Types of Colectomies

Colectomies

 

A colectomy is a surgical procedure in which part, or all, of the colon is removed. Colectomies are often performed as a treatment for colon cancer, but may also be used to definitively treat ulcerative colitis and other diseases of the colon. There are various types of colectomies, including hemicolectomy, subtotal and total colectomy, among others. This article provides a brief overview of colectomies.

 

A little anatomy, please

 

Once something that we swallow has passed through the esophagus, stomach and small intestine, what has not been absorbed will reach the large intestine, or colon. The colon almost forms a complete square in the abdomen. It starts in the lower right side, where the appendix is located, travels toward the head where it bends 90 and makes its way across the body. Once it gets to the upper, left part of the abdomen, it bends 90° once again and progresses to the rectum and anus. The colon is not necessarily a place where a lot of food absorption takes place (that is the small intestine); rather the colon is important for drawing water out of and storing feces until it passes.

 

 

Types of colectomies

 

If the entire colon is removed, it is called a total colectomy and if a portion is removed, it is called a subtotal colectomy. Another term that is used when only a portion of the colon is removed is hemicolectomy. Generally surgeons want to spare as much of the colon as possible to preserve as much normal function as possible. In cases of colon cancer, it may be possible to remove only half of the colon and still remove all of the cancer. How is this determined? Even though the entire digestive tract is essentially a long tube, various places and structures within the digestive tract have different blood supply and different lymph drainage (think lymph nodes). If the colon cancer is found in the early part of the colon, a right hemicolectomy may be performed (based on the patient’s right or left—like right or left hands). Likewise if the tumor is near the end of the digestive tract, a left hemicolectomy may be done. In Crohn’s disease, a small portion of the colon may be removed and the healthy parts reconnected (an anastomosis). In severe ulcerative colitis, however, the surgeon can cure the disease if a total colectomy is performed.

 

After the colectomy

 

Many people dread one particular outcome of colectomy: a colostomy. A colostomy is a surgical opening that is created in the side of the body to which the remaining colon is attached. The colostomy site now serves to remove waste from the body, the timing of which is no longer under the control of the patient. Unfortunately, a colostomy may be necessary for many patients, at least temporarily. A newer approach is to colectomy is to reattach the remaining end of the colon to the anus. This preserves (close to) normal defecation for the patient.

 

A colectomy can be a life-saving experience for those with cancer and provide a life free of symptoms for those with certain other diseases of the colon. However, colectomies are surgeries that come with some lifestyle adjustments that are important to discuss with your general or colorectal surgeon prior to colectomy surgery.