Open Colon Resection: Recovery Time, Diet, And What To Expect

The large intestine is the long, tube-like, organ that makes up the final part of the human digestive system. Its function is to absorb the remaining fluid, salt, and vitamins from food previously broken-down in the small intestine, as well as to eliminate the leftover waste material from your body in the form of stool (feces).

The large intestine is comprised of the cecum (along with the appendix), colon, rectum, and the anal canal. However, the majority of the large intestine is made up of the colon, which is divided into four parts:

• Ascending colon
• Transverse colon
• Descending colon
• Sigmoid colon

The parts of the large intestine are in relation to the peritoneum, a membrane that serves as the lining of the abdominal cavity, and as such can be classified as either intraperitoneal (inside the peritoneum), such as cecum, appendix, transverse and sigmoid colon, or retroperitoneal (behind the peritoneum), such as both the ascending and the descending colon, as well as the rectum.

What is a colon resection?

Colon resection, also known as a colectomy (derived from Latin words for colon, meaning large intestine, and the suffix "-ectomy", which stands for surgical removal) is a medical procedure which involves the surgical removal of the large intestine.

Depending on the extent of the surgery, colectomy can be classified as:

• Total colectomy, where the entire colon is removed.
• Proctocolectomy. The entire colon is removed, along with the rectum.
• Hemicolectomy, in which the entire left or right portion of the colon are removed.
• Partial colectomy, a surgery during which only a portion of the colon is removed.

If an entire specific segment (such as the transverse or sigmoid colon) is removed, this is known as a segmental colectomy.

What medical conditions are treated with a colectomy?

The most common underlying reason for this type of surgery is a malignant tumor of the colon and/or rectum, called colorectal cancer. On a global scale, this type of cancer is the third most common malignancy in men, and the second most common malignancy in women, only after breast cancer.

Polyposis is a condition where there are numerous benign tumors in the bowel wall, called polyps. Although they are initially benign, these polyps do show potential to become cancerous. To avert further complications, it is advised that the problematic area should be removed. This procedure is called a prophylactic colectomy.

Diverticulosis of the colon is a condition characterized by the existence of small pouches in the wall of the bowel, typically found in the lower portions of the colon. These pouches are called diverticula and they are formed due to the existence of weak spots in the bowel wall, most commonly on places where arteries connect to the bowel. They are usually found in people whose diet is low in fiber, and therefore require more bowel pressure in order to pass the stool.

Diverticulosis usually shows no symptoms and is mostly accidentally diagnosed during colonoscopy. However, in about 10 percent of the patients, these pouches can become inflamed, which causes a disease called diverticulitis. If untreated, the inflammation may lead to severe complications.

For example, diverticulitis complications may lead to the obstruction of the bowel, or the pouch may rupture, causing internal bleeding. In such cases, the problematic part of the colon is taken out, while the remaining healthy parts are joined together. Surgery is also indicated in immunocompromised patients, or if case of multiple inflammations.

Colectomy may also be performed in patients with inflammatory bowel diseases (IBD), such as Crohn’s disease or ulcerative colitis, when other therapeutic approaches have shown unsatisfying results. The scope of colectomy surgery depends on the surface of the area affected. Because of the fact that ulcerative colitis may relapse, the surgery may be repeated. This is why it’s rare that you see a patient with an ulcerative colitis being treated with a partial colectomy.

Other indications for colectomy include bowel perforation as a result of an external trauma, cases of severe ischemia (restriction of blood supply) to the bowel, and some specific forms of constipation.

How should I prepare for a colectomy?

Prior to colon resection surgery, your doctors will tell you how to prepare, specifically what you should or shouldn’t do. This process involves the cleaning the inside of your bowels with the help of laxatives the day before the procedure, and an enema on the day of surgery. Other medications may also be prescribed. Check with your doctor if you should stop taking any of your regular medications, such as blood-thinners and antibiotics, in order to minimize the risks.

Dietary changes are also of great importance, meaning that you mustn’t eat or drink certain products, such as food high in fiber, alcohol, or any other substance which isn’t easily digested.

How is a colectomy performed?

Initially, colectomy procedures were performed exclusively as open surgeries. Basically, the doctor would make a large incision, cut out the desired part of the colon, and then patch the healthy parts up.

However, advances in technology made a new, minimally invasive procedure, called laparoscopic surgery available. Instead of making one large incision, the idea here is to make several smaller incisions, large enough that surgical tools and a small camera can fit inside the abdomen. The surgeon can than remove the part of the colon in question. This approach is usually reserved for smaller surgeries, and demands an experienced and skilled surgeon.

When a large part of the colon (or even just the rectum) is taken out, sometimes there are simply no healthy parts left to be reconnected. In such cases, it is necessary to create a small opening on the abdomen and connect it to the bowel in order for the stool to be evacuated. This opening is called a stoma, whereas the procedure is called colostomy. This surgery allows the bowel content to be eliminated into an external colostomy bag. In cases where the small bowel exits this surgical opening, it is called an ileostomy.

However, unlike this permanent (or end) colostomy, this procedure can also be temporary, such as in cases where a part of the bowel needs to heal before it’s reconnected and continue to serve its regular function.

Other than creating a stoma, there are other ways to eliminate the bowel content, such as an ileoanal anastomosis, or “J-pouch surgery”, where a part of the small bowel is reshaped so it can hold stool, serving as a makeshift rectum. After that, a subsequent operation is performed, where the small bowel is connected directly to the anus, therefore making it possible to defecate in a more natural way. The small bowel (ileum) can also be directly connected to the anus, in a so-called pull-through procedure.

What should you do after colon resection surgery?

The main benefits of a laparoscopic colon resection surgery include faster recovery time, meaning you’ll spend less time bound to your bed. In these cases, the initial recovery time for a colon resection usually takes one week, whereas recovery from an open colectomy may take up to two months. Laparoscopic colon resection surgery also shortens the time period in which you can return to your regular daily activities.

Because of the scope of the procedure, many colectomy patients are prescribed painkiller medications. Other drugs that are included in the treatment are medications to help the bowel recover more quickly, allowing the patient to start eating solid foods again. Keep in mind that you are only allowed clear liquids for the first few days after the colectomy procedure.

The same goes for behavioral changes. Patients are generally advised to eat smaller meals after a colon resection, and to chew slowly. Exercise is also important, especially walking or swimming. It is very hard to adjust to a whole new lifestyle, and it’s up to the patient to explore strategies that will suit them best.

Follow-ups are usually recommended after two weeks and two months, in order to make sure that everything is under control.