Preparing for a Colectomy

Preparing for a Colectomy
Michael Morton, MD - Colorectal Surgeon

A colectomy is a procedure to remove all or part of the colon. The colon, also known as the large intestine, is the lower part of the intestinal tract. In a partial colectomy, only part of the colon is removed. In a total colectomy, the entire colon is removed.

Reasons for Colectomy

A colectomy may be done to treat a variety of conditions, including:

• Colon or rectal cancer
• Inflammatory intestinal diseases, such as ulcerative colitis and Crohn’s disease
• Intestinal blockage
• Trauma to the intestine
• Small pouches in the colon wall—diverticular disease
• Precancerous polyps, especially those seen in familial adenomatous polyposis
• A hole in the colon wall
• Dead colonic tissue
• Bleeding from the colon

For colon cancer, the goal is to remove all of the cancer. If you have a precancerous condition, a colectomy may prevent the development of cancer. If you had surgery because of other conditions, a successful operation will alleviate or improve your symptoms.

What to Expect from a Laparoscopic Colectomy Procedure

Prior to the Procedure

Before your colectomy, your doctor will likely do a physical examination and recommend blood tests. In addition, imaging tests that take pictures of internal body structures may be done, including:

• Colonoscopy with biopsy
• CT scan
• MRI scan
• Ultrasound
• X-rays (may be with or without contrast material) and/or barium enema

Talk to your doctor about your medications. You may be asked to stop taking some medications up to 1 week before the procedure. Your doctor may recommend preparation several days in advance of your procedure. This may include:

• A special diet.
• Your colon must be completely cleaned out. A number of cleansing methods may be used, including enemas, laxatives, and a clear-liquid diet. You may be asked to drink a large container of a solution that will aid in the complete emptying of the colon. This preparation may start several days before the procedure.
• Antibiotics—It is important to take them as directed.
• Showering the night before your procedure using antibacterial soap.
• Wearing comfortable clothing.
• Arranging for a ride to and from the hospital.
• Arranging for help at home for the first days after your procedure.

During the Procedure

A laparoscopic colectomy typically takes 1 to 4 hours. You will be given general anesthesia so that you will be asleep and pain free during the procedure. The type of colectomy you have will determine how the procedure is performed:

Partial Colectomy

Small incisions are made in the abdomen and instruments are inserted through these incisions. The diseased portion of intestine is then removed and the 2 loose ends of intestine are sewn together. Some soft tubes may be left in the abdomen to drain any accumulating fluids. Stitches or staples are used to close the area and a bandage is placed over the incisions.

Total Colectomy

In a total colectomy, the entire colon is removed through the incision. In some cases, the last part of the small intestine, called the ileum, is connected to the rectum. A small pouch is made from the ileum to store stool. This pouch mimics the function of the rectum and preserves anal function. Stitches or staples are used to close the area and a bandage is placed over the incisions.

Colostomy or Ileostomy

With either procedure, you may need a colostomy or ileostomy:

• Colostomy: brings the large intestine to the wall of the abdomen
• Ileostomy: brings the small intestine to the wall of the abdomen

In both procedures, an artificial opening called a stoma is created in the abdomen. One or both ends of the intestine are attached to the stoma, allowing feces to exit the intestine through the stoma. It collects in a pouch called an ostomy bag.

A colostomy may be temporary or permanent. A temporary colostomy allows the intestine to rest and heal. When your intestine has healed properly, you will undergo another operation to rejoin the ends of the intestine.

Following the Procedure

Immediately after surgery, you will be taken to a recovery room and monitored. On average, the usual length of stay is 5 to 6 days in the hospital. Your doctor may choose to keep you longer if complications arise.

Recovery at the Hospital

While still in the hospital, recovery from your colectomy may include the following:

• You may need antibiotics and medication for nausea and pain.
• You may require a nasogastric (NG) tube for a few days to help decompress your intestines. The tube enters through your nose and goes to your stomach.
• Your intestine will require some time to heal before it will function properly again. At first, you will get nutrition through intravenous therapy (IV), which delivers liquid nutrients directly into your veins. Gradually, as you improve, you will advance through liquid and soft diets to a regular diet.
• If you had a colostomy or ileostomy, a pouch will be attached on the outside of your body to collect waste materials. You will receive instructions about diet and activity. During the first few days after surgery, you may be restricted from eating.
• You will wear boots or special socks to help prevent blood clots.
• You will be asked to walk often after surgery.
• You may be asked to use an incentive spirometer, to breathe deeply, and to cough frequently. This will improve lung function.
• Your incision will be examined often for signs of infection.

During your stay, the hospital staff will take steps to reduce your chance of infection, such as hand washing, wearing gloves and masks, and keeping your incisions covered. You can help reduce your chance of infection by doing these same things and reminding healthcare providers to stay vigilant.

Recovery at Home

If you have a colostomy:

• You will need to take it easy for 1-2 months.
• A specialized nurse will teach you how to care for the stoma site and change the ostomy bag.
• Ask your doctor about when it is safe to shower, bathe, or soak in water.
• You will progress from a clear liquid, to a bland, low-fiber diet, to your regular diet after 6 to 8 weeks.
• Alert your physicians and pharmacist that you cannot take medications that are considered time-released or time-sustained.
• Do not use laxatives, because post-colostomy stools usually are quite liquid.
• Extra fluids will be lost in your stool, so be sure to drink plenty of liquids each day.
• In order to prevent inflammation and infection, you will need to practice good skin care in the area around the stoma.
• You may wish to join a support group or seek counseling to help you adjust to your colostomy.

Potential Complications

Problems from a laparoscopic splenectomy procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

• Damage to other organs or structures
• Infection
• Bleeding
• Hernia forming at the incision site
• Blood clots
• Complications from general anesthesia

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications, such as smoking, drinking, or chronic diseases such as diabetes or obesity.

When to Call Your Doctor

Contact your doctor if your recovery is not progressing as expected or if you develop complications, such as:

• Redness, swelling, increasing pain, excessive bleeding, warmth, drainage, or bulging at the incision site
• Nausea and/or vomiting that you cannot control with the medications you were given
• Severe abdominal pain
• Signs of infection, including fever and chills
• Cough, shortness of breath, or chest pain
• Pain and/or swelling in your feet, calves, or legs
• Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
• Not passing any stool
• Blood in your stool, or black, tarry stools
• Diarrhea
• Feeling weak or lightheaded

If you had a colostomy created, call your doctor if any of the following occur:

• Not collecting stool in the ostomy pouch
• The skin around the stoma appears irritated, moist, red, swollen, or develops sores

If you think you have an emergency, call for emergency medical services right away.

For more information regarding colectomy, colostomy, or colorectal surgery procedures in general, contact Dr. Michael Morton of Atlantic Surgical Associates at (603) 431-5242.

Sources:
American Cancer Society
National Institute of Diabetes and Digestive and Kidney Diseases