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    Total abdominal colectomy

    Ileorectal anastomosis; Subtotal colectomy

    Total abdominal colectomy is the removal of the large intestine from the lowest part of the small intestine (ileum) to the rectum. After it is removed, the end of the small intestine is sewn to the rectum.

    Description

    You will receive general anesthesia right before your surgery. This will make you asleep and unable to feel pain.

    During the surgery:

    • Your surgeon will make a surgical cut in your belly.
    • The surgeon will remove your large intestine. Your rectum and anus will be left in place.
    • Your surgeon will sew the end of your small intestine to your rectum.

    Why the Procedure Is Performed

    The procedure is done for people who have:

    • Crohn's disease that has not spread to the rectum or the anus
    • Many colon cancer tumors, when the rectum is not affected
    • Severe constipation, called colonic inertia

    Risks

    Total abdominal colectomy is usually safe. Your risk depends on your general overall health. Ask your doctor about these possible complications:

    Risks for any surgery are:

    • Blood clots in the legs that may travel to the lungs
    • Breathing problems
    • Infection, including in the lungs, urinary tract, and belly
    • Heart attack or stroke

    Risks for this surgery are:

    • Bleeding inside your belly
    • Damage to nearby organs in the body
    • Scar tissue may form in the belly and cause a blockage of the small intestine
    • The end of the small intestine that is sewn to the rectum may come open (anastomosis), which may be life threatening
    • Wound may break open
    • Wound infections

    Before the Procedure

    Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

    Before you have surgery, talk with your doctor or nurse about the following things:

    • Intimacy and sexuality
    • Pregnancy
    • Sports
    • Work

    During the 2 weeks before your surgery:

    • Two weeks before surgery you may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), Naprosyn (Aleve, Naproxen), and others.
    • Ask your doctor which drugs you should still take on the day of your surgery.
    • If you smoke, try to stop. Ask your doctor for help.
    • Always let your doctor know about any cold, flu, fever, herpes breakout, or other illnesses you may have before your surgery.
    • Eat high fiber foods and drink 6 to 8 glasses of water every day.

    The day before your surgery:

    • Eat a light breakfast and lunch.
    • You may be asked to drink only clear liquids such as broth, clear juice, and water after noon.
    • Do NOT drink anything after midnight, including water. Sometimes you will not be able to drink anything for up to 12 hours before surgery.
    • Your doctor or nurse may ask you to use enemas or laxatives to clear out your intestines. They will give you instructions.

    On the day of your surgery:

    • Take the drugs your doctor told you to take with a small sip of water.
    • Your doctor or nurse will tell you when to arrive at the hospital.

    After the Procedure

    You will be in the hospital for 3 to 7 days. By the second day, you will probably be able to drink clear liquids. Your doctor or nurse will slowly add thicker fluids and then soft foods as your bowel begins to work again.

    Outlook (Prognosis)

    After this procedure, you can expect to have 4 to 6 bowel movements a day. You may need more surgery and an ileostomy if you have Crohn's disease and it spreads to your rectum.

    Most people who have a total abdominal colectomy recover fully. They are able to do most of the activities they were doing before their surgery. This includes most sports, travel, gardening, hiking, and other outdoor activities, and most types of work.

    References

    Cima RR, Pemberton JH. Ileostomy, colostomy, and pouches. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 113.

    Fry RD, Mahmoud NN, Maron DJ, Ross HM, Rombeau J. Colon and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 52.

    Cunningham D, Atkin W, Lenz HJ, Lynch HT, Minsky B, Nordlinger B, et al. Colorectal Cancer. Lancet. 2010;375:1030-1047.

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              Tests for Total abdominal colectomy

                Review Date: 12/10/2012

                Reviewed By: Robert A. Cowles, MD, Associate Professor of Surgery, Yale University School of Medicine, New Haven, CT. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, and Stephanie Slon.

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