Surgery of the Large Intestine
Colectomy is the surgical removal of all or a part of the colon (large intestine) and joining the remaining portion to the small intestine.
Colectomy on one side of the colon is referred to as Hemicolectomy.
Right hemicolectomy is the removal of the right side of the colon and joining the small intestine to the remaining portion of the large intestine. Similarly. Left Hemicolectomy the removal of the left side of the colon and joining the small intestine to the remaining portion of the large intestine. Total colectomy involves removing the entire colon.
Partial colectomy refers to removing a part of the colon. Proctocolectomy involves removing both the colon and rectum. Sigmoid colectomy involves the removal of the sigmoid colon(part of the large intestine closest to the rectum and anus) and if indicated a portion of the rectum.
Colectomy is indicated for patients with uncontrolled bleeding of the colon, intestinal obstruction, Crohn’s disease, ulcerative colitis, colon cancer and diverticulitis.
Colectomy may be performed in two ways:
- Open surgery – In this technique, the surgeon makes a large incisional cut in the abdomen and disconnects all of the colon or a part of it from the surrounding tissues and blood vessels and removes it.
- Laparoscopic surgery- In this technique the surgeon makes two to three tiny incisions in the abdomen and enters the laparoscope through one of the incisions to view the abdomen. Surgical instruments are entered through the other incisions and the affected portion of the colon or all of it is disconnected from the surrounding tissues and removed.
Depending on which portion of the colon is removed, the surgeon rejoins the healthy ends of the bowel to restore bowel function. It may be done in one of the following ways
- After a partial colectomy, healthy remaining ends of the colon are joined back, creating what is referred to as an anastomosis which restores normal bowel function
- After a total colectomy, the small intestine is attached to an opening created in the abdomen to allow wastes to be excreted out of the body. This procedure is known as an ileostomy. It may be short term or permanent.
- The surgeon may also attach one end of the healthy large intestine to an opening created in the abdomen. This procedure is referred to as a Colostomy and may be short term or permanent.
- After a proctocolectomy, a portion of the small intestine is used to create a pouch that is attached to the anus that allows normal excretion of wastes.
Why Laparoscopic surgery over open surgery?
Laparoscopic surgery is less painful and has fewer complications as the abdominal muscles are not cut. The recovery is faster and the patients are mobile within a few hours after the surgery and may be discharged on the same day of the surgery. The cosmetic results are excellent as compared to an Open surgery.