What is a colectomy?

Being diagnosed with a disease of the colon (also called the bowel or large intestine) can be scary. To take charge of your health, try to learn as much as you can about your treatment options.

One option is colectomy. This is surgery to remove the diseased or damaged part of your colon. Your healthcare provider might suggest a colectomy to treat:

• Inflammatory bowel disease (ulcerative colitis or Crohn’s disease)

• Diverticulitis

• Cancer

A colectomy can be done in two ways:

• Open colectomy. The surgeon makes a long, vertical cut (incision) on your belly (abdomen).

• Laparoscopic-assisted colectomy. The surgeon makes many small cuts in the skin over your belly. Then they put a tiny video camera into one of the cuts to see inside your body. They use long, thin tools put into the other cuts to perform the surgery. People often have less pain and recover faster because of the small incisions.

Your healthcare team will suggest which option is best for you. Be sure you know what to expect and how your body will work afterward.

Why might I need a colectomy?

You might need a colostomy for a short time to let your colon heal after surgery. You’ll have a second surgery a few months later to reconnect the bowel. However, depending on your diagnosis, the colostomy may be permanent.

When you have a colectomy to treat cancer, the surgeon removes the part of the colon that has cancer in it. They also remove a small piece of the colon on either side of the cancer. They may also remove nearby lymph nodes to check for cancer.

What are the risks of a colectomy?

Many people feel scared or anxious before surgery. These feelings are normal. Talking about your questions and concerns can help you feel better. Your surgeon will talk with you about any risks before the surgery. Some common risks for a colectomy are:

• Reactions to anesthesia

• Pneumonia

• Blood clots in the legs or lungs

• Internal bleeding

• Infection at the incision or inside the belly

• Hernia

• Scar tissue (adhesions) in the stomach, which can block the intestines

• Leaking where the intestines are sewn together

• Damage to nearby organs

How do I get ready for a colectomy?

Before a colectomy, your healthcare team will do tests to learn more about your specific bowel disease or cancer. These tests are needed to plan your surgery. They may include X-rays, scans, blood tests, an electrocardiogram (ECG), and a colonoscopy.

A colonoscopy allows the surgeon to look inside your colon and rectum. It’s done with a flexible, tubelike scope that has a tiny light and video camera on the end.

Your provider will most likely tell you to prepare with the following:

• Bowel prep. Your bowels must be empty before the surgery. You’ll need to change what you eat and drink for a few days before surgery. You may need to do bowel prep one to two days before surgery, too. This may include a laxative and enemas to clean out your bowels.

• Fasting for surgery. Be sure follow any instructions you're given about not eating or drinking before surgery.

• Stopping certain medicines. You may need to stop taking some of your medicines in the week before the surgery such as blood thinners. Be sure to tell your provider about all the medicines you take. That includes prescription and over-the-counter medicines, vitamins, herbs, supplements, marijuana, and street drugs.

• Preventing infection. You may be asked to shower with a special soap before your surgery. You might also be given antibiotics to help prevent infection.

Any advice and rules from your provider will help you have a successful surgery and recovery. Ask questions about anything you don’t understand. Take notes and record visits with your provider to help you remember all their instructions.

What happens during a colectomy?

Here is what to expect during surgery:

• You'll be given general anesthesia for the surgery. These medicines make you sleep and not feel pain during surgery.

• Your healthcare team will connect you to monitors to watch your breathing, heart rate, and blood pressure.

• The skin over your belly will be cleaned and hair there may be clipped or shaved.

• For an open colectomy, the surgeon will make a long cut (incision) on your stomach. For a laparoscopic-assisted colectomy, several small incisions will be made.

• The surgeon will remove the diseased part of your colon.

• The surgeon may sew together the two open ends of the colon. Or they’ll make an opening to the outside of your body (stoma).

• If you have cancer, the surgeon may remove lymph nodes near it. Surgeons often take out at least 12 of these lymph nodes.

• Once the surgery is done, the surgeon will close the incision.

What happens after a colectomy?

You will wake up in the recovery room. You’ll stay there until you're fully awake, alert, and breathing well. You'll be hooked up to machines that watch your vital signs (such as your heart rate and blood pressure). Then you'll go to a hospital room. Your healthcare team will check in to see how you’re feeling as you recover. You'll likely be in the hospital for 3 to 7 days.

You'll need to take pain medicine for several days to control your pain. Managing pain at this stage is important so that you can cough, take deep breaths, and get out of bed a bit easier as you recover.

You may receive some liquids as your colon begins to work again. Your healthcare team will let you know when you can eat solid foods again. You will need to follow a low-residue, low-fiber diet for a few weeks to decrease the amount of stool passing through your bowel as it heals. A dietitian will talk with you about what to eat and what to avoid.

If you have a colostomy, an ostomy nurse will teach you how to take care of your stoma.

Your provider will keep a close eye on you as you heal in the hospital. Before you leave, make sure you know what problems or side effects to watch for. Ask questions about anything that concerns you.

Your provider will schedule follow-up appointments to check on your progress.

When to call the healthcare provider

Talk with your healthcare provider about problems you should watch for. Knowing what to look for can help you deal with any serious side effects or issues quickly. Call right away if any of the following occur:

• Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider

• Chills

• Cough or shortness of breath

• Fast, irregular heartbeat

• New chest pain

• Signs of infection around the incision, such as redness, drainage, warmth, and pain

• Drainage from the incision site

• Incision opens up or the edges pull apart

• Any abnormal bleeding or bleeding that soaks the bandage

• Trouble passing urine or changes in how your urine looks or smells

• No bowel movement for two or more days

• Swelling in your hand, arm, or chest that gets worse or isn't getting better a week or two after surgery

• Pain, redness, swelling, or warmth in an arm or leg

Know what problems to watch for and when you need to call your healthcare provider. Also be sure you know what number to call to get help after office hours and on weekends and holidays.