Dr. Eric Williams Owings, 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.

During the procedure, the surgeon inserts the laparoscope, which contains a light and camera that allows the surgeon to see what is happening inside the body. Then tiny tools are placed through the small openings and used to perform the surgery.

The most common laparoscopic surgery is gallbladder removal, but laparoscopic surgery may also be used for the removal of a kidney or appendix, to treat certain cysts and tumors, for bariatric surgery, for some GERD treatments, or for hernia repairs, among others.

Because laparoscopic surgery only uses a few tiny incisions, the scars are minimal and recovery is easier than with open surgery.

Peritoneal dialysis can be performed at home by oneself after an initial surgery. To start, a physician (generally a surgeon) will make a small incision in the lower abdomen and insert and surgically attach a catheter (thin tube). At home, the patient connects a pump to the abdomen catheter, delivering dialysate (dialysis fluid) from a bag hanging on a wheeled stand. This fluid enters the peritoneal cavity (greater abdomen area containing the stomach, liver, and intestines) and collects waste through osmosis, where waste in the blood moves across a membrane and into the dialysate. This process continues for several hours until the fluid concentration is equal between the blood and dialysate, at which point the fluid can be drained. The fluid can then be passed through a machine called a cycler, which removes waste and allows for the dialysate to be reused. This process is repeated about four times per day. Dialysis patients must limit the amount of fluid they consume prior to receiving dialysis and should also avoid eating salty foods. The cycler cannot filter more than a certain amount of waste products from the blood.

Kidneys are important organs, and peritoneal dialysis can be vital for those with renal dysfunction. Peritoneal dialysis may be a more convenient alternative to hemodialysis, which requires going into a clinic.