Is A Colon Resection A Major Surgery?

Colon resection surgery (colectomy) removes a length of intestine that is diseased or dead, and then re-connects the severed ends to each other or to an ostomy in the abdomen attached to a colostomy bag to catch feces.

Colon resection (colectomy) is the surgical removal of part or the entire colon. Colectomy is a major surgery and may take up to four hours for completion. Colectomy is performed under general anesthesia and may require hospitalization for up to a week or more.

A colorectal surgeon performs the colon resection in an operation room in the hospital. The surgery may be performed as

• Open resection
• Laparoscopic resection
• Robot-assisted laparoscopic resection

The advantages of laparoscopic resection over an open resection include:

• Shorter hospital stays
• Less invasive procedure with smaller incisions and scars
• Decreased formation of adhesions
• Reduced bleeding
• Quicker healing and less need for painkillers
• Faster recovery and return to normal daily activities

Laparoscopy, however, may not be suitable for all patients, and the surgeon will make an informed decision based on individual needs.

Preparation

Prior to a colon resection the patient needs to

• Undergo blood and imaging tests, and colonoscopy if necessary.
• Go through bowel preparation by taking laxatives to make sure the colon is clear of stool.
• Go on a clear liquid diet for a day prior to the surgery.
• Avoid eating or drinking anything for 8 hours prior to the surgery.
• Inform the doctor of any allergies.
• Check with the doctor before taking any regular medications.
• Stop taking blood thinners days prior, according to the surgeon’s advice.
• Start an antibiotic course to prevent infection.
• Have an enema to clear the colon of any residual fecal content.

Procedure

• The doctor attaches an IV line for administering medications.
• An anesthesiologist administers anesthesia and monitors the patient’s vital functions during the surgery.
• The anesthesiologist also intubates the patient to ensure adequate oxygen supply.
• The surgeon makes one large or many tiny incisions in the abdominal wall, depending on the type of surgery.
• The surgeon cuts and removes the diseased part or the entire colon as required.
• The surgeon may also remove the surrounding lymph nodes in certain cancers.
• The surgeon connects the ends of the remaining healthy colon with staples or sutures in a procedure known as anastomosis.
• In a total colectomy the surgeon connects the ileum, the terminal part of the small intestine, to the rectum.
• In some resections the surgeon may also create an opening in the stomach wall (stoma). Through the stoma, the surgeon connects the resected end of the healthy colon (colostomy) or the small intestine (ileostomy), to a bag to collect the feces.
• The surgeon may place a drain before closing the incision with sutures.
• The surgeon may also place a urinary catheter which normally remains in place for a day or two.

Post-procedure

• The doctor withdraws the anesthesia and administers painkillers for post-operative pain management.
• The patient is monitored for several hours in the recovery room until the vital functions stabilize.
• Some patients with temporary colostomy or ileostomy undergo a revision surgery after 12 weeks. For some it may be permanent.

Most people recover fully from a colon resection and return to normal activities in about six weeks; however, recovery time will depend on the severity of the underlying disease.

Patients with chronic conditions such as cancer, Crohn’s disease or ulcerative colitis may need ongoing treatment.

Colon resection surgery is performed under general anesthesia and the patient will feel no pain during the procedure. During recovery, abdominal and incision pain are likely, which can be managed with pain medication.

The side effects of colon resection may include:

• Anesthetic side effects such as
  • Headache
  • Nausea
  • Confusion
• Abdominal pain from the surgery
  • Fatigue
  • Constipation and/or diarrhea
• Inconvenience of the attached ostomy bag

Colon resection is a relatively safe surgery for most people. The risks may be higher in certain patients, depending on their underlying conditions. The risks and complications include:

• Hemorrhage or uncontrolled bleeding
• Blood clots
• Wound infection
• Pneumonia
• Reaction to medication
• Paralyzed intestine (paralytic ileus)
• Damage to nearby organs, blood vessels or nerves
• Bowel obstruction from scar tissue formed after resection
• Leakage from the connection of the resected colon ends (anastomotic leak)
• Inflammation of the stomach lining (peritonitis)
• Bladder control problems
• Sexual problems
• Problems with colostomy
• Hernia at the surgical incision
• Sepsis and death