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Colectomy
 
 
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Colectomy consists of the surgical
Surgery

Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, or sometimes for some other reason....
 resection
Resection

Resection can mean:*Resection, in surgery, the partial or complete removal of an organ or other bodily structure. A doctor may say that a cancer is resectable....
 of any extent of the large intestine (colon
Colon (anatomy)

The colon is the last portion of the digestive system in most vertebrates; it extracts water and salt from feces before they are defecation from the body....
).

of the most common indications for colectomy are:



itionally, colectomy is performed via an abdominal incision (laparotomy
Laparotomy

A laparotomy is a surgery procedure involving an incision through the abdominal wall to gain access into the abdominal cavity. It is also known as coeliotomy....
), though minimally invasive colectomy, by means of laparoscopy, is growing both in scope of indications and popularity, and is a well-established procedure in many medical centers.

Resection of any part of the colon entails mobilization and ligation of the corresponding blood vessels.






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Encyclopedia


Colectomy consists of the surgical
Surgery

Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, or sometimes for some other reason....
 resection
Resection

Resection can mean:*Resection, in surgery, the partial or complete removal of an organ or other bodily structure. A doctor may say that a cancer is resectable....
 of any extent of the large intestine (colon
Colon (anatomy)

The colon is the last portion of the digestive system in most vertebrates; it extracts water and salt from feces before they are defecation from the body....
).

Indications

Some of the most common indications for colectomy are:

  • Colon cancer.
  • Diverticulitis
    Diverticulitis

    Diverticulitis is a common digestive disease particularly found in the colon . Diverticulitis develops from diverticulosis, which involves the formation of pouches on the outside of the colon ....
     and diverticular disease of the large intestine.
  • Trauma
    Physical trauma

    Physical trauma refers to a body injury. A trauma patient is someone who has suffered serious and life-threatening physical injury with the potential for secondary complications such as Shock , respiratory failure and death....
    .
  • Inflammatory bowel disease
    Inflammatory bowel disease

    In medicine, inflammatory bowel disease is a group of inflammation conditions of the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis.....
     such as Ulcerative Colitis
    Ulcerative colitis

    Ulcerative colitis is a form of inflammatory bowel disease . Ulcerative colitis is a form of colitis, a disease of the intestine, specifically the large intestine or colon , that includes characteristic Peptic ulcer, or open sores, in the colon....
     or Crohn's disease
    Crohn's disease

    Crohn's disease is an inflammatory disease which may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms....
    .
  • Prophylactic colectomy can be indicated in some forms of polyposis, Lynch syndrome and certain cases of inflammatory bowel disease
    Inflammatory bowel disease

    In medicine, inflammatory bowel disease is a group of inflammation conditions of the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis.....
     because of high risk for development of colorectal cancer.
  • bowel infarction
    Bowel infarction

    Bowel infarction or 'bowel death' results from a severely restricted blood supply to part of the bowel; this can in turn be due to an uncorrected Bowel_twist or bowel strangulation, or to occlusion of one of the mesenteric arteries....


Basic principles

Traditionally, colectomy is performed via an abdominal incision (laparotomy
Laparotomy

A laparotomy is a surgery procedure involving an incision through the abdominal wall to gain access into the abdominal cavity. It is also known as coeliotomy....
), though minimally invasive colectomy, by means of laparoscopy, is growing both in scope of indications and popularity, and is a well-established procedure in many medical centers.

Resection of any part of the colon entails mobilization and ligation of the corresponding blood vessels. Lymphadenectomy
Lymphadenectomy

Lymphadenectomy consists of the surgical removal of one or more groups of lymph nodes. It is almost always performed as part of the Surgical oncology....
 is usually performed through excision of the fatty tissue adjacent to these vessels (mesocolon), in operations for colon cancer.

When the resection is complete, the surgeon has the option of immediately restoring the bowel, by stitching or stapling together both the cut ends (primary anastomosis
Anastomosis

An anastomosis is a network of streams that both branch out and reconnect, such as blood vessels or leaf veins. The term is used in medicine, biology, mycology and geology....
), or creating a colostomy
Colostomy

A colostomy is a surgical procedure that involves connecting a part of the Colon onto the anterior abdominal wall, leaving the patient with an opening on the abdomen called a Stoma ....
. Several factors are taken into account, including:

  • Circumstances of the operation (elective vs emergency);
  • Disease being treated;
  • Acute physiological state of the patient;
  • Impact of living with a colostomy, albeit temporarily;
  • Use of a specific preoperative regimen of low residue diet
    Low residue diet

    A low residue diet is a diet designed to reduce the frequency and volume of stools while prolonging intestinal transit time. It is similar to a low fiber diet, but typically includes restrictions on foods that increase bowel activity, such as milk and milk products and prune juice....
     and laxative
    Laxative

    Laxatives are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool, most often taken to treat constipation. Certain stimulant, lubricant, and saline laxatives are used to evacuate the Colon for rectum and bowel examinations, and may be supplemented by enemas in that circumstance....
    s (so-called "bowel prep").


An anastomosis
Anastomosis

An anastomosis is a network of streams that both branch out and reconnect, such as blood vessels or leaf veins. The term is used in medicine, biology, mycology and geology....
 carries the risk of dehiscence
Wound dehiscence

Wound dehiscence is the premature "bursting" open of a wound along surgical suture. It is a surgical complication that results from poor wound healing....
 (breakdown of the stitches), which can lead to contamination of the peritoneal cavity
Peritoneal cavity

The peritoneal cavity is a potential space between the parietal peritoneum and visceral peritoneum. It is one of the spaces derived from the coelomic cavity of the embryo, the others being the pleural cavities and the pericardial cavity....
, peritonitis
Peritonitis

Peritonitis is defined as inflammation of the peritoneum . It may be localised or generalised, generally has an acute course, and may depend on either infection or on a non-infectious process....
, sepsis
Sepsis

Sepsis, is a serious medicine condition characterized by a whole-body Inflammation state and the presence of a known or suspected infection. and death
Death

Death is the permanent termination of the biological functions that define a life organism. It refers to both a particular event and to the condition that results thereby....
. Colostomy
Colostomy

A colostomy is a surgical procedure that involves connecting a part of the Colon onto the anterior abdominal wall, leaving the patient with an opening on the abdomen called a Stoma ....
 is always safer, but places a societal, psychological and physical burden on the patient. The choice is by no means an easy one and is rife with controversy, being a frequent topic of heated debate among surgeon
General surgery

This page is about the surgical specialty. For the goregrind band, see General Surgery General surgery, despite its name, is a surgical specialty that focuses on abdominal organs, e.g....
s all over the world.

Types


  • Right hemicolectomy and left hemicolectomy refer to the resection of the ascending (right) colon and the descending (left) colon, respectively. When part of the transverse colon is also resected, it may be referred to as an extended hemicolectomy
  • Transverse colectomy is also possible, though uncommon.
  • Sigmoidectomy is a resection of the sigmoid colon, sometimes including part or all of the rectum (proctosigmoidectomy). When a sigmoidectomy is followed by terminal colostomy
    Colostomy

    A colostomy is a surgical procedure that involves connecting a part of the Colon onto the anterior abdominal wall, leaving the patient with an opening on the abdomen called a Stoma ....
     and closure of the rectal stump, it is called a Hartmann operation; this is usually done out of impossibility to perform a "double-barrel" or Mikulicz colostomy
    Colostomy

    A colostomy is a surgical procedure that involves connecting a part of the Colon onto the anterior abdominal wall, leaving the patient with an opening on the abdomen called a Stoma ....
    , which is preferred because it makes "takedown" (reoperation to restore normal intestinal continuity by means of an anastomosis
    Anastomosis

    An anastomosis is a network of streams that both branch out and reconnect, such as blood vessels or leaf veins. The term is used in medicine, biology, mycology and geology....
    ) considerably easier.
  • When the entire colon is removed, this is called a total colectomy. If the rectum is also removed, it is a total proctocolectomy.
  • Subtotal colectomy is resection of part of the colon or a resection of all of the colon without complete resection of the rectum.


External links

  • . Dr. Brian Saunders MD FRCP; St. Mark’s Academic Institute; Harrow, Middlesex, UK. (Possible alternative to colectomy for removal of polyps.) Retrieved April 9, 2008.