Colectomy
Encyclopedia
Colectomy consists of the surgical
resection
of any extent of the large intestine (colon
).
was one of the early proponents of the usefulness of total colectomies, although his overuse of the procedure called the wisdom of the surgery into question.
), though minimally invasive colectomy, by means of laparoscopy
, is growing both in scope of indications and popularity, and is a well-established procedure in many medical centers. Recent experience have shown the feasibility of single port access colectomy,
Resection of any part of the colon entails mobilization and ligation of the corresponding blood vessels. Lymphadenectomy
is usually performed through excision of the fatty tissue adjacent to these vessels (mesocolon), in operations for colon cancer.
When the resection is complete, the surgeon has the option of immediately restoring the bowel, by stitching or stapling together both the cut ends (primary anastomosis
), or creating a colostomy
. Several factors are taken into account, including:
An anastomosis
carries the risk of dehiscence
(breakdown of the stitches), which can lead to contamination of the peritoneal cavity
, peritonitis
, sepsis
and death
. Colostomy
is always safer, but places a societal, psychological and physical burden on the patient. The choice is by no means an easy one and is rife with controversy, being a frequent topic of heated debate among surgeon
s all over the world.
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
resection
Segmental resection
Segmental resection is a surgical procedure to remove part of an organ or gland. It may also be used to remove a tumor and normal tissue around it. In lung cancer surgery, segmental resection refers to removing a section of a lobe of the lung.- External links :* entry in the public domain NCI...
of any extent of the large intestine (colon
Colon (anatomy)
The colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a...
).
History
Sir William Arbuthnot-LaneSir William Arbuthnot-Lane, 1st Baronet
Sir William Arbuthnot-Lane, 1st Baronet, Legion of Honour was a Scottish surgeon...
was one of the early proponents of the usefulness of total colectomies, although his overuse of the procedure called the wisdom of the surgery into question.
Indications
Some of the most common indications for colectomy are:- Colon cancer.
- DiverticulitisDiverticulitisDiverticulitis is a common digestive disease particularly found in the large intestine. Diverticulitis develops from diverticulosis, which involves the formation of pouches on the outside of the colon...
and diverticular disease of the large intestine. - TraumaPhysical traumaTrauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
. - Inflammatory bowel diseaseInflammatory bowel diseaseIn medicine, inflammatory bowel disease is a group of inflammatory conditions of the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis.-Classification:...
such as ulcerative colitisUlcerative colitisUlcerative colitis is a form of inflammatory bowel disease . Ulcerative colitis is a form of colitis, a disease of the colon , that includes characteristic ulcers, or open sores. The main symptom of active disease is usually constant diarrhea mixed with blood, of gradual onset...
or Crohn's diseaseCrohn's diseaseCrohn's disease, also known as regional enteritis, is a type of inflammatory bowel disease that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms...
. - Prophylactic colectomy can be indicated in some forms of polyposis, Lynch syndrome and certain cases of inflammatory bowel diseaseInflammatory bowel diseaseIn medicine, inflammatory bowel disease is a group of inflammatory conditions of the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis.-Classification:...
because of high risk for development of colorectal cancer. - bowel infarctionBowel infarctionBowel infarction or "bowel death" results from a severely restricted blood supply to part of the bowel; this can in turn be due to an uncorrected bowel twist or bowel strangulation, or to occlusion of one of the mesenteric arteries....
- Typhlitis
Basic principles
Traditionally, colectomy is performed via an abdominal incision (laparotomyLaparotomy
A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity. It is also known as coeliotomy.- Terminology :...
), though minimally invasive colectomy, by means of laparoscopy
Laparoscopy
Laparoscopy is an operation performed in the abdomen or pelvis through small incisions with the aid of a camera...
, is growing both in scope of indications and popularity, and is a well-established procedure in many medical centers. Recent experience have shown the feasibility of single port access colectomy,
Resection of any part of the colon entails mobilization and ligation of the corresponding blood vessels. Lymphadenectomy
Lymphadenectomy
Lymphadenectomy consists of the surgical removal of one or more groups of lymph nodes. It is almost always performed as part of the surgical management of cancer....
is usually performed through excision of the fatty tissue adjacent to these vessels (mesocolon), in operations for colon cancer.
When the resection is complete, the surgeon has the option of immediately restoring the bowel, by stitching or stapling together both the cut ends (primary anastomosis
Anastomosis
An anastomosis is the reconnection of two streams that previously branched out, such as blood vessels or leaf veins. The term is used in medicine, biology, mycology and geology....
), or creating a colostomy
Colostomy
A colostomy is a surgical procedure in which a stoma is formed by drawing the healthy end of the large intestine or colon through an incision in the anterior abdominal wall and suturing it into place. This opening, in conjunction with the attached stoma appliance, provides an alternative channel...
. Several factors are taken into account, including:
- Circumstances of the operation (elective vs emergency);
- Disease being treated;
- Acute physiological state of the patient;
- Impact of living with a colostomy, albeit temporarily;
- Use of a specific preoperative regimen of low residue dietLow residue dietA low residue diet is a diet designed to reduce the frequency and volume of stools while prolonging intestinal transit time. It is similar to a low fiber diet, but typically includes restrictions on foods that increase bowel activity, such as milk, milk products, and prune juice. A low residue diet...
and laxativeLaxativeLaxatives are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool, most often taken to treat constipation. Certain stimulant, lubricant, and saline laxatives are used to evacuate the colon for rectal and/or bowel examinations, and may be supplemented by enemas under...
s (so-called "bowel prep").
An anastomosis
Anastomosis
An anastomosis is the reconnection of two streams that previously branched out, such as blood vessels or leaf veins. The term is used in medicine, biology, mycology and geology....
carries the risk of dehiscence
Wound dehiscence
Wound dehiscence is a surgical complication in which a wound breaks open along surgical suture. Risk factors are age, diabetes, obesity, poor knotting or grabbing of stitches, and trauma to the wound after surgery.-Symptoms:...
(breakdown of the stitches), which can lead to contamination of the peritoneal cavity
Peritoneal cavity
The peritoneal cavity is a potential space between the parietal peritoneum and visceral peritoneum, that is, the two membranes that separate the organs in the abdominal cavity from the abdominal wall...
, peritonitis
Peritonitis
Peritonitis is an inflammation of the peritoneum, the serous membrane that lines part of the abdominal cavity and viscera. Peritonitis may be localised or generalised, and may result from infection or from a non-infectious process.-Abdominal pain and tenderness:The main manifestations of...
, sepsis
Sepsis
Sepsis is a potentially deadly medical condition that is characterized by a whole-body inflammatory state and the presence of a known or suspected infection. The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues...
and death
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....
. Colostomy
Colostomy
A colostomy is a surgical procedure in which a stoma is formed by drawing the healthy end of the large intestine or colon through an incision in the anterior abdominal wall and suturing it into place. This opening, in conjunction with the attached stoma appliance, provides an alternative channel...
is always safer, but places a societal, psychological and physical burden on the patient. The choice is by no means an easy one and is rife with controversy, being a frequent topic of heated debate among surgeon
General surgery
General surgery, despite its name, is a surgical specialty that focuses on abdominal organs, e.g., intestines including esophagus, stomach, small bowel, colon, liver, pancreas, gallbladder and bile ducts, and often the thyroid gland . They also deal with diseases involving the skin, breast, soft...
s all over the world.
Types
- Right hemicolectomy and left hemicolectomy refer to the resection of the ascending colonAscending colonThe ascending colon is smaller in caliber than the cecum.It passes upward, from its commencement at the cecum, opposite the colic valve, to the under surface of the right lobe of the liver, on the right of the gall-bladder, where it is lodged in a shallow depression, the colic impression; here it...
(right) and the descending colonDescending colonThe descending colon of humans passes downward through the left hypochondrium and lumbar regions, along the lateral border of the left kidney....
(left), respectively. When part of the transverse colonTransverse colonThe transverse colon, the longest and most movable part of the colon, passes with a downward convexity from the right hypochondrium region across the abdomen, opposite the confines of the epigastric and umbilical zones, into the left hypochondrium region, where it curves sharply on itself beneath...
is also resected, it may be referred to as an extended hemicolectomy - Transverse colectomy is also possible, though uncommon.
- Sigmoidectomy is a resection of the sigmoid colon, sometimes including part or all of the rectum (proctosigmoidectomy). When a sigmoidectomy is followed by terminal colostomyColostomyA colostomy is a surgical procedure in which a stoma is formed by drawing the healthy end of the large intestine or colon through an incision in the anterior abdominal wall and suturing it into place. This opening, in conjunction with the attached stoma appliance, provides an alternative channel...
and closure of the rectal stump, it is called a Hartmann operation; this is usually done out of impossibility to perform a "double-barrel" or Mikulicz colostomyColostomyA colostomy is a surgical procedure in which a stoma is formed by drawing the healthy end of the large intestine or colon through an incision in the anterior abdominal wall and suturing it into place. This opening, in conjunction with the attached stoma appliance, provides an alternative channel...
, which is preferred because it makes "takedown" (reoperation to restore normal intestinal continuity by means of an anastomosis) considerably easier. - When the entire colon is removed, this is called a total colectomy, also known as Lane's Operation. If the rectum is also removed, it is a total proctocolectomy.
- Subtotal colectomy is resection of part of the colon or a resection of all of the colon without complete resection of the rectum.
External links
- "How I Do It" — Removing large or sessile colonic polyps. Dr. Brian Saunders MD FRCP; St. Mark’s Academic Institute; Harrow, Middlesex, UK. (Possible alternative to colectomy for removal of polyps.) Retrieved April 9, 2008.