Name of the Procedure:

Colectomy, total, abdominal, with proctectomy; with ileostomy

Common Name(s): Total Abdominal Colectomy with Proctectomy and Ileostomy
Medical Term: Colectomy

Summary

A total abdominal colectomy with proctectomy and ileostomy is a surgical procedure where the entire colon and rectum are removed, and an opening (ileostomy) is created in the abdominal wall to allow for the elimination of waste.

Purpose

This procedure is typically performed to treat severe diseases of the colon, such as ulcerative colitis, Crohn's disease, or colon cancer. The goal is to remove the diseased or damaged portions of the digestive tract and create a new pathway for waste to leave the body.

Indications

• Severe inflammatory bowel diseases, such as ulcerative colitis or Crohn's disease, which do not respond to medical treatment.
• Colorectal cancer.
• Familial adenomatous polyposis.
• Life-threatening complications such as perforation, bleeding, or obstruction of the colon.

Preparation

• Patients may need to fast for 8-12 hours before the procedure.
• A bowel prep, which involves taking laxatives to clear the intestines, is usually required.
• Adjustments to medications, especially blood thinners, may be necessary.
• Pre-operative diagnostic tests, such as blood work, imaging, and colonoscopy, may be performed.

Procedure Description

1. Anesthesia: The patient is given general anesthesia to be asleep and pain-free during the surgery.
2. Incision: A surgical incision is made in the abdomen.
3. Removal: The entire colon and rectum are carefully removed.
4. Ileostomy: A section of the small intestine (the ileum) is brought through an opening in the abdominal wall to create a stoma, through which waste will exit the body.
5. Closure: The surgical site is closed using sutures or staples, and the ileostomy is fitted with a pouching system to collect waste.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity and the patient's condition.

Setting

The procedure is performed in a hospital's surgical suite.

Personnel

• Surgeon
• Surgical assistants
• Anesthesiologist
• Operating room nurses

Risks and Complications

• Infection
• Bleeding
• Damage to nearby organs
• Anastomotic leak (if any intestinal connections are made)
• Ileostomy-related complications such as skin irritation or blockage

Benefits

The primary benefit is the resolution of symptoms and prevention of complications related to the underlying disease. Patients can expect an improvement in quality of life once they recover.

Recovery

• Post-operative hospital stay of 5-7 days.
• Pain management with medications.
• Avoid heavy lifting and strenuous activity for 6-8 weeks.
• Follow-up appointments to monitor healing and ileostomy function.
• Learning to care for the ileostomy, which will require using a pouching system to collect waste.

Alternatives

• Medications to manage symptoms (e.g., anti-inflammatory drugs, immunosuppressants)
• Partial colectomy (removal of only part of the colon)
• Non-surgical treatments like biologic therapies

Pros and Cons:

• Medications may delay the need for surgery but may not offer a permanent solution.
• Partial colectomy might be less invasive but might not address widespread disease.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-surgery, there may be discomfort and pain, managed through medications. As the patient learns to manage their ileostomy, support from nursing staff and educational resources will be provided to ensure comfort and ease in adapting to the new lifestyle.