Name of the Procedure:

Colectomy, partial; with coloproctostomy (low pelvic anastomosis)

• Common names: Partial Colectomy, Low Pelvic Anastomosis

Summary

A partial colectomy with coloproctostomy (low pelvic anastomosis) is a surgical procedure that involves the removal of a portion of the colon. The remaining segment is then connected to the rectum. This procedure is often employed to treat conditions that affect the lower part of the colon and rectum.

Purpose

Medical Conditions Addressed:

• Colorectal cancer
• Diverticular disease
• Inflammatory bowel disease (such as Crohn's disease or Ulcerative Colitis)
• Large polyps not removable by other methods

Goals/Expected Outcomes:

• Removal of diseased or damaged sections of the colon
• Restoration of bowel continuity and function

Indications

• Persistent abdominal pain and discomfort
• Chronic constipation or bowel obstruction
• Gastrointestinal bleeding unresponsive to conservative treatment
• Diagnosis of colorectal cancer or precancerous conditions
• Severe cases of diverticulitis

Preparation

• Fasting for 8-12 hours prior to surgery
• Bowel preparation: A prescribed laxative to clear the intestines
• Medication adjustments: Blood thinners may need to be paused
• Diagnostic tests: Blood tests, colonoscopy, imaging studies (CT scan or MRI)

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: An incision is made in the abdomen to access the colon.
3. Resection: The diseased portion of the colon is surgically removed.
4. Anastomosis: The remaining section of the colon is connected to the rectum, creating a coloproctostomy.
5. Closure: The abdominal incision is closed with sutures or staples.

Tools/Equipment:

• Surgical instruments
• Staplers or sutures for anastomosis
• Laparoscope (in minimally invasive procedures)

Duration

• The procedure typically takes between 2 to 4 hours.

Setting

• Performed in a hospital operating room.

Personnel

• Surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

Common Risks:

• Infection
• Bleeding
• Hernia at the incision site

Rare Complications:

• Anastomotic leakage
• Bowel obstruction
• Injury to nearby organs
• Deep vein thrombosis (DVT)

Management:

• Antibiotics for infection
• Pain relief medication

Benefits

• Alleviation of symptoms caused by the diseased portion of the colon
• Reduced risk of cancer progression
• Improved digestive function

Realization of Benefits:

• Benefits may be noticeable within a few weeks post-surgery, with full recovery in a few months.

Recovery

Post-procedure Care:

• Hospital stay of 5 to 7 days
• Pain management with prescribed medications
• Gradual reintroduction of diet, starting with liquids

Recovery Time:

• Initial recovery within 4 to 6 weeks
• Full recovery within 2 to 3 months

Restrictions:

• Avoid heavy lifting and strenuous activities for several weeks
• Follow-up appointments for monitoring

Alternatives

• Non-surgical: Medical management with medications
• Minimally Invasive: Endoscopic removal of polyps or lesions
• Other Surgeries: Total colectomy or segmental resection
• Pros and Cons: Non-surgical methods may not fully address severe conditions, while other surgeries may involve more extensive recovery times.

Patient Experience

During the Procedure:

• The patient will be under general anesthesia and will not feel any pain.

After the Procedure:

• Some pain and discomfort at the incision site, manageable with pain medication
• Possible side effects: Temporary changes in bowel habits, such as increased frequency of bowel movements

Pain Management:

• Prescribed pain relievers
• Comfort measures: Positioning, use of cushions, and gentle activity