomosis. With the insertion of an ileal pouch, your ileum can be linked directly to your anus. The pouch serves as an internal substitute for a colostomy or ileostomy bag. Your surgeon builds the pouch from the ileum to act as a reservoir for waste storage, similar to what your rectum used to do. This technique is frequently performed during follow-up procedures, but it can also be performed as part of your proctocolectomy surgery.

Partial Colectomy Recovery

The extent of the operation will determine how quickly you recover from a colectomy. The length of your hospital stay will be determined by the procedure you have and the time required for recuperation.

Before leaving the hospital, you will be instructed how to care for your surgical incisions and stoma (if present), as well as any other instructions. A professionally trained stoma nurse/therapist will give you detailed advice on how to care for the stoma (if present).

Your medical team will discuss the drugs you will be taking with you, such as those for pain, blood clot, infection, and constipation prevention, as well as those for other disorders.

When you go home, your provider will tell you what you should and should not do. This will frequently include:

Do not lift anything heavier than a particular weight, climb, or engage in intense exercise unless you are advised you may.
Change your diet as directed. Following surgery, you may be instructed to follow a low-residue (low fiber) diet.
Unless otherwise directed, drink 8 to 10 glasses of water each day.
Try not to strain to have a bowel movement.
Do not drive if you are under the influence of pain medication.
Depending on your career, you may usually return to work in 2-3 weeks.
Discuss showering, immersing surgical incisions in water, food, sexual activity, and stoma care with your healthcare team.

Risks

Colectomy carries a risk of serious complications. Your risk of complications is based on your general health, the type of colectomy you undergo and the approach your surgeon uses to perform the operation.

In general, complications of colectomy can include:

Bleeding.
Blood clots in the legs (deep vein thrombosis) and the lungs (pulmonary embolism).
Infection.
Injury to organs near your colon, such as the bladder and small intestines.
Tears in the sutures that reconnect the remaining parts of your digestive system.

You'll spend time in the hospital after your colectomy to allow your digestive system to heal. Your health care team will also monitor you for signs of complications from your surgery. You may spend a few days to a week in the hospital, depending on your condition and your situation.

Foods to Eat After a Colectomy

Diarrhea and dehydration are some of the most prevalent side effects of a colectomy. These symptoms might occur because your colon has not yet resumed normal function. The colon absorbs fluids as one of its functions. Diarrhea and dehydration might develop if this is not done properly.

Applesauce, bananas, pears, peaches, melons, and other foods that are simple to digest can help to reduce diarrhea. Cooked beets, boiled white rice Rice cream or wheat cream, Low-carbohydrate cereals (avoid high-fibre cereals like wheat bran), pasta, peanut butter, potatoes, pretzels, spinach Yogurt, tapioca, and angel food cake or white bread or toast

Eggs, cooked fish or tender meat, mild cheese, soft-cooked fruits or vegetables, pudding, sherbet, and ice cream are some low-residue meals.

Foods to Avoid Following a Colectomy

Since you are still healing, it's best to stay away from foods that might carry the risk of food poisoning. These include:

Non-pasteurized soft cheeses (choose only pasteurized cheese)
Undercooked meat
Uncooked fish (avoid sushi for the time being)
Fruits or vegetables that you haven't thoroughly washed

Having surgery may make you more likely to get an infection. And food poisoning shortly after a colectomy could land you back in the hospital.

Conclusion

A partial colectomy is a procedure that removes a portion of your colon. It is also known as colon resection surgery. A colectomy may be required if part or all of your colon has ceased working or if it has an incurable illness that puts other sections of your body at risk. Colon cancer and inflammatory bowel disease are two common causes.

A colectomy can be performed in two ways: open or laparoscopically assisted. The surgeon may suture the severed ends of the colon together so that waste may exit your body naturally. Alternatively, the colon may need to be connected to an aperture (stoma) in the abdominal wall, where waste exits the body and accumulates in a bag linked to the hole. Stomas are normally transient, although they can become permanent.

If you have any of the following symptoms, contact your doctor: Fever of 100.4°F (38°C) or higher, or as advised by your doctor, Swelling, redness, bleeding, or leaking fluid from the incision Pain that worsens, Breathing difficulty.