Colon Resection

About Colon Resection

Colon resection, or colectomy, removes a diseased segment of the large intestine. It is performed for colorectal cancer, complicated diverticulitis, inflammatory bowel disease, volvulus, bowel ischemia and some benign polyps that cannot be removed endoscopically. The operation involves mobilizing the colon, dividing its blood supply, with ligation close to the origin of the vessels in cancer surgery so that the associated lymph nodes are removed, removing the affected segment and joining the remaining ends in an anastomosis, either hand sewn or stapled. Right sided resections usually end with a connection between the ileum and colon, while left sided and rectal operations such as low anterior resection connect the colon to the rectum or anus. A temporary diverting ileostomy may be created to protect a very low anastomosis, and the Hartmann procedure, resection with an end colostomy and no anastomosis, is used in emergencies such as perforated diverticulitis. Randomized trials including the COST trial in North America and the COLOR trial in Europe established that laparoscopic colectomy gives oncologic results comparable to open surgery for colon cancer, with faster recovery. Enhanced recovery after surgery programs, combining early feeding, multimodal pain control and early mobilization, have shortened hospital stays. The most serious specific complication is anastomotic leak, which is more common after rectal and emergency surgery; others include abscess, bleeding, bowel obstruction and wound infection. Total colectomy or proctocolectomy with an ileal pouch is performed for ulcerative colitis and familial adenomatous polyposis.