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Colorectal Resection

Definition

An operation to remove a section of the large intestine, most often to remove injured or diseased parts of the colon.

Parts of the Body Involved

The surgery is performed on the large intestine, also known as the colon.

Reasons for Procedure

Colorectal resection is most often performed due to colon cancer.

Other conditions that may warrant this procedure are:

  • Intestinal obstruction causing perforation or gangrene
  • Ulcerative colitis
  • Trauma to the intestine
  • Intestinal polyps, especially the precancerous type seen with familial polyposis syndrome.
  • Perforated diverticulum
  • Ischemic bowel (an area of intestine to which the blood supply has been cut off, resulting in tissue death)

Risk Factors for Complications During the Procedure

  • Obesity
  • Previous abdominal or pelvic surgery, with scar tissue formation
  • Prior radiation therapy to the abdomen or pelvis
  • Diabetes
  • Infection
  • Pre-existing heart and/or lung problems
  • Debilitation, malnutrition
  • Peritonitis (inflammation of the peritoneum, which is the lining of the abdomen)
  • Bowel perforation and contamination of the abdomen with intestinal contents

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Physical Exam
  • Blood Tests
  • Ultrasound exam of the abdomen—a test that uses sound waves to visualize the inside of the abdomen
  • X-ray exam of the abdomen, after swallowing a barium drink and/or receiving a barium enema
  • CT Scan—a type of x-ray that uses a computer to make pictures of the inside of the body
  • MRI Scan—a test that uses magnetic waves to make pictures of the inside of the body
  • Colonoscopy with biopsy samples—visual exam and removal of tissue inside of the large intestine with a flexible tube that is attached to a light and a viewing device

In the days leading up to your procedure:

  • Drink eight, 8-ounce glasses of water daily.
  • If recommended by your doctor, follow a special diet for several days before surgery.
  • Your colon must be completely cleaned out before the procedure. A number of cleansing methods may be used, including enemas, laxatives, and a clear-liquid diet. You may be asked to drink a large container of solution that aids in the complete emptying of the colon. This preparation may start several days before the procedure.
  • Take antibiotics, if prescribed by your doctor.
  • Eat a light meal the night before your procedure and do not eat or drink anything after midnight.
  • You may be asked to shower the morning of your procedure, and you may be given special antibacterial soap to use.
  • Arrange for a ride to and from the hospital.
  • Arrange for help at home for the first days after your procedure.

During Procedure

IV fluids, sedation, and anesthesia will be administered.

Anesthesia

General anesthesia is used during the surgery.

Description of the Procedure

The surgeon makes an incision over the area of intestine that needs to be removed, and cuts through skin and muscle to reach the inside of the abdomen, which is called the peritoneal cavity. The intestine is clamped in two places, on either side of the piece to be removed, and the surgeon cuts through the intestine next to each clamp. The diseased portion of intestine is removed, and the two loose ends of intestine are sewn together. The surgeon may need to leave some soft tubes in the abdomen to drain any accumulating fluids.

If the surgeon determines that the intestine needs time to rest and heal prior to resuming normal function, you may require a colostomy. Either the intestine closest to your stomach or both ends of the intestine are attached to an artificial opening the surgeon creates in your abdomen, called a stoma. This allows waste material (feces) to exit your intestine through the stoma and into a collection pouch called an ostomy bag. A colostomy may be left in place for several months while your intestine heals. When the surgeon determines that your intestine has healed properly, you will undergo another operation to rejoin the ends of the intestine and reverse the colostomy. However, if the majority of your large intestine has been removed, you may require a permanent colostomy.

After the colorectal resection is complete, the surgeon closes the muscles and skin of the abdomen using either stitches or staples, and a sterile dressing is applied. If you have a colostomy, an ostomy bag is attached to collect feces.

Surgical Resection of a Colorectal Tumor Mass

Surgical Resection of a Colorectal Tumor Mass

© 2008 Nucleus Medical Art, Inc.

After Procedure

The removed section of intestine is examined by a pathologist.

How Long Will It Take?

The surgery should be about 1 to 4 hours, but may be longer if the procedure is complicated.

Will It Hurt?

Anesthesia prevents pain during the procedure.

Possible Complications

  • Accidental damage to the remaining intestine, or neighboring organs or structures
  • Infection
  • Bleeding
  • Pneumonia and other risks of general anesthesia, which you should discuss with your anesthesiologist before surgery
  • Blood clots in the legs
  • Hernia developing in the incision
  • Intestinal obstruction due to development of scar tissue

Average Hospital Stay

You can expect to stay in the hospital for about 5 to 7 days.

Postoperative Care

  • You may require antibiotics, as well as antinausea and pain medications.
  • Your intestine will require some time to heal before it will function properly again. Initially, you'll receive nutrition through an IV. As your tolerance of food and liquids improves, you'll slowly be advanced through liquid and soft diets to a regular diet.
  • You may be given special compression stockings to wear after surgery to decrease the possibility of blood clots forming in your legs.
  • You may be asked to use an incentive spirometer, to breathe deeply, and to cough frequently, in order to improve lung function after general anesthesia.

If you have a colostomy created:

  • An enterostomal nurse (ETN) or your surgeon will teach you how to care for the ostomy site.
  • This surgery will change some aspects of the way your intestine functions.
  • In the first weeks after your operation, avoid high fiber foods, including corn, celery, apples, nuts, popcorn, grapes, and other foods with hulls, peels, and seeds. When your doctor says you may eat these foods again, begin with small amounts, so you can see how your intestine adjusts to digesting them.
  • Alert your physicians and pharmacist that you cannot take medications that are considered long-acting or sustained release.
  • Do not use laxatives because post-colostomy stools are usually quite liquid.
  • Drink eight, 8-ounce glasses of liquid a day (not including caffeinated beverages) because extra fluids will be lost in your stool.

Outcome

The outcome varies depending on why you had the colorectal resection. If you have colon cancer, a good outcome includes a pathology report showing that the entire cancerous area has been removed, with clean margins on either side. If you have a precancerous condition (such as certain types of polyps, familial polyposis, ulcerative colitis), then you may have prevented the eventual development of cancer. If you had surgery due to other conditions, a successful operation will alleviate or improve your symptoms.

If you've had a colostomy created, your daily waste (feces) will collect in a pouch attached to your ostomy site. Or, if you have the type of colostomy that you can drain by catheter at set intervals, you may just wear a small patch, cap, or bandage over the ostomy site. Considerations for living with a colostomy include:

  • Your stool is likely to be looser (more liquid) than it was before your colostomy.
  • You'll need to practice meticulous skin care of the area around the stoma in order 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 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 can't control with the medications you were given after surgery, or which persist for more than two days after discharge from the hospital
  • 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
  • Blood in your stool, or black, tarry stools

If you have a colostomy created:

  • Nausea, vomiting, and/or diarrhea
  • Severe abdominal pain
  • Feeling weak or dizzy
  • Not urinating the usual quantity
  • Bleeding from the stoma
  • Stoma is not functioning (you aren't collecting any stool in the pouch)
  • The skin around the stoma appears irritated, moist, red, swollen, or develops sores

RESOURCES:

American Cancer Society
http://www.cancer.org

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
http://www.niddk.nih.gov

CANADIAN RESOURCES:

Canadian Society of Colon and Rectal Surgeons
http://www.colon-rectalsurgery.org/index.htm

Health Canada
http://www.hc-sc.gc.ca/index_e.html

References:

American Gastroenterological Association website. Available at: http://www.gastro.org/wmspage.cfm?parm1=2 .

National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ .



Last reviewed November 2007 by Daus Mahnke, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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