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Total abdominal colectomy

Definition

Total abdominal colectomy is the removal of the large intestine from the ileum (lowest part of the small intestine) to the rectum. After it is removed, the end of the small intestine is sewn to the rectum.

Alternative Names

Ileorectal anastomosis

Description

You will receive general anesthesia right before your surgery. This will make you unconscious and unable to feel pain.

During the surgery:

• Your surgeon will make an incision (cut) in your belly. Then your surgeon will remove your large intestine. Your rectum and anus will be left in place.
• Your surgeon will sew the end of your ileum to your rectum.

Why the Procedure Is Performed

The procedure is done for people who have:

• Crohn's disease that has not spread to the rectum or the anus
• Many colon cancer tumors, but their rectum is not affected
• Severe constipation, called colonic inertia

Risks

Total abdominal colectomy is usually safe. Your risk depends on your general overall health. Ask your doctor about these possible complications:

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Infection, including in the lungs, urinary tract, and belly
• Heart attack or stroke

Risks for this surgery are:

• Bleeding inside your belly
• Wound infections
• Damage to nearby organs in the body
• The end of your small intestine that is sewn to your rectum may come open. This is called anastomosis. This may be life threatening.
• Scar tissue may form in your belly and cause blockage of your small intestine.
• Your wound may break open.

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

Talk with your doctor or nurse about these things before you have surgery:

• Intimacy and sexuality
• Sports
• Work
• Pregnancy

During the 2 weeks before your surgery:

• Two weeks before surgery you may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), Naprosyn (Aleve, Naproxen), and others.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your doctor for help.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illnesses you may have before your surgery.
• Eat high fiber foods and drink 6 to 8 glasses of water every day.

The day before your surgery:

• Eat a light breakfast and lunch.
• You may be asked to drink only clear liquids such as broth, clear juice, and water after noontime.
• Do NOT drink anything after midnight, including water. Sometimes you will not be able to drink anything for up to 12 hours before surgery.
• Your doctor or nurse may ask you to use enemas or laxatives to clear out your intestines. They will give you instructions for this.

On the day of your surgery:

• Take your drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You will be in the hospital for 3 to 7 days. By the second day, you will probably be able to drink clear liquids. Your doctor or nurse will slowly add thicker fluids and then soft foods as your bowel begins to work again.

Outlook (Prognosis)

After this procedure, you can expect to have 4 to 6 bowel movements a day. You may need more surgery and an ileostomy if you have Crohn's disease and it spreads to your rectum.

Most people who have a total abdominal colectomy recover fully. Most people are able to do most activities they were doing before their surgery. This includes most sports, travel, gardening, hiking, and other outdoor activities, and most types of work.

References

Cima RR, Pemberton JH. Ileostomy, colostomy, and pouches. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2006:chap 110.

Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Coln and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 50.

Khatri VP, Asensio JA, eds. Subtotal colectomy/panproctocolectomy and j-pouch reconstruction. Operative Surgery Manual. 1st Ed. Philadelphia, Pa: Saunders; 2003:chap 35.

Scriver G, Hyman N. Ileostomy construction. Operative Techniques in General Surgery. 2007;9(1): 43-49.

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