Colon surgery or colectomy is the removal of part of the colon. The colon or large intestine follows the small intestine. It is about 1.5 m long, and its primary role is to absorb water from the stool to make them less liquid. Colectomy is administered for conditions such as:
- Colon Cancer
- A complication of the colonic diverticulum (herniation of the colon mucosa mainly on the sigmoid colon)
- Inflammatory bowel disease (Ulcerative Colitis and Crohn’s disease)
It consists of the removal of part of the colon followed by reestablishment of the intestinal circuit by a seam or anastomosis between the two parts of the intestine. If it is impossible or there is a problem with the healing of the intestinal seam, an artificial anus or stoma can be made, which is most often temporary.
The right colectomy involves removing the right side of the colon and the distal portion of the small intestine. It must take away the blood vessels and the ganglia of the right colon. Indeed, in the event of cancer, it is important to remove these nodes, which will be examined under a microscope to know if they are invaded or not by the tumor. This element is important for the decision of chemotherapy after the operation.
The digestive continuity is re-established by a seam between the small intestine and the colon. The suture can be carried out using threads or mechanical clamps. The intervention occurs by laparoscopy, i.e., using several small incisions and a small opening of 5 cm to exit the colon and the tumor, most often towards the umbilicus. It lasts about 1 hour 30 minutes (between 1 and 2 hours).
Left Colectomy and Sigmoidectomy
The left colectomy is the removal of the left part of the colon. It involves the mobilization and lowering of the left colic angle, the descending colon section, and the upper part of the rectum. In the event of cancer, it must remove the blood vessels and the ganglia of the left colon.
It is important to remove these nodes, which will be examined under a microscope to know if they are invaded by the tumor or not. This element is important for the decision of chemotherapy after the operation.
Complications During and After Colectomy
- In the event of operating difficulties (locally advanced tumor, adhesions, wound in another organ such as the duodenum or the ureter), this may require conversion to an opening or laparotomy.
- Classic postoperative complications such as haemorrhage, hematoma, or infection, including scar abscess because the colon contains a lot of bacteria
- Anastomotic fistula or leak: problem of scarring at the level of the intestinal seam. This problem is rare (around 5%) but potentially serious and may require reoperation or even the temporary creation of an ostomy or artificial anus. It occurs mainly during the 1st postoperative week and warrants rigorous monitoring to detect such a complication early on.
- Delay in the resumption of transit or postoperative ileus: thanks to Improved Recovery after Surgery (ACR), this phenomenon is less frequent. It results in bloating, the absence of gas or stools, nausea, or even vomiting and can prolong or lead to hospitalization.