A colon resection or colectomy is performed in the hospital as an inpatient procedure using general anesthesia. Preoperative examination includes assessing the cardiovascular, pulmonary, and renal function of the patient as well as routine laboratory studies.
A colonoscopy is performed preoperatively to confirm the presence and location of polyps and malignant lesions. Computed tomography (CT) of the abdomen and pelvis usually is done. Colon lesions that are found on colonoscopy are biopsied either pre-operatively or during colectomy to stage possible malignancy.
Colon Resection Overview
The large intestine, or colon, is the lower part of the digestive tract. Diseases of the colon are common, and more than one-half million surgical procedures are performed in the United States every year to treat them.
Indications for colon resections include:
- Colon cancer
- Diverticular disease
- Gastrointestinal bleeding
- Inflammatory bowel disease
- Intestinal polyps
- Large bowel obstruction
During a colon resection, the diseased part of the bowel is removed and the two healthy sections of the colon are reattached. This is called an end-to-end anastomosis. If an anastomosis is not possible because of the extent of the disease or its location, the surgeon creates a colostomy. A temporary colostomy is made when the colon needs longer to heal after surgery and the anastomosis is performed later.
Colectomies are classified according to the portion of the colon to be removed as well as the type of procedure used. If the right side of the colon is to be removed, the procedure is called a right hemicolectomy. If the part of the colon on the individual’s left side is to be removed, it is known as a left hemicolectomy.
A transverse colectomy is performed when the part of the colon that crosses from the right to the left side (transverse colon) is removed. In an anterior resection of the sigmoid colon, the part of the colon next to the rectum (sigmoid colon) is removed.
Two types of colon resection
Procedures are performed regularly, open and laparoscopic. The patient is placed lying face upward (supine), and a tube is inserted through the nose into the stomach (nasogastric tube) to remove gastric secretions. A Foley catheter is inserted into the bladder to divert urine during the surgery. In either procedure, the abdomen is cleansed with an antibacterial surgical scrub solution.
In open procedures, an incision is made in the middle of the abdomen (midline). The small bowel is moved to the side of the abdomen and held in place with retractors. The colectomy needed is then performed through the midline incision. After removal of the diseased portion of the colon, the intestine is reconnected (anastomosed). The anastomosis may be either hand-sewn or stapled.
In laparoscopic colon resections, surgeons create four or five small openings, each about 0.5inch (1.5 cm) long in the abdomen. The laparoscope and ancillary equipment (camera, dissection tools) are inserted through the wounds, and the procedure is performed with visual guidance on a television monitor. In some cases, one of the small openings may be lengthened to 2 to 3 inches (5 to 7.5 cm) in order to complete the procedure.
With either procedure, the surgeon works down through abdominal tissues to the segment of the colon to be removed. It is loosened from surrounding tissues (dissected and mobilized), and the blood vessels that supply that part of the colon are identified and sealed off with electrocautery. Vessels that supply the remaining segments of the colon are closed off to prevent bleeding during the surgery.
The diseased portion of the colon is removed. The healthy ends of the colon that remain usually are reconnected. (anastomosed). Sometimes the colon cannot be reconnected, and an artificial opening (colostomy) is required to divert the passage of waste outside the body. The colostomy can be temporary or permanent depending on the extent of the colon resection. Drain tubes may be placed to allow drainage of any secretions that accumulate. The incision is sutured closed, and dressings are placed over the incision.
Before Surgery for Colon Resection
Before your surgery, you may be asked to follow a special diet to help reduce your discomfort, and should drink plenty of water (eight 8-ounce glasses of water daily).
Inform your doctor about any medications you take, including over-the-counter supplements. Some medications must be out of your system before surgery.
Preparing For Surgery
Your colon must be completely cleaned out before the procedure. This is called a “bowel prep.” Your doctor may have you do this at home or in the hospital. A number of cleansing methods may be used, including enemas or laxatives and a clear-liquid diet
Clear liquid diet: for 12 to 24 hours before your surgery, you will be told not to eat any solid foods and to drink only clear liquids. These include broth, plain coffee, gelatin, and clear fruit juice
Take nothing by mouth (“NPO”) after midnight on the night before your surgery. This includes water and chewing gum. Your stomach must be empty. If there are any required medications that your doctor has okayed, including antibiotic pills, take them with a small sip of water
- Arrange for a ride home from the hospital
- Arrange for help at home for the first few days after the surgery
- Prior to the operation, blood tests, an electrocardiogram (EKG), or a chest x-ray might be required
During Colon Resection Surgery
The day of surgery you will come to the hospital and the nurses will get you ready for surgery. They may clean and shave the surgical area, start an IV, and answer any last-minute questions.
You will be put to sleep by the anesthesiologist before the procedure begins.
You will be admitted into the hospital for 4 to 8 days. During your stay, you’ll be monitored carefully to make sure you’re healing well and that your colon has started working again.
A nasogastric (NG) tube, going through your nose and into your stomach, may be used to keep your stomach empty for a few days. The surgery will cause a postoperative ileus. This is a temporary paralysis of a portion of the intestines preventing food or drinks from moving forward. For this reason, it is important for you to slowly start your diet to prevent complications. You’ll receive the fluids you need intravenously during that time.
When you start to pass gas, it is a sign that your colon is working again. The hospital will then start you on a liquid diet. If you are tolerating the liquid diet with no nausea or increased abdominal pain, you will progress to a soft diet, typically in a day or so. You should continue the soft diet for 2 to 8 weeks after surgery, depending on your healing and what your doctor instructs. We will provide a list of foods to help you choose a soft diet when you have returned home.
You should be up and walking within a day or two after surgery. This will encourage your circulation and bowel function to return to normal, and may prevent complications.
Do your breathing exercises to make sure you are inflating your lungs completely. It may be painful for your abdomen at first but it is important to do these exercises to clear any fluid that may be in your lungs from surgery, and prevent pneumonia.
Caring For Yourself After Surgery
Activity/Work: When you return home, take it easy. Do not do any strenuous activities or heavy lifting of more than 5 to 10 pounds for at least 4 to 6 weeks after surgery. (A gallon of milk weighs just over 8 pounds.) You can begin having sex again when you feel ready, usually 2 to 4 weeks post surgery. You can return to work 1 to 2 weeks after laparoscopic surgery, and 3 to 4 week after an open surgical repair, depending on the type of work and if light duty is acceptable.
Shower: You can shower 24 to 48 hours after surgery, unless otherwise instructed by your doctor. There will be sterile tape (called a “steri-strip”) over the incision. Leave the tape on while showering. Do not soak in a bath or hot tub. Sometimes an incision is stapled and you won’t have steri-strips. In this case you can shower without a bandage. Be sure to dry the area well afterwards.
Driving: Do not drive while taking pain medications. It is considered driving “under the influence.” You will be able to drive when you feel capable of making a quick decision and no longer need narcotic pain medications.
Incision care: Your incision will be dressed with a sterile bandage or “steri-strips.” Leave this bandage on until it falls off on its own or until your doctor takes it off in the office. There may be some redness around the edges of the incision. An infection may be starting if the drainage is thick green or yellow, or if the skin around the incision is increasingly red or warm to touch. Call your doctor if these symptoms occur.
Fever: Your temperature can vary after surgery and a low-grade temperature is common. If your temperature exceeds 101.5 degrees or if it is accompanied by chills, vomiting, or flu-like symptoms, you should call the office.
Pain: Pain control is very important after surgery. Be sure to stay ahead of the pain and take your pain medication as prescribed by your doctor. You may add Advil (ibuprofen) to your pain medication if you do not have any allergies or contraindications for taking it. Ask your doctor if you have any questions.
Right shoulder pain is common after laparoscopic surgery. This may be due to the gas used to inflate your abdomen. It will dissipate in a few days.
Constipation is common after surgery. Taking pain medications such as vicodin or percocet also cause the bowel to move more slowly. A stool softener, such as Colace, milk of magnesium, or prune juice may help.
Diarrhea is also common after a colon resection. Your colon is shortened and therefore stool may pass at a faster rate. Give it time, approximately 6-8 weeks, and your colon should start to function more normally. When a long piece of colon is removed, however, a faster transit time may be a permanent side effect of the surgery.
Nausea is common after surgery. Be sure to take your pain medication on a full stomach. Stick to a soft, bland diet for the first few weeks after surgery. If necessary, call your doctor for prescription medication to aid with nausea.
You will start a liquid-to-soft diet in the hospital. Continue this diet for the first 2 to 6 weeks after surgery. Refer to our handout on soft diet after Colon surgery. [document titled: Soft diet post-colon resection]
- Eat foods that are easy to swallow and digest, such as soup, bananas, gelatin, pudding, and yogurt.
- Eat frequent, small meals.
- Once you begin eating regular meals, you may feel full faster. This will go away over time.
When to Call the Doctor
- Fever over 101.5 degrees
- Nausea or vomiting
- Persistent, increasing pain
- Increased redness or drainage from an incision
- Change in skin color/jaundice
- Pain or swelling in your calf
- Cough or shortness of breath
When To Go To The Emergency Room
- Uncontrolled bleeding from an incision
- Persistent vomiting
- Change in mental status
- Severe shortening of breath, chest pain
Staying Healthy After Surgery
In 4 to 8 weeks you will be recovered from surgery and back on a regular diet, but it is important to keep your colon healthy. This includes eating plenty of high-fiber fruits, vegetables, and whole grains throughout the day. Also, drink plenty of liquids such as water and juice. Some patients find that avoiding seeds and nuts that might get stuck in a diverticula helps prevent a flare up and pain.
Eat enough fiber: You need 25 to 30 grams of fiber each day. Try choosing fiber-rich foods throughout the day and add pure (unprocessed) bran to your food or drinks. You can also use a stool-bulking agent such as psyllium (like Metamucil) or methylcellulose (Citrucel).
Drink enough liquids: Liquids help your body digest food and move it through your system in a timely manner. Most people should drink at least 8 glasses of liquid each day. Avoid coffee and sodas because they may cause spasms and pressure in your colon. To increase your liquid intake try the following:
- Bring a bottle or a jug of water with you to work and pour yourself a cup every hour
- Drink plenty of liquids with and between meals
- Take water with you when you exercise to replenish the liquid your body loses