Colectomy is a procedure to remove part or all of the large intestine, or colon. If inflammation has damaged the rectum, a surgeon may remove it as well, a procedure called proctocolectomy. Both procedures are performed using general anesthesia.
Doctors may recommend colectomy for people with Crohn’s disease or ulcerative colitis. They decide if colectomy is appropriate based on the results of diagnostic tests and whether the disease has progressed despite medication.
Colectomy is most often recommended for people with ulcerative colitis who have excessive bleeding in the intestine or rectum and do not respond to medical treatment. Because ulcerative colitis is limited to the colon, doctors consider colectomy a cure for the disease.
For those with Crohn’s disease, doctors may recommend colectomy if ulcers, infection, or strictures in the large intestine don’t respond to medication. Colectomy may relieve symptoms of Crohn’s disease for months or years, but it is not considered a cure because the disease may affect any part of the gastrointestinal tract.
What to Expect During Surgery
A surgeon may perform a colectomy using a minimally invasive laparoscopic technique, in which he or she makes several small incisions in the abdomen. The surgeon then inserts a laparoscope—a thin, flexible instrument with a light and camera on the end—through one of the incisions. The camera sends live images to a nearby monitor, giving the doctor a clear view of the interior of the abdomen.
If a surgeon requires more direct visualization of the colon, he or she makes a longer incision in the abdomen to reach the colon directly. This is called an open technique.
In either approach, the surgeon removes the diseased part of the colon. If some of the colon is healthy, the surgeon performs a partial colectomy and removes only the diseased part of the colon. If IBD has progressed throughout the entire colon, he or she may perform a total colectomy. If the colon and rectum are damaged, both are removed. Most people still have a functioning digestive system after surgery.
Pouch Surgery and Ileostomy
If the colon and rectum have been removed, the surgeon may need to perform an additional procedure to help the body process waste. For people with ulcerative colitis, this procedure is called an ileal pouch anal anastomosis. For those with Crohn’s disease, a surgeon may perform an ileostomy.
To perform an ileal pouch anal anastomosis, also called “pouch surgery,” a surgeon uses part of the small intestine to construct an internal pouch that remains permanently within the abdomen. This pouch mimics the function of the rectum by providing a place for waste to collect and allows people to pass waste through the anus. This procedure avoids the need for a permanent ileostomy.
Because Crohn’s disease affects the small intestine, an ileal pouch would be vulnerable to becoming infected or diseased. Surgeons perform an ileostomy instead. In this procedure, the surgeon creates an opening in your abdomen, called a stoma. The end of the small intestine, called the ileum, is attached to the stoma. This allows stool to exit your intestine through the opening.
Waste collects in an external pouch called an ostomy bag that is worn around the waist. An ileostomy may be temporary or permanent. A doctor determines the next steps based on the results of the surgery, your age, and your overall health.
A temporary ileostomy allows the intestine to rest and heal. When your intestine has healed fully, a surgeon may perform another operation to rejoin the ends of the intestine. In some instances, he or she may be able to create an internal pouch to collect and store stool, mimicking the function of the rectum and restoring the ability to pass waste through the anus.
Doctors determine whether this is possible based on a number of factors, including how much of the colon was removed, how far the disease has progressed in other areas of the gastrointestinal tract, and your overall health.
What to Expect After Surgery
Immediately after surgery, NYU Langone pain management specialists and ostomy nurses help you control postoperative pain and adjust to the ostomy bag. You should expect to remain in the hospital for two to five days for observation while you begin to heal.
While you are in the hospital, our ostomy team provides support and answers any questions you have about living with an ostomy bag. Most people can easily conceal the bag beneath their clothing.
For those with a temporary ileostomy, the second surgery typically occurs two or more months later. During this time, doctors schedule follow-up appointments every one or two weeks to monitor the intestine as it heals.