This is an operation to remove the right side of the colon or part of it and usually part of the end of the small bowel. It is commonly performed for bowel cancer, other tumours, large polyps that cannot be removed at colonoscopy, and inflammatory conditions of the bowel, especially Crohn’s disease. Occasionally, appendicitis can be sufficiently damaging that it needs a right hemicolectomy to be performed.
It can be performed “open” with an incision in the abdominal wall or laparoscopically, commonly called “key hole surgery”.
After the end of the small bowel and the resected part of the right colon are removed, along with their blood supply, the two ends of bowel are joined together (anastomosed) with stitches or stapling devices.
It is uncommon to require a bag or stoma in association with a right hemicolectomy.
You will require some time in hospital following the surgery – 2-5 days after laparoscopic procedure and up to 7 days after an open procedure, depending on how soon after the surgery you are able to tolerate a diet and comfortable enough to move around. As with any major bowel resection, there are risks/complications – either specifically related to the bowel, either a leak or a bleed at the join (anastomosis), or generally related to an operation, such as wound infection, chest infection, leg and lung clots (deep venous thrombosis and pulmonary emboli). The surgery can also be associated with exacerbations of other medical conditions such as problems with your heart and lungs, diabetes, blood pressure and kidney problems.
It is important to discuss the specifics of your operation with your surgeon.
Left hemicolectomy is the surgical removal of the left side of the large bowel (see the first figure below); sigmoid colectomy is the surgical removal of the sigmoid colon. These operations are mostly performed for cancers of the left colon and sigmoid colon.
See Right Hemicolectomy for other information about bowel resection.
Colectomy is a surgical procedure to remove the majority of the colon. Total Colectomy may be necessary to treat or prevent diseases and conditions that affect your colon, also known as the large intestine or large bowel. Such conditions include –
- Bleeding that can’t be controlled.Severe bleeding from the colon may require surgery to remove the affected portion of the colon.
- Bowel obstruction.A blocked colon is an emergency that may require total or partial colectomy, depending on the site of the obstruction and any secondary damage due to distension of or loss of blood supply to the colon.
- Colon cancer.Early-stage cancers may require only a smaller section of the colon to be removed during colectomy. Multiple cancers, cancers presenting at a later stage and cancers presenting as an obstruction may require more of the colon to be removed.
- Crohn’s disease.If medications aren’t helping you, removing the affected part of your colon may offer temporary relief from signs and symptoms. Colectomy may also be an option if precancerous changes are found during a test to examine the colon (colonoscopy).
- Ulcerative colitis.Your doctor may recommend total colectomy if medications aren’t helping to control your signs and symptoms. Colectomy may also be an option if precancerous changes are found during a colonoscopy.
- Your doctor may recommend surgery to remove the affected portion of the colon if your diverticulitis recurs or if you experience complications of diverticulitis.
- Preventive surgery.If you have a very high risk of colon cancer due to the formation of multiple precancerous colon polyps, you may choose to undergo total colectomy to prevent cancer in the future. Colectomy may also be an option for people with inherited genetic conditions that increase colon cancer risk, such as familial adenomatous polyposis or Lynch syndrome.
In the elective situation, the type of surgery considered best for you and your clinical circumstances will be discussed, along with any options. It may obviously be a little more difficult to have this discussion at length in the emergency situation.
A rectosigmoidectomy, Hartmann’s operation or Hartmann’s procedure is the surgical removal of part of the rectum and the sigmoid colon with closure of the anorectal stump and formation of an end colostomy. It is used to treat bowel cancer or other complicated inflammatory conditions in the rectosigmoid region, most commonly in the urgent situation, when it is not deemed safe to perform an anastomosis (make a join in the bowel). More rarely it is used palliatively patients with advanced colorectal tumours.
This is an operation to remove all or part of the rectum and usually part of the sigmoid colon. It is most commonly performed for bowel cancer. It can be performed “open” with an incision in the abdominal wall or laparoscopically, commonly called “key hole surgery”.
After the segment of bowel is removed, along with its blood supply, the two ends of bowel are joined together (anastomosed) with stitches or stapling devices. This requires the anal canal to be preserved, and the bowel upstream to be able to be brought down to join the rectum or anus without compromising the blood supply.
It is uncommon to require a bag or stoma in association with a high anterior resection, which involves removing the upper part of the rectum. If it is required it is usually only when there is technical concern about the anastomosis or there are patient co-morbidities that make an unprotected anastomosis unnecessarily risky.
It is more common to require a bag or stoma in association with a low or very low anterior resection, which involves removing most or all of the rectum. The bag or stoma is usually a loop ileostomy to divert faecal matter from the downstream bowel join.
Anterior resection is a major surgical procedure. The most concerning surgical risk is a leak from the anastomosis, which can occur in between 10-20% of patients especially if the join is “ultra” low and the pelvis has been preoperatively irradiated. It is also attended by the other common surgical risks, such as wound infections as the bowel needs to be opened during the procedure, and medical risks such as heart and lung problems, fluid balance and kidney issues, as well as calf clots (DVT’s) which can travel to the lungs (pulmonary emboli).
Pain relief is well organised after the procedure. Fluids and return to a normal diet are determined by your surgeon’s usual protocol and your individual circumstances.
Your surgeon will discuss the particulars of your surgery with you preoperatively.
Abdominoperineal resection (APR) is an operation in which a surgeon removes the anus, rectum and part of the sigmoid colon using incisions in your abdomen and between your buttocks (perineum). It is most commonly performed for rectal and anal cancers, in particular in the situation where the rectal cancer being removed is very low in the rectum and it is not possible to get an adequate clearance of the tumour when removing and preserving enough sphincter muscle to maintain continence.
At the completion of the surgery, the end of the residual colon will be brought to the skin on the left hand side of the abdomen, allowing faecal material to drain in to a bag. This arrangement is known as a colostomy or stoma. Unlike the anus, the stoma has no sphincter muscles. Faecal material will thus drain in to the bag as the colon contracts.
Abdominoperineal resection is major surgery and will require the patient to be in hospital for around a week postoperatively to recover, and learn the basics of managing their colostomy.