A guide to bowel surgery
Bowel surgery can be used to address many colorectal conditions. In this article, consultant colorectal surgeon Mr Haney Youssef describes the types of bowel surgery and what they can treat.
What is bowel surgery?
The bowel is the long tubular organ at the bottom of the digestive system. Bowel surgery, also called colectomy, is common to treat bowel and colon cancer and inflammatory bowel diseases like ulcerative colitis and Crohn’s disease, but can also be used for addressing obstructions or perforations in the bowel.
There are many types and approaches to bowel surgery. The procedure used for a patient will depend on:
- The ailment of the patient
- Their physical condition
- Which part (if not all) of the bowel needs to be removed
Bowel surgery typically involves the removal of at least a portion of the bowel, in order to halt the spread of cancer, or to get rid of defective or severely damaged sections of the organ.
What are the types of bowel surgery?
The types of bowel surgery are named according to which portion of the bowel is removed, such as:
- Total colectomy, where all of the large bowel is removed
- Proctocolectomy, where the large bowel and the rectum are removed
- Panproctocolectomy, where the large bowel, anus, and rectum are removed
- Sigmoid colectomy, where the final section of the bowel is removed
- Right hemicolectomy, where the right half of the colon is removed
- Anterior resection, where part of the rectum is removed
- Proctectomy, where the entire rectum is removed
- Abdominoperineal resection, where all of the rectum and anus is removed
What happens during bowel surgery?
Bowel surgery is always performed with the patient under a general anaesthetic. Patients are often asked to cleanse their bowels before the procedure, either by taking a laxative or by undergoing an enema. Bowel surgery can be conducted openly, where one large incision along the wall of the abdomen allows the surgeon to access the internal structures, or laparoscopically, where multiple smaller incisions are made in the abdomen and the surgeon can perform the resection using fine thin tools and a special camera scope — an emerging technique of laparoscopic surgery is robotic surgery, where the surgeon operates a robotic console to perform the procedure with higher precision and dexterity.
When part of the bowel is removed, the surgeon will then connect the healthy tissue on either side of the portion together in what is called an anastomosis. In some cases, however, this isn’t possible, so the surgeon may need to take the healthy end of the bowel through a hole they make in the abdomen. This hole is called a stoma, and the procedure is either called a colostomy (if the large bowel is removed) or an ileostomy (if the small bowel is removed). The food waste will pass through the stoma, rather than the anus, and this procedure can be permanent or temporary, again depending on the patient’s needs and condition.
What happens after bowel surgery?
After the bowel surgery, most patients will have a catheter to empty their bladder and a drain in their abdomen to drain excess fluids. They stay in the hospital for around a week to recover and ensure there are no complications following the surgery, after which they are free to go home. The recovery time can vary, but patients are advised to avoid heavy lifting and strenuous activities for at least six weeks.
To ease the postoperative process, doctors and healthcare teams are beginning to implement enhanced recovery after surgery (ERAS) programmes, which are multidisciplinary plans to help patients recover faster after surgery by reducing strain and providing them with resources and therapies to optimise their comfort.