Name of the Procedure:

Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy

Summary

A total abdominal colectomy is a surgical procedure where the entire colon is removed. This operation can be performed without removing the rectum (proctectomy). Depending on the case, the procedure may involve creating an ileostomy (an opening in the abdominal wall for waste to pass) or connecting the ileum (end of the small intestine) to the rectum (ileoproctostomy).

Purpose

The procedure is typically performed to treat severe, chronic bowel diseases such as ulcerative colitis, Crohn's disease, or colorectal cancer. The main goal is to remove diseased or damaged sections of the colon to alleviate symptoms, prevent complications, and improve quality of life.

Indications

• Severe cases of inflammatory bowel diseases (IBD) like ulcerative colitis and Crohn's disease
• Colorectal cancer
• Familial adenomatous polyposis (a genetic condition with a high risk of colon cancer)
• Severe bowel obstructions or bleeding
• Chronic, uncontrolled diverticulitis

Preparation

• The patient will need to fast for a specified period before the surgery.
• Bowel preparation (e.g., laxatives) may be required to clear the intestines.
• Pre-operative assessments may include blood tests, imaging studies, and consultations.
• Medication adjustments may be necessary, especially anti-inflammatory drugs and blood thinners.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: An abdominal incision is made.
3. Removal: The entire colon is carefully separated from surrounding tissues and removed.
4. Reconnection: If an ileoproctostomy is performed, the ileum is connected to the rectum. If an ileostomy is needed, the ileum is brought through an opening in the abdominal wall to create a stoma.
5. Closure: The incision is closed with sutures or staples.

Duration

The procedure typically takes between 3 to 5 hours, depending on complexity.

Setting

This surgery is performed in a hospital operating room.

Personnel

• General surgeon or colorectal surgeon
• Nurses
• Anesthesiologist
• Surgical technologists

Risks and Complications

• Infection
• Bleeding
• Anesthesia-related complications
• Bowel obstruction
• Stoma-related issues in ileostomy cases
• Leakage at the site of ileoproctostomy
• Blood clots

Benefits

The primary benefits include relief from symptoms associated with severe bowel diseases, prevention of disease progression, and, in cancer cases, removal of malignancy. Patients may start to see improvement in symptoms within weeks after recovery.

Recovery

• Hospital stay: Generally, about 5 to 7 days.
• Post-procedure: Pain management, gradual reintroduction to food, and wound care.
• Restrictions: Avoid strenuous activities and heavy lifting for several weeks.
• Follow-up: Regular check-ups to monitor recovery and manage any complications.

Alternatives

• Medications: Anti-inflammatory drugs, immune suppressants, and biologics.
• Less extensive surgery: Partial colectomy.

• Non-surgical therapies: Dietary changes, pain management, and lifestyle adjustments.

  Each alternative has its pros and cons, with varying degrees of effectiveness and risks.

Patient Experience

Patients may experience discomfort and surgical pain initially, managed with pain relief medications. Adjusting to an ileostomy may require lifestyle modifications and education. Support from healthcare professionals, including dietitians and stoma care nurses, can aid in the transition.