When medication alone does not adequately treat inflammatory bowel disease (IBD), surgery may be necessary. The two main forms of IBD, Crohn’s disease (CD) and ulcerative colitis (UC), can both affect the colon, or large intestine. (CD can also affect other parts of the digestive tract like the mouth and small intestine.) A colectomy is a type of surgery that may be recommended for these patients if their disease does not affect the rectum or anus. It is a surgical procedure used to remove all or part of the large intestine. After it has been removed, the colorectal surgeon attaches the end of the remaining part of the intestine to the rectum. This means that the patient will still be able to pass stool through the anus.1,2
There are four types of colectomy surgeries:
- Total colectomy: removal of entire colon
- Partial colectomy: removal of part of the colon
- Hemicolectomy: removal of the right or left side of the colon
- Proctocolectomy: removal of both the entire colon and the rectum2
What happens during a colectomy?
There are two different ways that a colorectal surgeon may perform a colectomy:1,2
- Open colectomy
- Laparoscopic colectomy
An open colectomy is a more invasive surgery than a laparoscopic colectomy. During an open colectomy, a colorectal surgeon will make a long incision in the patient’s abdomen and use surgical tools to manually cut out the affected parts of the colon, or in the case of a total colectomy, the entire colon.2
Laparoscopic colectomy is a less invasive surgery. During a laparoscopic colectomy, a surgeon will make several tiny incisions in the abdomen. Then, a small video camera will be inserted into the patient’s colon. The surgeon will use the camera to bring the colon outside of the patient’s body though one of the small incisions. This allows the surgeon to operate on the colon outside of the patient’s body. Once the necessary portion of the colon has been removed, the surgeon will reinsert the colon through the incision.2
After either procedure, the surgeon will connect the remaining part of the intestine to the rectum so the body is able to pass stool through the anus.
What happens after a colectomy?
Patients who have undergone a colectomy will typically stay in the hospital to recover for 3-7 days. During recovery, the patient will slowly reintroduce liquids. Once the bowels begin to work again, the patient will be able to reintroduce soft foods. Most people who have had a colectomy will recover fully and will be able to return to most of the activities they were doing before surgery.1,2
Healthcare providers will advise patients about how to care for themselves well during and after the recovery process. For example, patients may be advised to adjust their diets or take supplements to ensure that their bodies are receiving enough nutrients following a colectomy. Patients may also be advised to not do any heavy lifting or intense exercising during the recovery period, or until their healthcare advisor advises them that it is safe to do so.2,3
What are some risks associated with colectomy?
Risks associated with colectomy include common risks associated with any surgery, such as:2,3
- Adverse reaction to anesthesia
- Tears in sutures
- Blood clots
Some risks specific to a colectomy include:2,3
- Bleeding in belly
- Damage to nearby organs
- Scarring of the connection between intestine and rectum, which can cause a blockage
This is not a complete list of risks associated with colectomy.