Colectomy surgery for inflammatory bowel disease (IBD)

Colectomy surgery removes some, or all, of the colon (large intestine) which has been damaged due to Crohn's disease or ulcerative colitis (UC) - which are both forms of inflammatory bowel disease (IBD).

Other terms used to describe the surgery include colon resection surgery or hemicolectomy.

What forms of IBD is colectomy surgery used to treat?

All forms of ulcerative colitis and Crohn’s disease affecting the large intestine (colon) - Crohn’s (granulomatous) colitis and ileocolitis.

Why is colectomy surgery needed for IBD?

If your IBD is not responding to other treatments - such as medication - and you have severe inflammation or damage to all, or part, of your large intestine (colon) then you may decide to have a colectomy. In a colectomy all, or part, of your colon is removed.

You may also have this surgery if your bowel perforates or you have bowel cancer or a very high chance of developing it.

How is colectomy surgery done?

There are a few different types of colectomy surgery and it’s important to understand which you are having. These are:

• Right hemicolectomy - resection (removal) of the ascending colon (right side)
• Left hemicolectomy - resection (removal) of the descending colon (left side)
• Transverse colectomy - resection (removal) of the horizontal part of the colon (this is uncommon)
• (Sub-)total colectomy - removal of all of the colon, leaving the rectum
• Partial colectomy - resection (removal) of a small part of the colon
• Sigmoidectomy - resection of the sigmoid colon
• Proctocolectomy - removal of all of the colon and also the rectum

This article refers to the right and left hemicolectomy, transverse colectomy and total and partial colectomy surgery. There are separate articles on sigmoidectomy and proctocolectomy surgery.

The day before your surgery you will likely be asked to take a bowel preparation which will give you diarrhoea to clear the bowel of any faeces to make the operation easier. You may also need to follow a specific diet and avoid some medications.

Shortly before your surgery your blood pressure and breathing will be monitored and you will be prepared for theatre. You may be given medicine through a vein in your arm. Just before the surgery you will be given a general anesthetic which will put you in a sleep-like state so that you won’t be aware of what’s happening.

Colectomy surgery can be carried out either through open surgery or laparoscopic (keyhole) surgery. The type of surgery you receive will depend on your circumstances and the surgeon you have. It should be discussed with you prior to your operation.

Open surgery: An incision will be made along your abdomen to provide access to the colon for your surgeon. They will then identify the damaged section of the colon and remove it.

Laparoscopic surgery: Several small incisions (or ports) are made in the abdomen. A small camera is inserted through one of the ports to direct the surgeon to the colon. Surgical instruments are inserted through the other incisions and the damaged piece of the colon is pulled through one of the ports and operated on externally, before being reinserted. This type of surgery is meant to result in a quicker recovery time for the patient and also less scarring. In some cases the surgeon will discover during surgery that they need to convert to open surgery due to unforeseen circumstances.

Once the surgeon has removed the damaged parts of the colon the intestinal tract must be reconnected.

The surgeon then has several options:

• If only a small section of the colon is removed the two healthy ends of the colon (or the small intestine and colon) may be reattached allowing you to continue passing stools in the normal way. The join is known as an anastomosis
• If all the colon is removed then the small intestine may be joined to the anus (restorative proctocolectomy with ileoanal pouch) or rectum (colectomy with ileorectal anastomosis)
• A stoma - an opening in your abdominal wall in which the colon (or end of the small intestine) is brought to the surface and body waste is collected in an external bag (ostomy bag). This may be temporary or permanent

Which one of these is done depends on which parts of the colon are being removed and your own personal preferences.

How the surgeon closes the incision/s in your abdomen depends on whether you received open or laparoscopic surgery. The wound in open surgery is often large and runs down the middle of the abdomen. In general this will be closed using clips which will then need to be removed around 10 days after surgery. The wounds in laparoscopic surgery are much smaller and often a special type of glue is used to fix them back together. This glue dries and falls off naturally. In both cases stitches may also be used - these can be dissolvable or may need removing around 10 days after surgery.

Recovering from colectomy surgery

After your surgery you may need to stay in hospital for around a week until you regain normal bowel function. The length of your stay will also depend on whether you had open or laparoscopic surgery.

You may receive nutrition through an intravenous drip until your bowel has healed a little and you are able to drink more normally. You will probably be encouraged to eat and drink as soon as you feel able and will be encouraged to move around.

If your surgery involved the formation of a stoma then you will see an ostomy nurse who will teach you how to care for it.

It will probably take several weeks after leaving hospital for you to begin to feel better. You will probably be advised against any heavy lifting or strenuous physical activity and you may not be able to drive for a couple of weeks.

You may be recommended to follow a certain diet, or avoid certain foods, in the weeks immediately after surgery to aid healing.

Possible complications of colectomy surgery

• There are risks associated with any abdominal operation and you should discuss the risks specific to you with your surgeon before the operation
• Wound infections can occur at the incision sites - in both open and laparoscopic surgery. These may require antibiotics to be treated
• Injury to nearby organs including the intestines and bladder or blood vessels and the ureter can be caused
• Occasionally the join (anastomosis) between the two healthy sections of the bowel can leak. This is known as an anastomotic leak. In some cases further surgery is required to fix the leak, while in others draining of the fluid from the leak can allow the anastomosis an opportunity to heal properly.
• Blood clots can occur in the veins, and these can travel to the lungs.
• Hernia at the surgical incisions or bowel obstruction from internal scar tissue can also occur, even years later

Things to know about colectomy surgery

• Having a colectomy neither cures nor eliminates IBD. It only removes the diseased part of the large intestine and you may have a recurrence of the disease in other areas (particularly in Crohn’s) at a later time. People with UC who have a proctocolectomy will no longer experience inflammation in their digestive tract (as there is no colon, anus or rectum left), however they may still experience other IBD symptoms such as fatigue and joint pain
• Many people experience a remission of their disease after having a colectomy and are able to return to doing normal activities, however there are some people who experience little improvement in their condition
• The gastrointestinal tract does not always start functioning again immediately after surgery, and the time it takes for normal digestion to resume can be variable
• If only part of the colon is removed you may not notice a change in bowel function or frequency of bowel movements
• Patients who undergo laparoscopic colectomy typically experience quicker recovery times and less pain
• You are at increased risk of becoming dehydrated as the colon plays an important role in absorbing water from food waste