A colectomy is a surgical procedure involving the removal of all or part of the colon, which is also known as the large intestine. The colon is an essential part of the digestive system, responsible for absorbing water and electrolytes from food that has already been digested in the small intestine, as well as forming and storing stool until it is ready to be expelled from the body.

Depending on the extent of the disease or condition being treated, a colectomy can be partial (removing only a segment of the colon) or total (removing the entire colon). This procedure can be performed using traditional open surgery or minimally invasive techniques such as laparoscopy.

 

Why would someone need a colectomy?

There are several medical conditions that may necessitate a colectomy. Common reasons include:

Colon cancer: Colectomy is often performed to remove cancerous tumours in the colon. It may be part of a treatment plan that also includes chemotherapy and/or radiation therapy.

Diverticulitis: Severe cases of diverticulitis, which involves the inflammation or infection of pouches (diverticula) that can form in the walls of the colon, may require surgical intervention if other treatments fail.

Inflammatory bowel disease (IBD): Conditions such as Crohn’s disease and ulcerative colitis, which cause chronic inflammation of the digestive tract, may require a colectomy if they do not respond to medical treatments.

Bowel obstruction: A blockage in the colon that cannot be resolved by less invasive methods may necessitate the removal of the affected segment.

Volvulus: This is a condition where the colon twists on itself, cutting off its blood supply and potentially leading to tissue death. Surgical intervention is often required to correct this.

What's involved in the colectomy procedure?

The specific steps of a colectomy can vary depending on the part of the colon being removed and the surgical method used. Generally, the procedure involves the following:

Anaesthesia

The patient is given general anaesthesia to ensure they are asleep and pain-free during the surgery.

Incision

The surgeon makes an incision in the abdomen. In a laparoscopic colectomy, several small incisions are made, and a camera along with special instruments are used to perform the surgery.

Removal of the colon

The affected portion of the colon is carefully separated from surrounding tissues and blood vessels. It's then removed from the body.

Reconnection or stoma creation

If only part of the colon is removed, the remaining ends are reconnected (anastomosis). If the entire colon is removed, the end of the small intestine may be attached to the rectum or a stoma (an opening in the abdominal wall) may be created for waste to exit the body into a colostomy bag.

Closure

The incisions are closed with stitches or staples, and a dressing is applied.

What are the disadvantages of a colectomy?

While a colectomy can be life-saving and improve quality of life, it isn’t without risks and potential drawbacks. Some of the disadvantages include:

• Surgical risks: As with any major surgery, there are risks of complications such as infection, bleeding and adverse reactions to anaesthesia.
• Digestive changes: Removal of part or all of the colon can affect bowel habits, leading to diarrhoea, frequent bowel movements or bowel incontinence.
• Nutritional absorption: The colon plays a role in absorbing water and nutrients. Its removal can lead to issues such as dehydration and deficiencies in vitamins and minerals.
• Stoma complications: If a stoma is created, there can be complications such as irritation, infection or blockage.
• Recurrence of disease: In cases where the colectomy is performed to treat conditions like cancer or IBD, there is a possibility that the disease could recur in the remaining parts of the digestive tract.

How does life change after a colectomy?

Life after a colectomy can change significantly, depending on the extent of the surgery and the underlying reason for the procedure. Patients may need to make dietary adjustments, focusing on foods that are easier to digest and avoiding those that can cause irritation or blockages. Hydration becomes more important, especially if the colon was entirely removed, as the body’s ability to absorb water is reduced. Patients may also experience changes in bowel habits, such as more frequent and looser stools.

In cases where a stoma is created, patients need to learn how to care for it and manage the colostomy bag. This involves maintaining hygiene, changing the bag regularly and being aware of potential complications. Support groups and counselling can be beneficial for adjusting to these changes.

Do you need a colostomy bag after a colectomy?

Whether a colostomy bag is necessary after a colectomy depends on the extent of the colon removed and the specific surgical approach. If only part of the colon is removed and the remaining sections can be reconnected, a colostomy bag may not be needed.

However, if the entire colon is removed or if the remaining bowel cannot be reattached immediately, a temporary or permanent colostomy bag may be required. In some cases, a temporary stoma is created to allow the bowel to heal before a second surgery reconnects the remaining intestine.

What should you avoid doing after a colectomy?

Recovery after a colectomy involves several lifestyle adjustments and precautions to ensure proper healing and avoid complications. Patients are generally advised to:

Avoid strenuous activities

Heavy lifting, intense physical exercise and other strenuous activities should be avoided for at least six weeks after surgery to prevent strain on the abdominal muscles and incision sites.

Gradually reintroduce foods

It’s important to start with a liquid or soft diet and gradually reintroduce solid foods. High-fibre foods, fatty foods and those that cause gas or bloating should be avoided initially.

Stay hydrated

Drinking plenty of fluids is crucial, especially if the colon was entirely removed, to prevent dehydration.

Monitor for complications

Patients should be vigilant for signs of infection, such as fever, increased pain, redness, or discharge from the incision sites, and report these to their healthcare provider promptly.

Follow medical advice

Adhering to all post-operative care instructions from the healthcare team, including taking prescribed medications, attending follow-up appointments and possibly engaging in physical therapy, is essential for a smooth recovery.

By following these guidelines and maintaining open communication with their healthcare providers, patients can optimise their recovery and adjust to life after a colectomy with minimal complications.

What specialist performs a colectomy?

A colectomy is performed by a specialist known as a colorectal surgeon. Colorectal surgeons are highly trained in the diagnosis and surgical treatment of diseases affecting the colon, rectum, and anus. They have extensive knowledge and experience in managing conditions such as colorectal cancer, diverticulitis, inflammatory bowel disease (IBD), and other disorders of the lower digestive tract.

Colorectal surgeons collaborate closely with other medical professionals, such as gastroenterologists, oncologists, radiologists, and pathologists, to provide comprehensive care for patients. This multidisciplinary approach ensures that patients receive the best possible treatment tailored to their specific condition and needs.

Patients who require a colectomy are typically referred to a colorectal surgeon by their GP or another specialist following a diagnosis that indicates the need for surgical intervention. The colorectal surgeon will evaluate the patient’s condition, discuss the surgical options, and explain the potential risks and benefits of the procedure. They will also provide preoperative and postoperative care instructions to ensure the best possible outcome and recovery for the patient.