Laparoscopic Total Abdominal Colectomy

A laparoscopic total abdominal colectomy is an operation that removes the large intestine. Doctors use it to treat conditions including:

  • Inflammatory conditions of the intestine, such as Crohn's disease and ulcerative colitis
  • Familial polyposis, an inherited 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 3 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:

  1. Ascending (right)
  2. Transverse
  3. Descending (left)
  4. 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 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 they’ll identify the part of the ileum that they 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, they will make one of the surgical cuts bigger and pull the colon out of the abdominal cavity.

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Step 3: Completing the Surgery

To complete the procedure, the surgeon will then do one of two things:

  1. Form a hole called a stoma in the skin of your lower belly and attach it to either your small intestine (ileostomy) or colon (colostomy). This allows waste to leave your body through the stoma and into a bag. This may be temporary or permanent.
  2. Join your rectum and ileum with stitches or staples. In some cases, the surgeon makes a reservoir called an ileal pouch anal anastomosis (IPAA) from the small intestine. In either case, you should be able to poop in a relatively normal way.

The surgeon will then rinse the abdominal cavity and check the connection for leaks. Finally, they’ll stitch or tape all the surgical cuts in the abdomen.

Recovery

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.

WebMD Medical Reference Reviewed by Neha Pathak, MD on October 19, 2020

Sources

SOURCES:

Fichera, A. J Gastrointest Surg, July 2011.

Laparoscopic Surgical Center of New York. 

Mayo Clinic: “Colectomy.”

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