Large bowel resection

Large bowel resection is surgery to remove all or part of your large bowel. This surgery is also called colectomy. Removal of the entire colon and rectum is called a proctocolectomy. The large bowel is also called the large intestine or colon.

The large bowel connects the small intestine to the anus. Normally, stool passes through the large bowel before leaving the body through the anus.

Ascending colectomy; Descending colectomy; Transverse colectomy; Right hemicolectomy; Left hemicolectomy; Hand assisted bowel surgery; Low anterior resection; Sigmoid colectomy; Subtotal colectomy; Proctocolectomy; Colon resection; Laparoscopic colectomy; Colectomy - partial; Abdominal perineal resection

You will receive general anesthesia right before your surgery. This will make you unconscious and unable to feel pain. You will have either laparoscopic or open surgery.

Depending on what type you have, your surgeon will make 1 or more incisions (cuts) in your belly.

In a laparoscopic colectomy, the surgeon uses a camera to see inside your belly and small instruments to remove the part of your large bowel. You will have 3 to 5 small cuts in your lower belly. The surgeon passes the medical instruments through these cuts.

• You may also have a cut of about 2 to 3 inches if your surgeon needs to put a hand inside your belly.
• Your belly will be filled with gas to expand it. This makes the area easier to see and work in.
• Your surgeon will remove the diseased part of your large bowel.
• The surgeon will then sew the healthy ends of the bowel back together. This is called resecting.
• Then your cuts will be closed with stitches.

For open colectomy, your surgeon will make 6-inch cut in your lower belly.

• The surgeon will find the part of your colon that is diseased.
• The surgeon will put clamps on both ends of this part to close it off.
• Then the surgeon will remove the diseased part.
• If there is enough healthy large intestine left, your surgeon will sew or staple the healthy ends back together. Most patients have this done.
• If you do not have enough healthy large intestine to reconnect, your surgeon will make an opening called a stoma through the skin of your belly. Your large intestine will be attached to the outer wall of your belly. Stool will go through the stoma into a drainage bag outside your body. This is called a colostomy.

In most cases, the colostomy is short-term. It can be closed with another operation later. But, if a large part of your bowel is removed, the colostomy may be permanent.

Your surgeon may also look at lymph nodes and other organs, and may remove some of them.

Colectomy surgery usually takes between 1 and 4 hours.

Large bowel resection is used to treat a variety of conditions, including:

• Colon cancer
• Diverticular disease
• A block in the intestine due to scar tissue

Other reasons to perform bowel resection include:

• Ulcerative colitis  
• Traumatic injuries
• Precancerous polyps
• Familial polyposis

Talk with your doctor about these possible risks and complications.

Risks for any anesthesia are:

• Reactions to medicines
• Breathing problems

Risks for any surgery are:

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

Risks for this surgery are:

• Damage to nearby organs in the body
• Wound infections
• Wound breaks open
• Bleeding inside your belly
• Bulging tissue through the incision, called an incisional hernia
• The edges of your intestines that are sewn together may come open. This may be life-threatening.
• Scar tissue may form in your belly and cause blockage of your intestines.
• Problems with the colostomy.

See also: Colostomy

The outcome depends on the disease. Most patients have relief of their symptoms.

Most patients will stay in the hospital for 5 to 7 days. Complete recovery from surgery may take 2 months. During the first few days after surgery, eating is restricted.

Laparoscopic bowel resection for colon cancer may result in a faster recovery time than traditional open surgery.

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.