An abdominal colectomy (or large bowel resection) is a major surgery in which all of your large intestine is removed. This is typically done by making a large incision on your abdomen to remove the colon.
Your healthcare team may try other measures before moving to this step — but a colectomy may be needed to treat advanced stages of bowel disease.
Common conditions that could require a colectomy include:
Read on for an overview of what you need to know if you are having a total abdominal colectomy.
Exactly how this surgery is done depends on:
- your overall condition
- how much of the large intestine is being removed
- other conditions you may have
- your surgeon’s preference
The term “colectomy” refers to removal of part of your intestine, but the specific name of your surgery can depend on what part of your bowel is removed. Below are names of several colectomy types based on what is being removed:
|Total colectomy||The whole colon is removed.|
|Partial colectomy||Only part of the colon is removed.|
|Hemicolectomy||Only one side — the right or left — of the colon is removed.|
|Total proctocolectomy||The colon and the rectum are removed, but the anus remains intact.|
|Abdominal perineal resection||The end of the colon — the sigmoid colon — is removed along with the rectum and anus.|
|Segmental resection||Only a small part of the intestine is removed.|
|Low anterior resection||The uppermost part of the rectum is removed.|
|Sigmoidectomy||The lowest part of the colon — the sigmoid colon — is removed.|
The actual type of surgery you will have depends on your overall health and how much of your bowel is being removed. There are two types of procedures used to perform a colectomy:
Total open abdominal colectomy
With a total abdominal colectomy, a surgeon makes an incision down the middle of your abdomen to gain access to your large intestine. The diseased or damaged part of your large intestine will be removed.
At this point, the surgeon may have several options that they will discuss with you before the procedure.
If possible, the remaining ends of your large intestine (colon) will be sewn together to form an anastomosis. This isn’t always possible, even if it is planned beforehand. Extensive tissue damage or other complications may require your doctor to create new ways for you to get rid of the waste after your surgery.
Laparoscopic abdominal colectomy
This surgery may be used if you have smaller areas of damage. With this procedure, the surgeon makes a small incision in your abdomen and inserts a light, camera, and other operating tools to see the surgical area without making a large opening to remove smaller pieces of tissue.
In some cases, the surgeon may plan for a laparoscopic procedure but convert to open surgery if:
- there is a larger area of damage than originally determined
- there are other complications that require open surgery
As with any surgery, there are risks to having an abdominal colectomy, such as bleeding or poor wound healing.
In most cases, this surgery is necessary to treat or cure a condition that could cause your disease to worsen, spread, or even become fatal.
Talk with a doctor or surgeon before you plan to have this surgery to make sure you’re clear on the risks and what may be done during the surgery to prepare for any unexpected complications that may be discovered after the surgery has begun.
In the months before your procedure, you may have received a new diagnosis or ongoing care for a chronic condition that affects your large intestine.
Other treatments or medications may be offered to you. But if the discussion has turned to surgery, chances are alternative treatments are not enough to resolve your condition or allow you to have a quality of life that you’re happy with.
Once you’ve made the decision to have surgery, your healthcare team will order a number of tests to make sure you are healthy enough to undergo surgery.
These tests will look at your gastrointestinal health as well as your respiratory and cardiac health to determine whether you can safely undergo general anesthesia. This is an important step to try and help you avoid dangerous complications.
As your surgery date approaches, you will receive specific instructions on when to arrive at the hospital and what to do when you get there.
Your doctor may provide a suggestive estimate on how much time you should plan to spend in the hospital and stay home from work after your surgery. You may need to spend anywhere from 2 weeks to several months recovering, but these time frames depend a lot on how well you heal and whether you experience any surgical complications.
What happens after your surgery depends on whether you had open or laparoscopic surgery and whether there were any complications.
In most cases, you should prepare to stay in the hospital for 3 to 7 days after your surgery.
First 24 hours
For the first day after surgery, you will be monitored closely for signs of complications from the surgery or anesthesia.
You will also be given pain medications and intravenous fluids at first, but you might be able to consume clear liquids by the second day after your surgery.
First few weeks
When you are discharged from the hospital, you will either go home or to a rehabilitation facility depending on your individual needs and condition.
Laparoscopic surgery may allow you to heal faster, but you should be prepared to limit your activity and make some lifestyle changes for several weeks regardless of which type of surgery you had.
With most abdominal surgeries, the doctor will advise you to:
- limit your activity
- start with short walks and increase your distance gradually
- do not lift anything heavier than 10 pounds for 6 weeks after surgery
- do not drive for 2 weeks after surgery or as long as you are taking prescription pain medications
They will also instruct you on wound and incision care based on the type of procedure that was done and any complications you may have.
You will also receive specialized education if you have a new ostomy where waste will come out. This education will review:
- how to care for the ostomy
- what lifestyle changes you may need to make
- when to call the doctor if you run into any issues or complications
First few months
In the months after your surgery, your healthcare team will monitor your healing and check to be sure your bowels are functioning well.
If you did not have complications and do not have any other additional surgeries planned, you should be able to return to work and your typical activities after 4 to 6 weeks.
Your follow-up care depends on:
- the type of surgery you had
- what was removed
- whether you had any complications
You may also have follow-up appointments with several types of specialists, such as a gastrointestinal (GI) doctor. These specialists can monitor specific health issues and provide guidance on how to take care of yourself following these major changes in your bowels.
After a colectomy, you may need to make a number of lifestyle changes. This will include your initial activity level and learning to care for your stoma and ostomy if you have them, such as by wearing an ostomy bag.
Diet and your digestion will be a big part of these changes. By removing part of your intestine, you take out several steps in the digestive process. It’s common to have diarrhea, or loose stool, for weeks or even months after your surgery.
Your doctor will prescribe a diet specific to your needs to help with these symptoms, including:
- a high fiber diet
- proper hydration
- nutritional supplements
- avoidance of certain foods
There are many side effects that can happen with any surgery, but abdominal surgeries are particularly complex.
A number of additional risks are involved when the bowels are operated on. Leaks and poor wound closures can cause stool and other fluids to make it into places they don’t belong, potentially causing serious infections.
The most common complications after a colectomy include:
- blood clots
- scar tissue or adhesion formation
- poor wound closure or the opening of the surgical incision (dehiscence)
- bowel obstruction
- leaking or infection of the colostomy
Talk with the doctor about your individual health risks and anything you can do before surgery to reduce your risk of complications.
When to get in touch with a doctor
Seek immediate medical help if you have any of the following symptoms after your colectomy:
- bloody stools
- severe pain or stomach cramping
A colectomy is a major surgery where part — or all — of your large intestine is removed.
You may be able to have a less invasive laparoscopic surgery if only small pieces of intestine are removed, but open surgery is required when a significant portion or multiple parts of the digestive tract are taken out.
Healing can be slow after abdominal surgery, and you may have to learn to eat differently and care for an ostomy. Plan for your recovery to take several weeks to months and talk with your doctor about what to expect when it comes to your individual health long term.