Dr. Marylise Boutros, MD, FRCS

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 Then the colonoscope will be withdrawn.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.

The type of proctectomy performed depends on the severity and location of the cancer. If the cancer is confined to the rectum, only the rectum will need to be removed. Surgery can be done transanally, without an incision on the stomach, if the cancer can be reached through the anus.

For cancers higher in the rectum (closer to the colon), a low anterior resection is done. Low anterior resection uses an incision on the abdomen to access the cancerous portions of the rectum. The remaining parts of the large intestine can be connected in a procedure called anastomosis, and waste can exit through the anus as usual. In some cases, surgeons may choose to perform a type of anastomosis called temporary ileostomy. This involves attaching the end of the small intestine (ileum) to an opening in the abdomen (stoma), through which waste will exit the body and be collected in a small pouch. This is done if patients have previously undergone other cancer treatments, such as chemotherapy, to give the remaining ends of the large intestine time to heal before waste passes through them again. The ends will be reconnected at a later date, typically within several weeks.

For rectal cancer that has spread to the anus, abdominoperineal resection is an option. Abdominoperineal resection removes the cancerous lower rectum along with part or all of the anus and, sometimes, part of the colon. Removing part of the anus can lead to waste leaking, so a permanent colostomy is always done during abdominoperineal resection. Colostomy is similar to ileostomy, but instead of the ileum, the end of the colon is attached to a stoma, through which waste will flow into a collection bag. Surgeons will make incisions in the abdomen and around the anus to perform this procedure.

For the treatment of inflammatory bowel disease, proctocolectomy is done. IBD causes infections and ulcers to occur in the colon, but it can spread to other parts of the large intestine as well, such as the rectum. If this is the case, removing the rectum along with the colon in a proctocolectomy can be used to treat IBD in the event that it has not responded to conservative approaches, such as medication.

After a proctectomy, patients will need to stay in the hospital for around one week, if they experience no complications. Patients may receive restrictions on diet and physical activity following the procedure, as well as medication to treat any pain. If patients have a stoma, they will also be given instructions on how to care for it. Full recovery may take up to six weeks.