The colon (large intestine) is the last part of your digestive tract. This part of the bowel works to soak up water and store food waste. The colon is a tube-like muscle. This tube has a very smooth lining. The lining is made up of millions of cells. The colon in an adult is about 4 – 6 feet long. The rectum is the last 6 inches of the colon. A colectomy is surgery to remove all or part of your colon.
Part or all of the ascending colon and cecum are removed. The colon is then reconnected to the small intestine.
Part or all of the descending colon is removed. The transverse colon is then reconnected to the rectum.
Part or all of the sigmoid colon is removed. The descending colon is then reconnected to the rectum.
Low Anterior Resection
The sigmoid colon and a portion of the rectum is removed. The descending colon is reconnected to the remaining rectum.
Abdominal Perineal Resection
Part of or all of the sigmoid colon and the entire rectum and anus are removed. A colostomy will be made. A colostomy creates an opening in your stomach wall so waste can pass from the body.
Minimally invasive or laparoscopic surgery involves using multiple trocars (thin tubes) placed through 3 to 5 small incisions. These incisions are usually less than 0.5 cm (less than ¼ inch). Carbon dioxide gas is then used to slowly inflate the abdomen. A thin telescope is placed through one of the trocars. This allows the surgical team to view the inside of the abdomen on a TV monitor. Specialized instruments are placed through the other trocars to perform the operation. For colon surgery, one of the incisions is enlarged to remove the piece of colon. This larger incision can also be made initially, allowing one hand to be placed within the abdomen along with the camera and long instruments to assist with the operation. The procedure is performed under general anesthesia.
The doctor’s secretary will give you the date of your surgery and the time and place to report to that day. Your surgeon will do a physical exam before surgery. If you need other testing, such as a chest x-ray, blood tests or an EKG to check your heart, you will be told when and where those are scheduled. If you are taking aspirin, Coumadin, Plavix or any other type of medication that may thin your blood, please tell your doctor. You will need to stop this medication before surgery.
You will need to do a bowel prep to clean the stool out of your colon. Your doctor or nurse will give you more instructions based on the type of prep. You should not eat or drink anything after midnight the evening before your surgery.
Bring all your medicines in their original containers with you to the hospital. You will meet with the anesthesiologist. This doctor will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery. You will have an IV or intravenous line put in to give you fluid and medicine during your surgery. When it is time for you to go to surgery, your family will be asked to wait in the waiting area. Your doctor will talk to your family there after your surgery is done.
This procedure is performed under general anesthesia, which means you will be completely asleep. After you go to sleep, a tube will be put into your nose and down your throat into your stomach. This is called a nasogastric tube or NG. It is used to remove secretions in your stomach until your stomach and bowel begin to work again after surgery. You will also have a tube put in to drain your bladder of urine. This is called a Foley catheter. This will stay in for a few days after your surgery.
Compression devices are used to help keep your blood circulating in your legs. These are wraps placed around your legs. There is a pump attached that will put air into the wraps. The air is pumped in one part of the wrap and then another so that your leg is squeezed to help keep the blood in your veins moving, much like your leg muscles would do if you were up walking. This is done to lessen your chance of getting blood clots. These will be used after surgery until you are able to be up and walking.
Once everything is in position, the surgical team will work together to perform the operation. Monitors are used to observe your vital signs throughout the surgery. There will be stitches used to close the layers inside. You may have staples on the outside of the incision to hold it together after the surgery is done. When the operation is complete the breathing tube is removed. Most patients do not remember this.
After your surgery is done, you will be taken to the Post-Anesthesia Care Unit, or PACU. You will be there for 1-2 hours. When you are ready, you will be moved to your hospital room where your family will be able to see you. The nurses will continue to check your heart rate, blood pressure, temperature, breathing and your incision.
They will also be checking your tubes:
• NG to drain your stomach. This is sometimes removed in the operating room but otherwise will stay in for about 1-4 days.
• Foley catheter to drain your urine. This stays in for 2-3 days.
• IV for fluids and medicine. This will stay in until you are able to eat again.
For pain control, there may be a pump attached to your IV. This is called a PCA or patient controlled analgesia pump. You will have a button that you push when you start to feel it’s time for pain medicine. The pump is set so that you cannot get too much medicine. Often you will use this pump until you are able to eat and take pain medicine by mouth. The compression devices will stay on your legs while you are in bed during your hospital stay to lessen your risk of blood clots.
The procedure requires a 3 nights stay in the hospital after the operation.