Colorectal Resection

by Editorial Staff and Contributors

Definition

A colorectal resection is a surgery to remove a section of the large intestine, also called the colon. It is done to remove injured or diseased parts of the colon.

Reasons for Procedure

This surgery is performed to treat a variety of conditions, including the following:

  • Colorectal cancer
  • Diverticular disease —small pouches form in the wall of the colon
  • Inflammatory intestinal diseases, such as colitis, Crohn’s disease
  • Intestinal blockage
  • Trauma to the intestine
  • Precancerous polyps, especially those seen in familial polyposis
  • A hole in the wall of the colon, or a dead piece of intestine
  • Bleeding from the colon

For colon cancer, the goal is to remove all of the cancer. If you have a precancerous condition, then you may have prevented the development of cancer. If you had surgery due to other conditions, a successful operation will alleviate or improve your symptoms.

Possible Complications    TOP

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Damage to other organs or structures
  • Infection
  • Bleeding
  • Hernia forming at the incision site
  • Blood clots
  • Complications from general anesthesia
  • Intestinal obstruction due to development of scar tissue

Some factors that may increase the risk of complications include:

  • Smoking
  • Having neurological, heart, or lung conditions
  • Age older than 70 years
  • Obesity
  • Previous abdominal surgery or radiation therapy
  • Infection
  • Diabetes

What to Expect    TOP

Prior to Procedure

Your doctor will likely do a physical exam and recommend blood tests.

Imaging tests take pictures of internal body structures. Imaging tests include:

Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure, like:

  • Non-steroidal anti-inflammatory drugs
  • Blood thinners
  • Anti-platelets

Your doctor may recommend preparation several days in advance of your procedure. This may include:

  • A special diet.
  • Your colon must be completely cleaned out. A number of cleansing methods may be used. This may include enemas, laxatives, and a clear-liquid diet. You may be asked to drink a large container of solution. It will aid in the complete emptying of the colon. This preparation may start several days before the procedure.
  • Antibiotics. It is important to take them as directed.
  • A shower the night before your procedure using antibacterial soap.
  • Wearing comfortable clothing.
  • Arranging for a ride to and from the hospital.
  • Arranging for help at home for the first days after your procedure.

Anesthesia

General anesthesia will be used. You will be asleep.

Description of Procedure

The operation may be done either using a laparoscope or using standard open techniques. This description focuses on a standard open approach.

The doctor will make a cut in the skin over the area of intestine that needs to be removed. The cuts will pass through skin and muscle to reach the inside of the abdomen. The intestine will be clamped on either side of the piece that is to be removed. The intestine next to each clamp will be cut. The diseased portion of intestine will then be removed. The two loose ends of intestine will be sewn together. Some soft tubes may be left in the abdomen to drain any accumulating fluids.

If the procedure was done as an emergency, or if the doctor decides that the intestines need time to rest and heal, you may require a colostomy. In this procedure, an artificial opening will be created in your abdomen, called a stoma. One or both ends of the intestine will be attached to the stoma. This allows feces to exit your intestine through the stoma. It collects in a pouch called an ostomy bag. A colostomy may be left in place while your intestine heals.

Colostomy

Intestinal Colostomy
Copyright © Nucleus Medical Media, Inc.

When your intestine has healed properly, you will undergo another operation. The ends of the intestine will be rejoined. If the majority of your large intestine has been removed, you may require a permanent colostomy.

The muscles and skin of the abdomen will be closed. Stitches or staples may be used. A sterile dressing will be applied.

Immediately After Procedure

The removed tissue will be sent to a lab to be examined. You will be moved to a recovery room. There, you will be monitored for any negative reactions to the surgery or anesthesia.

How Long Will It Take?

About 1-4 hours

How Much Will It Hurt?

The anesthesia will prevent pain during the procedure. Ask your doctor about medication to help with the pain.

Average Hospital Stay

The usual length of stay is 5-7 days. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

At the Hospital

  • You may need antibiotics. You may also need medication for nausea and pain.
  • You may require a nasogastric (NG) tube for a few days. The tube enters through your nose and goes to your stomach. It is used to help decompress your intestines.
  • Your intestine will require some time to heal before it will function properly again. At first, you will get nutrition through an IV. As you improve, you will be slowly advanced through liquid and soft diets to a regular diet.
  • If you had a colostomy or ileostomy, a pouch will be attached on the outside of your body. Waste material will be collected in it. You will receive instructions about diet and activity. During the first few days after surgery, you may be restricted from eating.
  • You will wear boots or special socks to help prevent blood clots.
  • You will be asked to walk often after surgery.
  • You may be asked to use an incentive spirometer, to breathe deeply, and to cough frequently. This will improve lung function.
  • Your incision will be examined often for signs of infection.

At Home

If you have a colostomy:

  • You will need to take it easy for 1-2 months.
  • A specialized nurse will teach you how to care for the stoma site and change the ostomy bag.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • You will progress from a clear liquid, to a bland, low-fiber diet, to your regular diet after about 6-8 weeks.
  • Alert your physicians and pharmacist that you cannot take medications that are considered time-released or time-sustained.
  • Do not use laxatives, because postcolostomy stools are usually quite liquid.
  • Drink plenty of liquid daily as extra fluids will be lost in your stool.
  • You will need to practice good skin care of the area around the stoma. This will help to prevent inflammation and infection.
  • You may wish to join a support group or seek counseling to help you adjust to your colostomy.

Call Your Doctor    TOP

Call your doctor if any of the following occurs:

  • Redness, swelling, increasing pain, excessive bleeding, warmth, drainage, or bulging at the incision site
  • Nausea and/or vomiting that you cannot control with the medications you were given after surgery
  • Severe abdominal pain
  • Signs of infection, including fever and chills
  • Cough, shortness of breath, or chest pain
  • Pain and/or swelling in your feet, calves, or legs
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
  • Not passing any stool
  • Blood in your stool, or black, tarry stools
  • Diarrhea
  • Feeling weak or lightheaded

If you had a colostomy created, call your doctor if any of the following occurs:

  • Not collecting stool in the ostomy pouch
  • The skin around the stoma appears irritated, moist, red, swollen, or develops sores

If you think you have an emergency, call for medical help right away.

RESOURCES:

American Cancer Society
http://www.cancer.org
National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov

CANADIAN RESOURCES:

Canadian Society of Colon and Rectal Surgeons
http://cscrs.ca
Health Canada
http://www.hc-sc.gc.ca

References:

Colorectal cancer. American Cancer Society website. Available at: http://www.cancer..... Accessed May 24, 2013.
Colorectal cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated May 3, 2013. Accessed May 24, 2013.
Diverticulitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated March 26, 2013. Accessed May 24, 2013.
Inflammatory bowel disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Accessed May 24, 2013.
Colorectal cancer prevention and treatment. American Gastroenterological Association website. Available at: http://www.gastro..... Published April 23, 2010. Accessed May 24, 2013.
National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ .
Last reviewed May 2013 by Daus Mahnke, MD; Brian Randall, MD
Last Updated: 5/24/2013