n., pl., -mies.
Surgical removal of part or all of the colon.
colectomy
Dictionary:
co·lec·to·my (kə-lĕk'tə-mē)  |
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| Oncology Encyclopedia: Colectomy |
Key Terms: Diverticulitis, Hemicolectomy, Hepatic.
Definition
Colectomy is the surgical removal of all or part of the colon, the first part of the large intestine.
Purpose
Doctors perform colectomy to remove large Stage I colon cancer lesions or to cure colon cancer that: has spread beyond the mucous membrane, has infiltrated or spread beyond the intestinal wall, or is likely to recur.
Doctors also perform this procedure to improve patients' quality of life by relieving pain and preventing bleeding and other symptoms that occur when colon cancer invades organs near the bowel, and also, when non-surgical methods are unsuccessful, to treat diverticulitis, ulcerative colitis, and benign colon polyps.
Precautions
This surgery can significantly diminish bowel control and sexual function.
Description
Colectomy is the preferred therapy for colon cancers that can be cured. Performed in a hospital, under general anesthesia, this procedure involves removing the cancerous part of the colon, a margin of normal bowel, and any tissue or lymph nodes affected by the disease, and reconnecting the healthy segments of the colon (anastomosis). If infection or obstruction make it impossible to reconnect the colon, the surgeon creates an opening (stoma) in the abdominal wall (colostomy) through which feces passes from the body into a disposable collection bag.
Colostomy may be:
- temporary, with the ends of the intestines being reconnected at a later time, or
- permanent in patients whose cancer cannot be completely removed.
Open and Laparoscopic Procedures
Traditional, or open, colectomy is an invasive procedure requiring a wide surgical incision. This surgery allows the surgeon to view the internal organs very clearly.
Laparoscopic colectomy requires only a few small incisions, enables doctors to view the internal organs, and results in a shorter hospital stay and fewer side effects. Studies suggest that laparoscopic colectomy may be safer than open surgery for elderly patients. A clinical trial funded by the National Institutes of Health (NIH) is comparing survival rates for the two procedures.
Types of Colectomy
Left Radical Hemicolectomy
Doctors perform left radical hemicolectomy to remove cancer and other abnormal tissue in the:
- descending colon, which extends from the pelvis to the spleen,
- and splenic flexure, the place where the descending colon joins the part of the large intestine that extends across the middle of the abdomen (transverse colon).
When cancer is found in the splenic flexure, the surgeon removes the splenic flexure, the first half of the descending colon, and about one-third of the transverse colon.
Right Radical Hemicolectomy
Doctors perform this procedure to remove tumors and other abnormalities of the:
- section of large intestine nearest the appendix (cecum)
- portion of the large intestine that extends along the right side of the body from the small intestine to the transverse colon (ascending colon).
This procedure involves removing the cecum, descending colon, the hepatic flexure where the ascending colon joins the transverse colon, and the first one-third of the transverse colon. These procedures are considered radical because they involve removing nerves, blood vessels, and lymph nodes near the tumor.
Transverse Colectomy
Performed to remove disease in the transverse colon, this procedure includes removing the:
- transverse colon,
- and hepatic and splenic flexures.
Sigmoid Resection
Used to remove cancer in the part of the colon (sigmoid) between the descending colon and rectum, this procedure involves removing the:
- sigmoid colon
- bottom two-thirds of the descending colon
Rectosigmoid Resection
Used to remove tumors in the part of the colon (rectosigmoid) just above the rectum (sigmoid flexure), this procedure removes:
- the sigmoid colon
- most of the rectum and surrounding rectal tissue (mesorectum) Because tumors in this part of the colon usually involve the bladder, uterus, or other organs, the surgeon may insert drainage tubes or a catheter to draw urine from the bladder.
Abdominoperineal Resection (APR)
This extensive procedure, which may be performed in two parts or by two surgical teams operating at the same time, involves removing the:
- lower sigmoid colon
- rectum
- anus
- nearby lymph nodes, blood vessels, and nerves
Sphincter-saving APR is designed to minimize loss of bowel control by:
- removing only the tumor
- preserving nerves and blood vessels near the tumor.-These specialized procedures involve repositioning the tumor while removing it, can cause shedding of tumor cells, and may not be available in all hospitals.
After completing any of these procedures, the surgeon uses:
- sutures
- clips
- heat and electrical current (electrothermal bipolar vessel sealer)to tie off the ends of blood vessels before closing the incision.
Preparation
The day before the operation, the patient may consume only clear liquids, and may take nothing by mouth after midnight.
To reduce the possibility of infection, antibiotics are given to the patient the night before the operation.
Aftercare
A patient who has had an open colectomy will spend at least a week in the hospital and experience significant postoperative pain.
A patient who has had a laparoscopic colectomy will spend 4–5 days in the hospital, experience less pain, and resume normal activities within two weeks.
A patient who has had a colostomy must learn to care for the collection bag and keep the area clean. Patients who have had colostomies often worry about:
- not being able to care for themselves
- odors, gas, and leakage from the collection bag
- health problems
- recurrence of cancer A patient who is depressed about sexual dysfunction, bowel problems, or other aspects of treatment may benefit from professional counseling or from joining a support group.
Risks
Side effects of colectomy include bladder complications, diarrhea, bowel irregularities, urinary urgency, and sexual dysfunction.
Normal Results
Most patients experience postoperative pain. Patients who have laparoscopic surgery have less pain than patients who have open colectomy. Some patients require temporary colostomy until normal bowel function returns.
Most of these procedures do not affect sexual function, but rectosigmoid resection can make it difficult for a man to achieve erection during intercourse.
Questions to Ask the Doctor
- Which type of colectomy should I have?
- How will I feel and look after the operation?
- If I have to have a colostomy, will people be able to tell I'm wearing a bag?
Abnormal Results
Extensive surgery can cause:
- infection
- severe pain
- fecal incontinence
- prolonged recovery
Resources
Other
Colectomy. [cited May 20, 2001].
Colorectal Cancer Treatments. [cited May 20, 2001].
Laparoscopic Colorectal Surgery. [cited January 20, 2000 and May 21, 2001].
Surgery & Colon Cancer. [cited May 5, 2001].
What Are the Latest Treatments of Colon and Rectal Cancers? June 1999. [cited May 20, 2001].
—Maureen Haggerty
| Food and Nutrition: colectomy |
Surgical removal of all or part of the colon, to treat cancer or severe ulcerative colitis.
| Veterinary Dictionary: colectomy |
Excision of the colon or of a portion of it.
| Wikipedia: Colectomy |
| Intervention: Colectomy |
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|---|---|---|
| ICD-10 code: | ||
| ICD-9 code: | 45.8 45.73 | |
| MeSH | D003082 | |
| Other codes: | ||
Colectomy consists of the surgical resection of any extent of the large intestine (colon).
Contents |
History
Sir William Arbuthnot-Lane was one of the early proponents of the usefulness of total colectomies, although his overuse of the procedure called the wisdom of the surgery into question.[1]
Indications
Some of the most common indications for colectomy are:
- Colon cancer.
- Diverticulitis and diverticular disease of the large intestine.
- Trauma.
- Inflammatory bowel disease such as Ulcerative Colitis or Crohn's disease.
- Prophylactic colectomy can be indicated in some forms of polyposis, Lynch syndrome and certain cases of inflammatory bowel disease because of high risk for development of colorectal cancer.
- bowel infarction
Basic principles
Traditionally, colectomy is performed via an abdominal incision (laparotomy), though minimally invasive colectomy, by means of laparoscopy, is growing both in scope of indications and popularity, and is a well-established procedure as of 2006[update] in many medical centers. Recent experience have shown the feasibility of single port access colectomy,[2]
Resection of any part of the colon entails mobilization and ligation of the corresponding blood vessels. Lymphadenectomy is usually performed through excision of the fatty tissue adjacent to these vessels (mesocolon), in operations for colon cancer.
When the resection is complete, the surgeon has the option of immediately restoring the bowel, by stitching or stapling together both the cut ends (primary anastomosis), or creating a colostomy. Several factors are taken into account, including:
- Circumstances of the operation (elective vs emergency);
- Disease being treated;
- Acute physiological state of the patient;
- Impact of living with a colostomy, albeit temporarily;
- Use of a specific preoperative regimen of low residue diet and laxatives (so-called "bowel prep").
An anastomosis carries the risk of dehiscence (breakdown of the stitches), which can lead to contamination of the peritoneal cavity, peritonitis, sepsis and death. Colostomy is always safer, but places a societal, psychological and physical burden on the patient. The choice is by no means an easy one and is rife with controversy, being a frequent topic of heated debate among surgeons all over the world.
Types
- Right hemicolectomy and left hemicolectomy refer to the resection of the ascending colon (right) and the descending colon (left), respectively. When part of the transverse colon is also resected, it may be referred to as an extended hemicolectomy
- Transverse colectomy is also possible, though uncommon.
- Sigmoidectomy is a resection of the sigmoid colon, sometimes including part or all of the rectum (proctosigmoidectomy). When a sigmoidectomy is followed by terminal colostomy and closure of the rectal stump, it is called a Hartmann operation; this is usually done out of impossibility to perform a "double-barrel" or Mikulicz colostomy, which is preferred because it makes "takedown" (reoperation to restore normal intestinal continuity by means of an anastomosis) considerably easier.
- When the entire colon is removed, this is called a total colectomy, also known as Lane's Operation[3]. If the rectum is also removed, it is a total proctocolectomy.
- Subtotal colectomy is resection of part of the colon or a resection of all of the colon without complete resection of the rectum.[4]
References
- ^ Lambert, Edward C. (1978). Modern medical mistakes. Indiana University Press. p. 18. ISBN 0253154251. http://books.google.ca/books?lr=&client=firefox-a&id=Ub1rAAAAMAAJ&dq=Colectomy%2Btonsils%2Bmistake&q=Colectomy#search_anchor.
- ^ Bucher P, Pugin P, Ph Morel (2008). "Single port access laparoscopic right hemicolectomy.". Int J Colorectal Dis 23 (10): 1013–6. doi:. PMID 18607608.
- ^ Enersen, Ole Daniel. "Lane's operation". whonamedit.com. http://www.whonamedit.com/synd.cfm/709.html. Retrieved 2009-07-19.
- ^ Oakley JR, Lavery IC, Fazio VW, Jagelman DG, Weakley FL, Easley K (1985). "The fate of the rectal stump after subtotal colectomy for ulcerative colitis". Dis. Colon Rectum 28 (6): 394–6. doi:. PMID 4006633.
External links
- "How I Do It" — Removing large or sessile colonic polyps. Dr. Brian Saunders MD FRCP; St. Mark’s Academic Institute; Harrow, Middlesex, UK. (Possible alternative to colectomy for removal of polyps.) Retrieved April 9, 2008.
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 | Intestinal Polyps: Prevention |
| Ulcerative Colitis: Prognosis |
| Ulcerative Colitis: Treatment |
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Copyrights:
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 | Dictionary. The American Heritage® Dictionary of the English Language, Fourth Edition Copyright © 2007, 2000 by Houghton Mifflin Company. Updated in 2009. Published by Houghton Mifflin Company. All rights reserved. Read more |
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| Oncology Encyclopedia. Gale Encyclopedia of Cancer. Copyright © 2006 by The Gale Group, Inc. All rights reserved. Read more |
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| Food and Nutrition. A Dictionary of Food and Nutrition. Copyright © 1995, 2003, 2005 by A. E. Bender and D. A. Bender. All rights reserved. Read more |
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| Veterinary Dictionary. Saunders Comprehensive Veterinary Dictionary 3rd Edition. Copyright © 2007 by D.C. Blood, V.P. Studdert and C.C. Gay, Elsevier. All rights reserved. Read more |
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| Wikipedia. This article is licensed under the Creative Commons Attribution/Share-Alike License. It uses material from the Wikipedia article "Colectomy". Read more |
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Mentioned in
- Intestinal Polyps: Prevention
- Ulcerative Colitis: Prognosis
- Ulcerative Colitis: Treatment
- Colon Cancer: Treatment
- Crohn's Disease: Treatment
- purging
- Ileoanal Anastomosis (surgical term)
- Inflammatory Bowel Disease
- Ulcerative Colitis (psychoanalysis)
- Bowel Resection (surgical term)
- Colon Cancer
- Lower gastrointestinal surgery
- Pediatric Surgery (surgical term)
- Crohn's Disease
