What You Should Know About Colectomy

A colectomy can be done in 2 ways:

• Open colectomy. The surgeon removes the diseased colon by making a long, vertical cut (incision) on your belly (abdomen).
• Laparoscopic-assisted colectomy. The surgeon makes several small cuts in the skin over your belly. Then they put a tiny video camera into 1 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 afterwards.

After surgery, the remaining ends of the colon may be reattached to each other if possible.

If they remove a large portion or all the colon, they may need to create a small opening to the outside of the body (stoma). This is so you can pass stool through the opening. The stoma is a hole made in the skin over your belly (abdomen). Your intestine attaches to the stoma. Stool then goes into a bag that sticks to the skin around the stoma. This is called a colostomy.

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. But 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 healthy colon on either side of the cancer. They may also remove nearby lymph nodes to check to see if cancer has spread.

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 (lung infection)
• Blood clots in the legs or lungs
• Internal bleeding in the belly
• Infection at the incision or inside the belly
• Hernia
• Scarring (adhesions) in the belly, which can tighten around the bowel
• Leaking where the ends of the intestines are sewn together (anastomosis)
• Damage to nearby organs

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, imaging scans, blood tests, an electrocardiogram (ECG), and a colonoscopy.

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

Follow all instructions from your healthcare team on how to prepare for surgery.

Your provider will most likely tell you to prepare for:

• Emptying your bowels. Your bowels must be as empty as possible 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 1 to 2 days before surgery, too. This may include a laxative and enemas to clean out your bowels.
• 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.
• Fasting before surgery. Follow all instructions you're given about not eating or drinking before surgery.
• Preventing infection. You may be asked to shower with a special soap before your surgery. You might need to take antibiotics to help prevent infection.

Any advice and instructions 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. You can request a printed summary of the instructions discussed at your visit.

Here is what to expect during surgery:

• You'll receive general anesthesia. These medicines allow you to comfortably sleep and not feel pain during surgery.
• Your healthcare team will connect you to monitors to watch your breathing, heart rate, blood pressure, and oxygen saturation levels.
• 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 on your stomach. For a laparoscopic-assisted colectomy, they’ll make several small cuts.
• The surgeon will remove the diseased part of your colon.
• The surgeon may sew together the 2 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 to determine if cancer has spread to other areas of the body.
• Once the surgery is done, the surgeon will close the incision.

After surgery, your healthcare team will move you to the post-anesthesia unit care (PACU).

You will wake up in the PACU and be closely watched as you awake from the anesthesia. You’ll stay there until you're fully awake, alert, and breathing well. You'll be attached to monitors that watch your vital signs (such as your heart rate, heart rhythm, oxygen levels, and blood pressure). When you are stable, 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. It helps you to 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 and get ostomy supplies.

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.

Talk with your 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 your provider or seek medical care right away if you have any of the following:

• Fever of 100.4°F (38°C) or higher, or as advised by your provider
• Chills
• Fast, irregular heartbeat
• Signs of infection around the incision, such as redness, warmth, and pain
• Drainage or leaking from the incision site
• The incision opens, or the edges pulling apart
• Bleeding that soaks through the bandage
• Any abnormal bleeding from other parts of the body
• Trouble peeing
• Changes in how your pee looks or smells
• Not having a bowel movement for 2 or more days
• Swelling in your hand, arm, or chest that gets worse or isn’t getting better 1 or 2 weeks 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 or get immediate medical care. Also be sure you know what number to call to get help after office hours and on weekends and holidays.

Call 911 right away if you have either of these:

• Cough or shortness of breath
• New chest pain

Your provider may advise additional tests and procedures. Before you agree to a test or procedure, ask about:

• The name of the test or procedure
• Why you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits
• Any possible side effects or complications
• When and where you will have the test or procedure
• Who will do the test or procedure and what that person’s qualifications are
• What would happen if you did not have the test or procedure
• Any alternate tests or procedures
• When and how you will get the results
• Who to call if you have questions or problems
• Whether your insurance covers the test or procedure
• How much the test or procedure costs, out of pocket