What You Should Know Before Surgery
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Colon resection surgery, also referred to as a colectomy, is a surgical procedure that is used to remove part, or all, of your colon (large intestine). Depending on the type of procedure, your surgeon may also remove your rectum. Your doctor may recommend this operation if you’ve been diagnosed with a disease or condition that affects your colon.
Everyday Health sat down with Stefan Holubar, MD, a colorectal surgeon at the Cleveland Clinic, to talk more about colon resection surgery, how the procedure works, and what to expect when it comes to recovery.
Everyday Health: Why might someone need colon resection surgery?
Stefan Holubar: The most common reasons for a colectomy are colorectal cancer or a diverticulitis diagnosis. It may also be necessary if you have GI bleeding and inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease.
EH: Is there a specific type of colon resection surgery that’s usually recommended?
SH: The most common type is called partial or segmental. During this procedure, we remove the affected part of the colon. This is a pretty standard surgical method to treat diverticulitis and colorectal cancers that are uncomplicated. By uncomplicated, I mean that the cancer hasn’t spread outside the bowel into the abdominal cavity.
Sometimes we have to do extended colectomies, where multiple segments are removed, and sometimes we’re removing the entire colon and leaving the rectum behind.
The main differences between the types of surgeries that can be done are whether the procedure can be done via laparoscopic methods, which pairs the use of surgical incisions with a camera; robotic-assisted laparoscopic methods, which use a computer-controlled device to help with the positioning and use of surgical instruments; or open surgery, which involves one long incision through the middle of the abdominal wall.
EH: At what point do you recommend colon resection for someone diagnosed with colorectal cancer?
SH: It’s pretty much standard of care for patients with nonmetastatic colorectal cancer to have this procedure. In general, we like to do this within a month of diagnosis, plus or minus. This gives us the best chance of curing the colorectal cancer.
If you’ve been diagnosed with colorectal cancer, it’s standard to do surgery first. [Whether someone needs chemotherapy treatment or not] depends on whether there is lymph node involvement. If there is, the cancer is automatically considered stage 3.
EH: What is the difference between a colon resection and a colostomy?
SH: A colon resection is where we remove the part of the colon with the cancer, and then sew the two healthy ends back together. A colostomy is needed when the two parts of the colon can’t be reattached, and the digestive tract is instead attached to an opening outside of the body so the stool can pass through into a colostomy bag.
Resections are sometimes combined with colostomies if the patient has a perforation (a hole in the colon) prior to surgery. Sometimes, they’re done separately. The way we approach this has to do with a few factors: If it’s an emergency, or if the patient is acutely ill with a perforation, they may need the colostomy. Ideally, if we can, we want to do a resection [and avoid a colostomy].
EH: How should someone prepare for colon resection surgery?
SH: There are no dietary restrictions before the procedure, but patients do have to do blood work and a bowel prep before surgery. This is similar to the preparation for a colonoscopy, but we add antibiotics to decontaminate the stool as well. This is to prevent the risk of infection after surgery.
EH: What happens during colon resection surgery?
SH: It depends on the situation. In general, whether the surgery is done laparoscopically or open, the first step of this two-to-three hour surgery (which is performed under general anesthesia) is to free up the colon. That’s called mobilizing the colon, and that’s where we detach it from the inside of the body.
After the colon is freed up, we disconnect the affected area from the colon on either end, remove the affected area, and reattach the colon, like splicing two ends of a pipe together. This is called anastomosis. The lymph nodes in that segment being removed are sent to pathology [if it’s a cancer]. The time-consuming part is the dissection and mobilization at the beginning. If we’re using staples, putting the colon back together can be done in five minutes. If we sew by hand, that can take a half-hour.
EH: What complications can result from colon resection surgery?
SH: The risks include infection, bleeding, and damage to the organs and nerves, but most of these complications are related to whether the patient has had prior abdominal surgery and has scar tissue.
EH: What does colon resection recovery look like?
SH: We advise patients to take six weeks off from work for recovery. After surgery, patients are usually in the hospital for three to four days. Once you’re recovering at home, we recommend that you avoid driving for two weeks, until you can slam on brakes if necessary and are no longer taking pain medication. We also recommend that you avoid heavy lifting and follow a soft diet for a month to enable the colon to heal.
EH: What are some resources you recommend for anyone who wants to learn more about colorectal cancer and their treatment options?
SH: The American Society of Colon and Rectal Surgeons has an excellent patient portal with educational readings, videos and tips for patients. It’s very useful.
This interview was edited for clarity.
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