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Large bowel resection

Definition

Large bowel resection is surgery to remove all or part of your large bowel. This surgery is also called colectomy. The large bowel is also called the large intestine or colon.

• Removal of the entire colon and the rectum is called a proctocolectomy.
• Removal of part or all of the colon but not the rectum is called subtotal colectomy.

The large bowel connects the small intestine to the anus. Normally, stool passes through the large bowel before leaving the body through the anus.

Alternative Names

Ascending colectomy; Descending colectomy; Transverse colectomy; Right hemicolectomy; Left hemicolectomy; Hand assisted bowel surgery; Low anterior resection; Sigmoid colectomy; Subtotal colectomy; Proctocolectomy; Colon resection; Laparoscopic colectomy; Colectomy - partial; Abdominal perineal resection

Description

You will get general anesthesia before your surgery. This will make you asleep and pain-free. The surgery can be performed laparoscopically or with open surgery.

Depending on what type of procedure you have, your surgeon will make one or more cuts in your belly.

In a laparoscopic colectomy, the surgeon uses a camera to see inside your belly and small instruments to remove part of your large bowel. You will have three to five small cuts in your lower belly. The surgeon passes the medical instruments through these cuts.

• You may also have a cut of about 2 to 3 inches if your surgeon needs to put a hand inside your belly to feel or remove the diseased bowel.
• During laparoscopy, your belly will be filled with gas to expand it. This makes the area easier to see and work in.
• Your surgeon will remove the diseased part of your large bowel.
• The surgeon will then sew the healthy ends of the bowel back together. This is called anastomosis.
• Then the cuts on the skin will be closed with stitches.

For open colectomy, your surgeon will make a 6- to 8-inch cut in your lower belly.

• The surgeon will find the part of your colon that is diseased.
• The surgeon will put clamps on both ends of this part to close it off.
• Then the surgeon will remove the diseased part.
• If there is enough healthy large intestine left, your surgeon will sew or staple the healthy ends back together. Most patients have this done.
• If you do not have enough healthy large intestine to reconnect, you may have a colostomy.

In most cases, the colostomy is short-term. It can be closed with another operation later. But, if a large part of your bowel is removed, the colostomy may be permanent.

Your surgeon may also look at lymph nodes and other organs, and may remove some of them.

Colectomy surgery usually takes between 1 and 4 hours.

Why the Procedure Is Performed

Large bowel resection is used to treat many conditions, including:

• A block in the intestine due to scar tissue
• Colon cancer
• Diverticular disease (disease of the large bowel)

Other reasons to perform bowel resection are:

• Familial polyposis
• Injuries that damage the large bowel
• Intussusception (when one part of the intestine pushes into another)
• Precancerous polyps (nodes)
• Severe gastrointestinal bleeding
• Twisting of the bowel (volvulus)
• Ulcerative colitis

Risks

Talk with your doctor about these possible risks and complications.

Risks for any anesthesia are:

• Reactions to medicines
• Breathing problems

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Heart attack or stroke
• Infection, including in the lungs, urinary tract, and belly

Risks for this surgery are:

• Bleeding inside your belly
• Bulging tissue through the surgical cut, called an incisional hernia
• Damage to nearby organs in the body
• Damage to the ureter or bladder
• Problems with the colostomy
• Scar tissue that forms in the belly and causes a blockage of the intestines
• The edges of your intestines that are sewn together come open (anastomotic leak -- this may be life-threatening)
• Wound breaks open (dehiscence)
• Wound infections

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

Talk with your doctor or nurse about these things before you have surgery:

• Intimacy and sexuality
• Pregnancy
• Sports
• Work

During the 2 weeks before your surgery:

• Two weeks before surgery you may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), Naprosyn (Aleve, Naproxen), and others.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your doctor for help.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.
• Eat high fiber foods and drink 6 to 8 glasses of water every day.

The day before your surgery:

• A few days before surgery, you will be given a bowel prep that includes drinking fluids and taking laxatives and enemas. This is done to make sure that the colon is free of any stool.
• You may be asked to drink only clear liquids such as broth, clear juice, and water after noon.
• Do NOT drink anything after midnight, including water. Sometimes you will not be able to drink anything for up to 12 hours before surgery.

On the day of your surgery:

• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You will be in the hospital for 3 to 7 days. You may have to stay longer if your colectomy was an emergency operation.

You may also need to stay longer if a large amount of your small intestine was removed or you develop any complications. By the second or third day, you will probably be able to drink clear liquids. Your doctor or nurse will slowly add thicker fluids and then soft foods as your bowel begins to work again.

Outlook (Prognosis)

Most people who have a large bowel resection recover fully. Even with a colostomy, most people are able to do most activities they were doing before their surgery. This includes most sports, travel, gardening, hiking, and other outdoor activities, and most types of work.

If you have a long-term (chronic) condition, such as cancer, Crohn's disease, or ulcerative colitis, you may need ongoing medical treatment.

References

Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Coln and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 50.