Colectomy

Colectomy

Introduction to Procedure

We know that undergoing any procedure is a scary experience.  We understand the worry and anxiousness that is associated with surgeries and procedures and aim to walk the road to recovery with you every step of the way. We put this information together using the very helpful handbook, ‘Handbook of Surgical Consent” from Rajesh Nair and David J. Holroyd.  We hope that the following information will answer all your questions and help you with the preparation phase for your procedure.
 

Description of procedure

The operations listed below can all be performed either open or laparoscopically. Preoperatively patients are asked to undergo bowel preparation:

  • Colectomy and Rectal Excision
  • Abdominoperineal Excision of the Rectum
  • Anterior Resection of Rectum
  • Hartmann’s Procedure
  • Left Hemi-Colectomy
  • Right Hemi-Colectomy
  • Transverse Colectomy
  • Total Colectomy
  • Ileocecal Resection
Operative techniques

Depending on the operation, an anastomosis of healthy bowel will be made or alternatively and end-ileostomy or colostomy will be performed. Should the surgeon wish to protect the anastomosis they may elect to fashion a defunctioning stoma. This may be temporary and is potentially reversible – the decision for this will be made in the postoperative period once the patient has recovered from the initial operation.

Additional procedures that may become necessary
  • Extension of the resection margins to include extended colectomy, sub-total colectomy or pan-proctocolectomy depending on intraoperative findings.
  • Excision of gynaecological or urological organs.
  • Formation of defunctioning stoma.
Benefits
  • Diagnostic: To provide histopathological diagnosis of underlying pathology with or without local staging.
  • Therapeutic: To remove underlying pathology/disease process of bowel and restore function or reduce the risk of future complications.
Alternative procedures/conservative measures
  • Malignancy:  Should a patient be deemed fit for surgery and it thought possible to achieve an R0 resection, surgery should be advised.   If there is evidence of metastatic disease, then alternative treatments such as chemo-radiotherapy should be discussed.  If a tumour is likely to obstruct then options other than surgery include the use of colonic stents or diverting stomas.
  • HNPCC/FAP:  Should the patient be in a high-risk category for future development of colonic carcinoma, alternatives to surgery include surveillance colonoscopies at regular intervals.  It is important to inform the patient of the possibility of an interval cancer developing between consecutive colonoscopies.  For most FAP patients with polyps total proctocolectomy is advised.
  • Diverticular Disease: Dietary advice can be given for symptomatic disease.  In acute diverticulitis perforates this may be treated initially with antibiotics or, alternatively I an abscess cavity develops, this may be radiologically drained.  It is important to inform the patient that the disease process may persist or recur despite these measures at which point surgery may be the only option.
  • Inflammatory Bowel Disease: Medical therapy is generally advocated as first-line treatment for acute exacerbations. If unresponsive or there is risk of imminent perforation or indeed perforation of the bowel, surgery would be advocated.
  • Ischaemia:  Antibiotics, adequate oxygenation, intravenous fluids and bowel rest may resolve the acute event.  If the bowel is non-viable and the patient is fit for surgery, resection of the affected bowel with stoma formation is advocated.
Serious/frequently occurring risks
  • Bleeding, infection (including intra-abdominal sepsis in the presence or absence of an anastomosis and wound infection), perforation of bowel, anastomotic leak, ileus, possibility of blood transfusion, irresectability of tumour and recurrence, incisional or parastomal hernia, mortality (guidelines recommend operative mortality should be <20% for emergency surgery and <7% for elective surgery for colorectal cancer), possibility of a splenectomy (for left-sided colectomies), damage to or resection of female organs (e.g. hysterectomy, BSO) or resection of a segment of bladder, ureteric injury.
  • Pelvic surgery: Urinary and sexual dysfunction (impotence and retrograde ejaculation), faecal urgency, increase frequency of defecation.
  • Anastomotic leak: Anterior resection (leak rate varies from 6% - 7.4%), other colonic anastomosis (leak rate varies from 2.6% - 4.1%).
Blood transfusion necessary
  • Group and save: The process of determining the patient’s ABO blood group and screening serum for the presence of antibodies to common red cell antigens that can cause transfusion reactions.
  • Cross-match 2 – 6 units.
Type of anaesthesia/sedation
  • General anaesthesia (often with a regional block for postoperative pain control).
Follow-up or need for further procedure
  • Follow-up is required, depending on the underlying pathology this may necessitate further imaging to identify local, and systemic recurrence or a review of postoperative symptoms.

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