A laparoscopic total abdominal colectomy is an operation that removes the large intestine. Doctors use it to help treat conditions including:
- Inflammatory conditions of the intestine, such as Crohn's disease and ulcerative colitis
- Familial polyposis, an inherited (hereditary) condition in which hundreds to thousands of polyps (small growths) form along all of the large intestine
The term "laparoscopic" refers to a type of surgery called laparoscopy, which lets the surgeon do the operation through very small cuts in the abdomen. They use a laparoscope, which is a tool with a small camera on it, to see inside you.
The Three Steps of Laparoscopic Total Abdominal Colectomy
Step 1: Positioning the Laparoscope
First, you’ll get general anesthesia, so you’ll be asleep. Then the surgeon will make a small cut (about half an inch long) near your navel and insert a laparoscope through it. The surgeon can see images from the laparoscope on video monitors placed near the operating table.
Once the laparoscope is in place, the surgeon will make four or five more cuts less than half an inch long in the abdomen. The surgeon will work through those cuts.
Step 2: Dividing the Sigmoid Colon and Rectum
The colon is a large organ (about 5 feet long) stretching from the small intestine (ileum) to the rectum. Doctors divide the colon into four main sections:
- ascending (right)
- descending (left)
- sigmoid colon, which attaches to the rectum.
Your surgeon will carefully free the colon in sections, starting with the rectum and sigmoid colon, and finishing with the ascending (right) colon. He will also cut and close the main blood vessels (arteries) that supply blood to the colon throughout the surgery.
During the procedure, the surgeon will use a paddle-like instrument to hold loops of the intestine up and out of the way. When the entire large intestine is freed, the surgeon will free the right colon from the ileum. Then he’ll identify the part of the ileum that he will join with the rectum.
Finally, your surgeon will pass a snare-like instrument over the colon to make sure that all of the attachments to the tissue have been cut. This tool is designed to hold a wire loop, which the surgeon tightens around any remaining tissue growths to remove them. Once this is complete, he will make one of the surgical cuts bigger and pull the colon out of the abdominal cavity.
Step 3: Joining the Ileum and Rectum
Next, your surgeon will join your rectum and ileum. He'll use a circular stapler with an anvil-shaped head and center post and rod. First, the surgeon passes the anvil-shaped end of the stapler (the end with the post) into the ileum and stitches it into place. The post will extend beyond the cut end of the ileum.
To complete the procedure, the surgeon will then pass the rod of the circular stapler into the rectum, connect it with the center post, then close and "fire" it to join the ileum with the rectum. Some people may instead need the surgeon to make a reservoir called an ileal pouch anal anastomosis (IPAA) from the small intestine.
The surgeon will then rinse the abdominal cavity and check the connection for leaks. Finally, he’ll stitch or tape all the surgical cuts in the abdomen.
After surgery, your doctor will encourage you to boost your activity level steadily once you are home. Walking is great exercise! It will help your general recovery to strengthen your muscles, keep your blood circulating to prevent blood clots, and help your lungs remain clear.
If you are fit and did regular exercise before surgery, you may resume exercising when you feel comfortable and your doctor approves. However, you should avoid strenuous exercise, heavy lifting, and abdominal exercises such as sit-ups for 6 weeks after surgery.
When you go home, your doctor will probably recommend a “soft” diet, which means you can eat almost everything except raw fruits and vegetables. You should continue this diet until your post-surgical checkup. If the diet makes you constipated, call your doctor's office for advice.