Types of Colectomy Surgery

The Different Types Of Colectomy Surgery That May Be Done For Digestive Disease

Large Intestine
Part, or all, of the colon (large intestine) and rectum is removed during colectomy surgery. Photo © A.D.A.M.

Broadly put, the surgery to remove all or part of the colon (the large intestine) is called a colectomy. However, there are different types of colectomy surgeries. People with inflammatory bowel disease (IBD) may have colectomy surgery to treat their disease, but the type of surgery done, and how much of the colon is removed, is going to be different based on which form of the disease is present, and how extensive the damage is to the large intestine.

Colectomy surgery is often put into one of several different categories, based on how much of the colon is removed, or if all of it is removed. 

However, it should be noted that not every surgery done for IBD will fall exactly into one of these categories: there can be variations. Before you have surgery to remove part or all of your colon, talk to your surgical team about the exact surgery you are having. Use the guide below to familiarize yourself with some of the terms, to help yourself better understand the surgery that is being done for your particular case.

Proctocolectomy

In this type of colectomy surgery, the colon is removed, along with the rectum. "Procto" means "rectum." The rectum is the part of the body that is at the end of the colon that is used to hold stool before it is eliminated from the body through the anus. With both the colon and the rectum removed, the body will need a new way to dispose of stool.

For most people with IBD (either Crohn's disease or ulcerative colitis), a proctocolectomy also means the creation of an ileostomy. An ileostomy is when part of the small intestine is brought through the abdomen to create a stoma. Stool then leaves the body through the stoma, and is collected in an ostomy appliance that is worn on the outside of the body.

The ileostomy may be permanent or it may be temporary.

One type of surgery that is done at the same time or sometimes after a proctocolectomy is an ileal pouch-anal anastomosis (IPAA). This type of surgery is more commonly known as j-pouch surgery (although pouches have also sometimes been made in "S" or "W" shapes). In this surgery, the last part of the small intestine (the terminal ileum), is sewn together into the shape of a "J" and can then hold stool for a period of time, serving like a rectum. The j-pouch is connected to the anus during another surgery, often after a period of time with a temporary ileostomy. After surgery is done to connect the small intestine with the anus, stool can once again be eliminated through the anus (the bottom). This surgery is typically done for ulcerative colitis patients, but in some special cases it may be done for people with Crohn's disease

Another type of surgery that is done to restore the ability to move stool through the anus is called an ileoanal anastomosis (pull-through).

In this surgery, after the colon and rectum are removed, the small intestine is connected directly the anus. There is often a waiting time between the colectomy surgery and the pull-through surgery, where the patient has a temporary ileostomy to allow for healing. There is no pouch created from the small intestine. This surgery was done more often for people with ulcerative colitis prior to 1980, before the j-pouch procedure became the more preferred surgery. A pull-through is also sometimes done for people with Crohn's disease who do not have disease in their small intestine.

Total Colectomy

A total colectomy means that all of the colon has been removed. This term can be a bit confusing when compared to a proctocolectomy because in a total colectomy, the rectum is left in place. A total colectomy with some or all of the rectum left in place may be done in certain cases of either ulcerative colitis or Crohn's disease. A total colectomy will also require the creation of an ileostomy (with a stoma, where a bag is worn on the outside of the body to collect stool). The ileostomy may be permanent, but in some cases it might be temporary. More surgery, such as the j-pouch surgery or the pull-through surgery, might be done to "reconnect" the small intestine to the rectum and reverse the temporary ileostomy. After surgery is done to connect the small intestine with the rectum, stool can once again be eliminated through the anus (the bottom). 

Partial Colectomy

A partial colectomy is when part of the colon is removed, and it may also sometimes be called a subtotal colectomy. In this surgery, any part of the colon may be removed. A partial colectomy may be done for some people with Crohn's disease, and it might also be done to treat colon cancer or diverticulitis. After the part of the colon that is diseased is removed, the healthy colon on either side is connected. A colostomy, where part of the colon is brought through the abdomen so that stool can be eliminated into a bag worn on the abdomen, is often not needed.

A partial colectomy is almost never done for people with ulcerative colitis, because the disease will often recur in the healthy section of the colon that is left. In Crohn's disease, there is also a risk of the disease recurring in the colon, and more surgery is needed in some cases.

The decision to remove just part of the colon in people with Crohn's disease is a highly individualized decision, and takes into account the extent of the disease in the colon and rectum, as well as the age and overall health of the patient.

Hemicolectomy

In hemicolectomy surgery, either the right or the left half of the colon is removed. In a right hemicolectomy, the cecum, ascending colon, and a portion of the transverse colon are removed, along with the appendix, which is attached to the ascending colon. In a left hemicolectomy, the descending colon, and part of the transverse colon are removed. This procedure may be done to treat Crohn's disease, a bowel blockage, or colon cancer. Typically, the healthy sections of the colon are connected together and an ostomy is not needed.

Source:

Person B, Khaikin M. "Restorative Operations for Crohn's Disease." Clin Colon Rectal Surg. 2007 Nov; 20(4): 314–321. doi: 10.1055/s-2007-991031. 22 Dec 2015.

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