 | Click the icon to see an illustrated series depicting large bowel resection surgery. |
Subtotal Colectomy. Subtotal colectomy is more extensive than resection and removes more of the colon. Disease in the upper parts of the small intestine tends to require more extensive surgery than in the lower small intestine.
In general, either procedure requires a general anesthetic and involves the following:
- An incision is made in the abdomen.
- The diseased portion of the colon is identified and removed. (Strictureplasty is sometimes used alone with resection.)
- Once a diseased segment of the colon is removed, the two ends are reconnected, and this connection is called an anastomosis.
Open Surgery or Laparoscopy. Resection or subtotal colectomy may be performed using one of two surgical approaches:
- Open surgery, which requires a wide abdominal incision.
- Laparoscopy, which uses a few small incisions through which a tube is inserted containing a tiny camera for viewing the area. To date, however, this procedure is best suited for patients with short-segment disease in the ileum who also have no other complications, such as fistulas and abscesses.
 | Click the icon to see an image of a laparoscopy procedure. |
Complications After Resection or Subtotal Colectomy
- Short-bowel syndrome. If large segments of the small intestine are removed, the patient is at higher risk for short-bowel syndrome, a complication in which there is a problem absorbing nutrients. The risk is far lower with strictureplasty. The condition used to be fatal, but patients now can live normal and productive lives using total parenteral nutrition (the intravenous administration of nutrients), which can be self-administered at home in many cases.
- Leakage or obstruction in the areas where the colon has been reconnected (the anastomosis).
- Infections. In a 2003 study, the use of drugs that modify the immune system (azathioprine, 6-MP, methotrexate, and infliximab) was effective in reducing the risk for serious infection in the abdomen.
Proctocolectomy and Ileostomy
Proctocolectomy with ileostomy is removal of the entire colon and creation of an ileostomy. It involves the following:
- To perform proctocolectomy, the surgeon removes the entire colon, including the lower part of the rectum and the sphincter muscles that control bowel movements.
- To perform ileostomy, the surgeon makes a small opening in the lower right corner of the abdomen called a stoma. The surgeon then connects cut ends of the small intestine to this opening. A bag is placed over the opening and accumulates waste matter. It requires emptying several times a day.
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