COLON SURGERY

The colon or large intestine is the last portion of the intestinal tract its primary role is to absorb water and temporarily store waste material. The colon is divided into several segments based on the divisions of the blood vessels feeding it. These segments are the right colon, the transverse colon, the descending colon, the sigmoid colon and the rectum.

The indications for surgery on the colon are tumors, colon cancer or large precancerous polyps, infections such as diverticulitis and perforations, and bleeding from tumors, diverticulosis or abnormal blood vessels called arteriovenous malformations (AVM’s). Surgical removal of the colon is called a colectomy. Surgeons generally remove the segment (hemicolectomy or partial colectomy) that contains the tumor, infection or bleeding site. Other diseases such as ulcerative colitis and familial polyposis involve the entire colon and require a subtotal or total colectomy.

The colon is not essential and many people have their entire colon removed and lead a normal life. On rare occasions, the remaining colon or small intestine is attached to the skin on the anterior abdomen and drains into a bag, a colostomy. This is generally a temporary condition and a second operation can be performed to reattach the beginning part of the colon to the final part of the colon, the rectum, to return normal bowel function. If the distal rectum is the site of the disease, then the colostomy may be permanent.

Prior to surgery, patients must take a “bowel prep” that consists of a liquid diet, strong laxatives and antibiotic tablets over two days to reduce the bacteria in the colon to make surgery safer. This is generally done at home. Colon surgery requires a general anesthetic and takes from 1 ½ to 3 ½ hours. Patients generally need to stay in the hospital from 5 to 10 days after surgery and are fully recovered in 4 to six weeks.

In some circumstances, colon surgery can be preformed laparoscopically. In this case, a series of small incisions are made and a TV camera and long thin instruments are inserted into the abdomen. The identical surgery is then performed but without a large incision (opening) into the abdominal cavity. With the smaller incisions, the hospital stay and recovery period are shortened. This is a relatively new procedure and is used only in specific situations, but may be used more generally in the future as experience with the procedure around the world grows.