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Surgical removal of any extent of the colon From Wikipedia, the free encyclopedia
Colectomy (col- + -ectomy) is bowel resection of the large bowel (sometimes referred to as the colon which more precisely denotes a part of the large bowel). It consists of the surgical removal of any extent of the colon, usually segmental resection (partial colectomy). In extreme cases where the entire large intestine is removed, it is called total colectomy, and proctocolectomy (procto- + colectomy) denotes that the rectum is included.
Some of the most common indications for colectomy are:
Traditionally, colectomy is performed via an abdominal incision (laparotomy), though minimally invasive colectomy, by means of laparoscopy, is growing both in scope of indications and popularity, and is a well-established procedure as of 2006[update] in many medical centers. Recent experience has shown the feasibility of single port access colectomy.[1]
Resection of any part of the colon entails mobilization and ligation of the corresponding blood vessels. Lymphadenectomy 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), or creating a colostomy. Several factors are taken into account, including:
An anastomosis carries the risk of dehiscence (breakdown of the stitches), which can lead to contamination of the peritoneal cavity, peritonitis, sepsis and death. A number of factors may increase the risk of anastomotic dehiscence, either partial ('leak') or complete. Basic surgical principles include ensuring a good blood supply to the opposing ends, and a lack of tension at the join. The use of NSAIDS for analgesia following gastrointestinal surgery remains controversial, given mixed evidence of an increased risk of leakage from any bowel anastomosis created. This risk may vary according to the class of NSAID prescribed.[2][3][4]
Colostomy 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 surgeons all over the world.
As of 2012, more than 40% of colon resections in United States are performed via laparoscopic approach.[11]
To begin laparoscopic surgery for a colectomy typically 4 ports are placed in the abdomen to gain access to the peritoneal cavity. The next step is to mobilize the portion of the bowel that is to be resected. This is done by ligation of the mesentery and other peritoneal attachments. A stapler is used to resect the bowel and an anastomosis between the remaining bowel is created.[12]
Sir William Arbuthnot-Lane was one of the early proponents of the usefulness of total colectomies, although his overuse of the procedure called the wisdom of the surgery into question.[13]
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