Large Bowel Resection
Large bowel resection is also known as colectomy. This surgery removes diseased portions of the large bowel—also called the large intestine. The large intestine consists of several parts, one of which is the colon.
During this surgery, the surgeon removes the diseased parts of the bowel. The healthy parts are then reconnected. The surgery may remove all or part of the bowel.
If there is not enough healthy intestine after surgery, a colostomy may be performed. A colostomy is a procedure in which one end of the large intestine is moved outside the abdominal wall.
A colostomy bag is then attached to the abdomen. When stool passes through the large intestine, it drains into the bag. The stool that goes into the bag is usually soft or liquid.
A colostomy is often temporary. The patient has the bag until their intestines heal. A new operation is then done to remove the colostomy. In some cases, the colostomy is permanent.
What Is the Purpose of a Large Bowel Resection?
Large bowel resection may be necessary to treat conditions such as:
- colon cancer
- intestinal blockages caused by scar tissue or tumors
- diverticulitis, a disease of the large bowel
- precancerous polyps
It may also be done to treat:
- bleeding in the intestines
- volvulus, an abnormal twisting of the bowel
- ulcerative colitis, a type of bowel inflammation
- intussusception, in which part of the intestine slides into another part
How Is a Large Bowel Resection Performed?
You will receive general anesthesia before the surgery takes place. This will keep you asleep during the surgery. It will also keep you from feeling pain. Your surgeon may do a laparoscopic colectomy or open surgery.
In a laparoscopic surgery, the surgeon uses a camera to get a clear view of the intestines. The surgery is performed through a series of small incisions. It is less invasive than open surgery.
In open surgery, the surgeon makes a large incision in your abdomen to see the bowel directly.
The basic structure of both surgeries is the same:
- The surgeon accesses the bowel using one or more incisions.
- The diseased or damaged bowel is removed.
- The remaining bowel is stapled or sewn together. This is called an anastomosis.
- Colostomy is performed, if needed.
- Incisions are stitched closed.
Other organs may also have to be removed during the surgery.
According to the National Institutes of Health, lower bowel resection surgery generally takes one to four hours (NIH, 2011).
How Do I Prepare for Large Bowel Resection?
At least two weeks before surgery, inform your healthcare provider about all medications you are taking. Include supplements such as vitamins and herbs. You should also inform him or her about any recent illnesses, including a cold, flu, or herpes breakout.
Before surgery, your doctor may need you to:
- stop taking blood-thinning drugs, such as aspirin, ibuprofen, and naproxen
- stop smoking
- drink plenty of water
- eat foods high in fiber
A few days before the lower bowel resection, you may be required to:
- take laxatives (to help you defecate)
- have an enema (to clear the colon)
- drink only clear liquids, such as water, clear juice, and broth
On the day of the surgery, follow your doctor’s instructions. You may be asked not to eat or drink anything for 12 hours before the surgery.
What Are the Risks of Large Bowel Resection?
All types of surgery have a risk of:
- difficulty breathing
- heart attack or stroke
- blood clots
Risks specific to lower bowel resection also include
- bleeding inside the abdomen
- incisional hernia (tissue coming through the surgical cut)
- damage to the bladder or other nearby organs
- scar tissue
- dehiscence (wound opening)
- problems with colostomy, such as skin irritation
There are also risks of general anesthesia. These include reactions to medication and breathing difficulties.
What Happens After Large Bowel Resection?
You will generally stay in the hospital for three to seven days. You may need to stay in the hospital longer if you develop complications. You may also have to stay longer if you have a more serious underlying health problem.
You will have to follow specific instructions on how to eat after your surgery. You are generally able to drink clear liquids by the second or third day. As you heal, you will be able to drink thicker fluids and eat soft foods.
A full recovery may take about two months.
What Is the Long-Term Outlook for Large Bowel Resection?
Most people who have a lower bowel resection make a full recovery. You may have to use a colostomy bag temporarily. You may also need a permanent colostomy. A colostomy will not usually prevent you from doing activities you enjoy. (NIH)
You may also need ongoing medical care if you have a chronic bowel condition, such as:
- Crohn’s disease
- Ulcerative colitis