Total abdominal colectomy
Total abdominal colectomy is the removal of the large intestine from the lowest part of the small intestine (ileum) to the rectum. After it is removed, the end of the small intestine is sewn to the rectum.
Ileorectal anastomosis; Subtotal colectomy
You will receive general anesthesia before your surgery. This will make you asleep and unable to feel pain.
During the surgery:
- Your surgeon will make a surgical cut in your belly.
- The surgeon will remove your large intestine. Your rectum and anus will be left in place.
- Your surgeon will sew the end of your small intestine to your rectum.
Why the Procedure Is Performed
The procedure is done for people who have:
- Crohn disease that has not spread to the rectum or the anus
- Many colon cancer tumors, when the rectum is not affected
- Severe constipation, called colonic inertia
Total abdominal colectomy is most often safe. Your risk depends on your general overall health. Ask your health care provider 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
- Damage to nearby organs in the body
- Scar tissue may form in the belly and cause a blockage of the small intestine
- Leakage of stool from the connection between the small intestine and the rectum. This can cause an infection or abscess.
- Scarring of the connection between the small intestine and the rectum. This can cause a blockage of the intestine
- Wound breaking open
- Wound infections
Before the Procedure
Always tell your provider what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
Before you have surgery, talk with your provider about the following things:
- Intimacy and sexuality
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 which drugs you should still take on the day of your surgery.
- If you smoke, try to stop. Ask your provider for help.
- Always let your provider 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:
- Follow your provider's instruction about what to eat and drink. You may be asked to drink only clear liquids such as broth, clear juice, and water at some point during the day.
- You will be told when to stop eating and drinking. You may be asked to stop eating solid food after midnight, but you might be able to have clear liquids up until two hours before surgery.
- Your provider may ask you to use enemas or laxatives to clear out your intestines. You will get instructions on how to use them.
On the day of your surgery:
- Take the drugs you were told to take with a small sip of water.
- You will be told 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. You will slowly be able to add thicker fluids and then soft foods to your diet as your bowels begin to work again.
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 disease and it spreads to your rectum.
Most people who have a total abdominal colectomy recover fully. They are able to do most of the activities they were doing before their surgery. This includes most sports, travel, gardening, hiking, and other outdoor activities, and most types of work.
Cima RR, Pemberton JH. Ileostomy, colostomy, and pouches. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 113.
Cunningham D, Atkin W, Lenz HJ, Lynch HT, Minsky B, Nordlinger B, et al. Colorectal Cancer. Lancet. 2010;375:1030-47. PMID: 20304247 www.ncbi.nlm.nih.gov/pubmed/20304247.
Fry RD, Mahmoud NN, Maron DJ, Ross HM, Rombeau J. Colon and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 52.