Dr. Nicholas P. McKenna, MS, MD

A colectomy may be performed by laparoscopic or open surgery. A laparoscopic colectomy requires several small cuts on the abdomen, and uses a thin tube with a camera, called a laparoscope. Laparoscopic colectomies are less invasive than open procedures. For some individuals, a laparoscopic colectomy may not be possible, and instead an open colectomy is performed. In an open colectomy, a large incision is made on the abdomen. Open colectomies typically require longer recovery periods.

After the incisions are made, a portion of the colon is removed, and the remaining ends of the colon are attached to each other in a procedure called anastomosis. Waste can continue to travel through the body as normal. However, in some situations, it may be necessary for the end of the colon to be attached to an opening in the abdomen, called a stoma. This procedure is called an ostomy. Types of ostomies include:

• Colostomy, in which the remaining portion of the colon is attached to the abdominal opening.
• Ileostomy, in which the small intestine is attached to the abdominal opening.

An ostomy bag will be attached to the skin to collect waste. If the entire colon is removed, either an ileostomy is performed, or the small intestine is connected to the anus and waste may pass through as normal.

Stomas may be permanent or temporary. If the stoma is temporary, the ends of the colon will be rejoined in a later procedure. Temporary stomas are generally used to allow time for the colon to heal following surgery.

A colectomy may take between one and four hours. Following the procedure, patients will need to consume a liquid and low fiber diet before gradually returning to their normal diet. Patients will need to stay in the hospital for three to seven days for monitoring. Full recovery and return to normal activity may take anywhere from a few weeks to several months.

Patients may be asked to drink only liquids in the days before a colonoscopy, or they may be given an enema to remove residual fecal matter. Before the exam, patients are given medication to help them relax, and then lay on their side on a table. The scope is inserted into the anus and gently moved all the way through the large intestine. Air may be pumped into the intestine to improve the view for the physician. Any polyps that are found will be removed. Then the colonoscope will be withdrawn. A colonoscopy is not usually painful, but patients may feel some bloating or have some cramps right afterward. If patients have polyps removed, they might experience a small amount of bleeding. Any side effects should go away within a few hours.

Small bowel resection can be done through either a laparoscopic or open approach. If someone is having a laparoscopic small bowel resection, their surgeon will make multiple small incisions on the abdomen and insert a thin tube with a camera, called a laparoscope. If they are having an open small bowel resection, a large cut is made on the abdomen to expose the intestine. A laparoscopic small bowel resection is associated with less pain and requires a shorter recovery period, but depending on the condition, patients may have to undergo an open procedure.

After making the necessary incisions, the surgeon will remove the targeted portion of the intestine and then perform an anastomosis. Depending on the amount of intestine left, an anastomosis may involve the surgeon either joining together the ends of the intestine or creating a stoma which is an opening in the abdomen. In this procedure, called an ileostomy, the end of the small intestine (ileum) is attached to the opening in the abdominal wall. A drainage pouch will be attached to the skin to collect waste.

Stomas may be permanent or temporary. If the stoma is temporary, the ends of the intestine will be rejoined in a later procedure. Temporary stomas are generally used to allow time for the intestines to heal following surgery.

Small bowel resection is typically completed in one to four hours. After the operation, patients will need to stay in the hospital for a few days, and it may take some time before they can return to their normal diet.