bowel surgery

Colectomy or surgery to remove the large intestine

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Colectomy is usually performed when there are benign or malignant tumors in the large intestine. This procedure may also be necessary in the treatment of other non-tumor diseases such as intestinal endometriosis. It consists of removing the involved segment to avoid some very serious complications: such as bleeding, obstruction and intestinal perforation. These complications can lead the patient to undergo urgent surgery in addition to the risks of serious complications such as infection and even death. That is why it is important to make the correct diagnosis and schedule the treatment electively.

Colectomy can be divided into:

• Partial - removal of a part of the large intestine

• Total - removal of the entire large intestine

We can further divide the colectomy into:

• Right - right side bowel withdrawal. In this case, the ileocecal valve, the cecal appendix, the ascending colon and part of the transverse colon are normally removed.

• Left: removal of part of the transverse colon on the left side and the descending colon, which may include the rectosigmoid.

• Rectosigmoidectomy: is the removal of the rectum along with the sigmoid.

As for the access route, we can divide the surgeries into:

• open surgery

• Laparoscopic surgery

• Robotic Surgery

Videolaparoscopy and robotic surgery are also classified as minimally invasive surgery. However, all minimally invasive surgeries may need to be converted to open surgery in cases where it is difficult to continue surgery laparoscopically or robotically. In almost all cases where the minimally invasive technique is necessary to perform a small suprapubic incision to remove the surgical specimen.

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Should I go on a diet before colorectal surgery?

We advise patients, who will undergo left colectomy and rectosigmoidectomy, to follow a bland diet starting three days before the date of surgery. On this diet, the patient should avoid some foods. You will be able to access this complete diet by downloading the file below or following the medical advice provided in the consultation.

How is recovery after surgery?

It is expected that the individual will be able to get out of bed with assistance soon after surgery, or the next day. The patient should get up and try to walk as this stimulates bowel function and helps prevent deep vein thrombosis. There may be pain and discomfort, but these sensations are controlled with medications prescribed by the doctor. In almost all cases, an abdominal drain is left that can be removed before discharge or even in the office.  

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Right after the procedure, the patient will be able to walk slowly. This practice decreases the chances of thrombosis and pulmonary infection. 

After surgery to remove part of the colon and rectum, it is common for the patient to have some temporary effects such as diarrhea, nausea, constipation and tiredness. Gradually, the person will feel comfortable and safe to walk, climb stairs, lift weights, shower alone, have sex, drive and return to work. Everything at its time. It is essential to respect the limits of the body.

How is the diet after colectomy?

To improve the recovery process, it is necessary to adopt nutritional measures, such as a liquid diet in the first days, and gradually switch to a pasty and solid diet, according to medical guidelines. Hospital discharge should take place between 3 and 7 days, but the diet should continue at home and partial rest, too.

length of stay

The average length of stay is 5-7 days, but it can be a little longer when the surgery is performed through conventional means and large incisions. The patient is usually referred to  the ICU in the immediate postoperative period and staying for 1 to 2 days. After discharge from the ICU, he stays in the hospital for around 3 to 5 days in his room, until he presents a good acceptance of the oral pasty diet, when he will be able to be discharged with instructions to return to the office for 7 to 10 days.

Is there a risk of complications from the surgery?

Any operation involves risks. In the case of colectomy, complications such as internal bleeding, wound infection, bowel obstruction, leakage of fluid in the bowel, clots, damage to other organs and pneumonia can occur. Minimally invasive surgeries, however, have less risk compared to open surgeries. Whenever there is a more serious complication, such as leakage of intestinal contents (called fistulas) it may be necessary to make a temporary diversion of the intestinal contents through an ostomy (ileostomy or colostomy). These ostomies are usually temporary and need a new surgical approach within 2 months for their closure.  

To minimize the possibilities of complications, it is important to have a qualified medical team and to carry out an adequate preoperative period.  

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Coming soon video of the surgery.