Colectomy is a surgical procedure to remove all or part of your colon. Your colon, part of your large intestine, is at the end of your digestive tract. Overall, in humans, the large intestine is about 1.5 meters (5 ft) long, which is about one-fifth of the whole length of the gastrointestinal tract. This long, coiled, tubelike organ, removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus.

The large intestine houses over 700 species of bacteria that perform a variety of functions, as well as fungi, protozoa, and archaea. The microbes in a human gut often number in the vicinity of 100 trillion and can weigh around 200 grams (0.44 pounds). This mass of microbes is symbiotic, in that they produce products that the large intestines absorb, thereby creating a mutually beneficial environment. For example, bacteria help to metabolize fatty acids and in turn, they produce Vitamins such as K and Biotin, which are reabsorbed back into the blood. This bacteria is involved in the production of certain antibodies, produced by the immune system as a preventative barrier against infections. This delicate balance is often easily disrupted by poor dietary choices.

Colectomy may be necessary to treat or prevent advanced diseases and conditions that affect your colon, such as cancer, severe diverticulitis, severe bleeding, a severe blockage that cuts off blood supply, or the inflammatory diseases Crohn’s, colitis, and others that may be linked to infections and perforations. Depending on the condition, sometimes a Colectomy is approached as a bowel resection, which may necessitate the removal of not only a portion of the colon but a portion of the small intestines and/or rectum, as well.

Anatomy of the Large Intestine

Causes of Colon Problems

As with many diseases, the cause of many colon problems can be wide and varied, running the spectrum from trauma, or medication side effects, to hereditary causes, to a poor diet with a sedentary lifestyle. However, typically, with most disorders of the colon, whatever the source is, the beginning stages usually involve the development of a persistent disruption to the beneficial bacteria and lining of the organ, possible cellular DNA damage to colon cells, and polyps or benign growths. If these conditions continue for too long a period, more serious developments, such as bleeding, blockage, diverticulitis, colitis, or even conversion of benign growths to malignant cancer can progress.

The following are the most common diseases or disorders of the colon:

  • Angiodysplasia of the colon
  • Appendicitis
  • Chronic functional abdominal pain
  • Colitis
  • Colorectal cancer
  • Colorectal polyps
  • Constipation
  • Crohn's disease
  • Diarrhea
  • Diverticulitis
  • Diverticulosis
  • Hirschsprung's disease (aganglionosis)
  • Ileus
  • Intussusception
  • Irritable bowel syndrome
  • Pseudomembranous colitis
  • Ulcerative colitis and toxic megacolon

Major causal factors that may increase your risk of colon disorders and cancer include:

  • Older age. Colon cancer can be diagnosed at any age, but a majority of people with colon cancer are older than 50. The rates of colon cancer in people younger than 50 have been increasing, but doctors aren't sure why.
  • African-American race. African-Americans have a greater risk of colon cancer than do people of other races.
  • A personal history of colorectal cancer or polyps. If you've already had colon cancer or noncancerous colon polyps, you have a greater risk of colon cancer in the future.
  • Inflammatory intestinal conditions. Chronic inflammatory diseases of the colon, such as ulcerative colitis and Crohn's disease, can increase your risk of colon cancer.
  • Inherited syndromes that increase colon cancer risk. Some gene mutations passed through generations of your family can increase your risk of colon cancer significantly. Only a small percentage of colon cancers are linked to inherited genes. The most common inherited syndromes that increase colon cancer risk are familial adenomatous polyposis (FAP) and Lynch syndrome, which is also known as hereditary nonpolyposis colorectal cancer (HNPCC).
  • Family history of colon cancer. You're more likely to develop colon cancer if you have a blood relative who has had the disease. If more than one family member has colon cancer or rectal cancer, your risk is even greater.
  • Low-fiber, high-fat diet. Colon cancer and rectal cancer may be associated with a typical Western diet, which is low in fiber and high in fat and calories. Research in this area has had mixed results. Some studies have found an increased risk of colon cancer in people who eat diets high in red meat and processed meat.
  • A sedentary lifestyle. People who are inactive are more likely to develop colon cancer. Getting regular physical activity may reduce your risk of colon cancer.
  • Diabetes. People with diabetes or insulin resistance have an increased risk of colon cancer.
  • Obesity. People who are obese have an increased risk of colon cancer and an increased risk of dying of colon cancer when compared with people considered normal weight.
  • Smoking. People who smoke may have an increased risk of colon cancer.
  • Alcohol. Heavy use of alcohol increases your risk of colon cancer.
  • Radiation therapy for cancer. Radiation therapy directed at the abdomen to treat previous cancers increases the risk of colon cancer.

Colon Cancer Development
Back to top

Diverticulosis vs. Diverticulitis

Symptoms of Colon Problems

Symptoms for most colonic disorders typically include:

  • Abdominal discomfort, such as cramps, gas, bloating, or pain
  • A feeling that the bowel hasn’t emptied completely
  • A persistent change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool
  • Rectal bleeding or blood in your stool
  • Weakness or fatigue
  • Unexplained weight loss and difficulty digesting certain foods
  • Structural changes such as hemorrhoids, blockages, or polyps

Certain conditions, such as polyps and early stages of lining disruptions and/or perforations, may be small and produce few if any, symptoms. For this reason, doctors recommend regular screening tests to help prevent all diseases, including colon cancer, by identifying and removing abnormal structural developments or polyps before they turn into malignant or metastasized cells.

Because the gastrointestinal tract is so large in the abdominal cavity, and the effects of digestion/ elimination of food can easily overlap other systems and organs, such as bladder, gallbladder, liver, reproductive, or endocrine hormones, and the lymphatic’s foundation for the immune system, the GI tract has been recently coined as the second brain. In its huge effect on the body’s many systems, many symptoms can overlap and become difficult to discern in origin.

Back to top

Colectomy Treatment & Recovery

Colectomy, whether full or partial, is major surgery, immediately affecting a person’s ability to absorb nutrients and eliminate wastes. As such, Dr. David W. Ford approaches the intestinal problems with a thorough barrage of tests to try to determine if resection can be minimized as much as possible. As mentioned earlier, regular screening tests to help prevent all diseases are recommended. The goal is to identify any abnormal structural developments, colon lining disruptions, polyps, or cancers. If colon cancer is identified, Dr. David W. Ford will work with his patient’s oncologists to apply many treatments that are available to help control it, including surgery, radiation therapy, and drug treatments, such as chemotherapy, targeted therapy, and immunotherapy.

Pre-Operative Tests:

To begin, however, Dr. David W. Ford will order as the first treatment for GI tract disorders involving the colon, all or some of the following:

  • Colonoscopy
  • Stool DNA Test
  • Fecal occult blood test or Fecal immunochemical test
  • Virtual colonoscopy (CT colonography)

Depending on the condition of the colon found, a Colectomy may be recommended, especially if non-surgical treatments, such as antibiotics, steroids, or other immune-supporting drugs, have already been employed. However, because the large intestines are so large and disorders so varied, Dr. David W. Ford tries to limit colon removal to as little as possible, while comprehensively removing the affected areas as thoroughly as possible.

what to expect during colonoscopy

Colectomy Types

Polypectomy
Polypectomy is an outpatient procedure to remove polyps, that can be performed during a colonoscopy.
Local Excision
Local Excision treats cancer in the rectum or anus, removing cancer and a small portion of the wall of the rectum, usually done through the anus.
Partial Colectomy
Partial Colectomy – removes only a small piece of the colon (less than hemicolectomy), reattaches the remaining two ends of the colon, and leaves the rectum intact, usually performed on patients with Crohn’s disease, colon cancer, or diverticulitis, and never requiring a colostomy bag. Depending on location removal, partial includes wedge resection, segmental resection, cecectomy (cecum), transverse colectomy, sigmoidectomy (sigmoid), ileocolectomy, or enterocolectomy.
Proctosigmoidectomy
Proctosigmoidectomy – Unlike the Sigmoidectomy under Partial Colectomy, Proctosigmoidectomy includes removal of the rectum in addition to all or part of the sigmoid colon. If the small intestines cannot be directly attached to the anus, a colostomy may be created, from the small intestines via a stoma, for waste disposal outside the body.
Abdominoperineal Resection
Abdominoperineal Resection – Although similar to Proctosigmoidectomy, Abdominoperineal Resection also removes the anus in addition to the sigmoid (descending) colon, and rectum before a permanent colostomy is constructed.
Hemicolectomy
Hemicolectomy – removal of either the right or the left half of the colon. In a right hemicolectomy, the cecum, ascending colon, and a portion of the transverse colon are removed, along with the appendix, which is attached to the ascending colon. In a left hemicolectomy, the descending colon, and part of the transverse colon are removed. This procedure may be done to treat Crohn's disease, a bowel blockage, or colon cancer. Typically, after the healthy sections of the colon are connected, an ostomy is not needed.
Total Abdominal Colectomy
Total Abdominal Colectomy – removal of all of the colon, but unlike a proctocolectomy, the rectum (where stool can be held for a time), is left. A total colectomy, with some or all of the rectum left, may be done in cases of either ulcerative colitis or Crohn's disease and requires ileostomy creation (with a stoma and colostomy bag, worn on the outside of the body to collect stool). Total colectomy can be done at the same time as an ileorectal anastomosis and avoid the need for an ostomy. The ileostomy may be permanent or temporary and more surgery, such as the j-pouch surgery or the pull-through surgery, might be done to "reconnect" the small intestine to the rectum and reverse the temporary ileostomy, allowing stool to be eliminated through the anus again.
Back to top

Colectomy Surgical Methods

Dr. David W. Ford employs either Open Colectomy Surgery or the da Vinci Surgically assisted laparoscopic Colectomy, depending on the needs of his patients. In some cases, Dr. David W. Ford will begin with the da Vinci surgical system and find it necessary to make a larger incision because of scar tissue from previous operations or another complication during surgery arises. Dr. David W. Ford’s decision regarding which approach to use is based on the amount of colon that needs to be removed, features of any abnormal structures, polyps, or tumors including size, type, appearance on imaging studies, and whether or not the patient has had prior abdominal surgery.

Robotically-Assisted Colectomy with
The Da Vinci® Robotic Surgical System

Surgical robotics for minimally invasive surgery

The da Vinci Surgical System allows Dr. David W. Ford to perform minimally invasive Colectomies with clinically supported precision and accuracy. During the robotically assisted colectomy, Dr. David W. Ford makes four small ports or incisions, each less than 1 inch long, in the abdomen. A laparoscope (a tube with a tiny video camera) is usually inserted into your abdomen, just under the ribs, through one of the incisions. Dr. David W. Ford who is seated in the operating room operates via the Surgeon Console that controls the Patient Cart’s robotic devices, including various surgical instruments and the camera. The images gathered from the laparoscope’s camera are high-definition 3D, which are sent to a monitor that Dr. David W. Ford uses to guide the surgical system during the colon removal.

If needed, the abdomen can be inflated with a harmless gas (carbon dioxide), which creates space to allow Dr. Ford to view the inside of the body. Dr. David W. Ford then delicately resects (or frees) the colon and rectum from its attachments, ties off the blood supply, and cuts the segment to separate the part that needs removal. Once the colon (and rectum or anus if necessary) has been dissected free, it is removed through one of the incisions. If a colostomy is needed, it is created with a stoma at one of the incision sites. You may require a drain at the incision site before your incisions are sutured, glued, or surgically clipped, and you're taken to a recovery area. Usually, after 1 - 3 days of observation in the hospital, a patient can be discharged.

Many robotically-assisted surgical systems are FDA approved and in use today. However, many are specially designed for specific organs, procedures, or conditions, such as lung or pulmonary surgeries or knee and other extremity replacement surgeries. The da Vinci Robotic Surgical System is the premier system specialized in colectomies. Dr. David W. Ford is not only an expert board-certified surgeon but also certified in the use of this leading-edge technology.

This robotic platform offers Dr. David W. Ford fully wristed instruments and a 3D high-definition camera with 10x magnification. As a result, colon removal can be done with more precision, and complex situations can be fixed with small incisions. Furthermore, the robot doesn’t get tired and Dr. Ford sits during surgery, so there is less surgeon fatigue. For the patient, this translates into quicker recovery, less pain, and fewer complications.

Other benefits of robotic colectomies include:

  • Access to clear three-dimensional images (unlike laparoscopic surgery’s two-dimensional images) of the inside of the abdomen for more precise surgery.
  • Dr. Ford can easily use stitches to sew tissue on the inside of the abdomen.
  • The patient is left with tiny scars rather than one large incision scar.
  • The possibility of much less pain, faster recovery and quicker return to normal diet and activities after surgery are observed, compared to all other types of intestinal surgery.

Should robotically-assisted surgical laparoscopic surgery be recommended as part of Colectomy treatment, Dr. David W. Ford and his team will have the best state-of-the-art technology at their disposal to usher in your recovery.

How The Da Vinci® Robotic Surgical System works

Da Vinci surgical systems are comprised of three components: surgeon console, patient-side cart, and vision cart.

Surgeon Console

Surgeon Console

The surgeon console is where I sit during the procedure, have a crystal-clear 3DHD view of your anatomy, and controls the robotic instruments. Through a few small incisions, the tiny instruments are "wristed" and move like a human hand, but with a far greater range of motion.
Patient Cart

Patient Cart

The patient-side cart is positioned near the patient on the operating table. It is where the instruments used during the operation move in real time in response to your surgeon’s hand movements at the surgeon console.

A camera provides a high-definition, 3D magnified view inside your body. Every hand movement your surgeon makes is translated by the da Vinci system in real time to bend and rotate the instruments with precision.

Vision Cart

Vision Cart

The vision cart makes communication possible between the components of the system possible, and supports the 3D High Definition vision system.

Back to top

Robotic-Assisted Surgery

"The da Vinci Surgical System allows me to make smaller incisions, resulting in reduced risk of infection, minimize scarring, reduce pain, and accelerate recovery time, allowing my patients to return to normal activities more quickly."
David W. Ford, MD, FACS
da Vinci Surgical System

Traditional (Open) Colectomy:

If complications arise with size, location, or amount of colon that needs to be removed during surgery, Open Colectomy may be used. The most common reasons to convert during surgery to an open operation include signs of cancer, unexpected findings, difficult anatomy, a tumor that is larger than expected, and a tumor that is invading into surrounding organs. During an open colectomy, Dr. David W. Ford will make an incision in the abdomen, cut the colon on either side of the diseased segment, and remove the section of the diseased colon through one of the incisions. The two divided ends of the colon are sutured or stapled together in an anastomosis. If the colon cannot be sewn back together, it is brought up through the abdomen to form a colostomy via a stoma. If necessary, a drain may be placed at the incision site, with a few days in the hospital recovering. Once home, it may take four to six weeks to fully recover.

Post-Operative Treatment of Colectomies

With open colectomy, the body must heal from the large incision in the abdomen that cuts through tissue and muscle. Recovery in the hospital is usually four to five days. In five to eight weeks, you'll be able to return to some of your normal activities. By comparison, people who have a robotic colectomy reduce hospital stay to about 3 days, with normal eating and bowel movements, and are back to work in 2 weeks with less pain.

A liquid diet is usually administered initially, followed by a bland soft diet until the bowels have fully recovered. Patients with Colectomies or Colostomies can live a full, active and healthy life.

Pain management efforts are more successful if you take the medication as soon as you start to feel uncomfortable, rather than waiting until the pain is severe. Should you require a refill, please plan ahead, as we do not call in prescriptions after hours. Scheduled medication, such as narcotics, cannot be called in and must be written in-person.

You may call with any problems, questions, or concerns at 843-797-5151

Prescription Refill Hours:
Monday – Thursday 8:30 AM – 4:30 PM
Friday before 2:00 PM

Please call if you experience any of the following:
  • Temperature greater than 101 degrees
  • Incisions with increasing areas of redness, thick or colored discharge, worsening tenderness
  • Nausea and vomiting or an inability to tolerate anything by mouth
  • Progressively worsening pain

Pain

Acetaminophen (Tylenol)
  • 650mg to 1000mg every 6 – 8 hours for first 3 days, scheduled
  • After 3 days, may continue as needed for pain
  • Do not exceed 4000mg in 24 hours
  • Avoid if history of hepatic (liver) impairment, alcohol abuse
Non-Steroidal Anti-Inflammatories (NSAIDs), choose one:
  • Ibuprofen (Advil, Motrin) 400mg by mouth every 6 – 8 hours, as needed
  • Naproxen (Aleve) 440mg by mouth every 12 hours, as needed. Avoid if history of renal (kidney) impairment, or a history of coronary artery disease (CAD), hypertension. Avoid multiple NSAIDs at once (e.g. Ibuprofen + Naproxen)
Narcotics and Opioids
  • Oxycodone, Hydrocodone & combo pills are for severe breakthrough pain ONLY
  • If a combo pill (e.g. Percocet, Lortab, Vicodin, Norco), do NOT take with Tylenol.
  • Do not drive or operate machinery while taking narcotic pain medication.
  • Narcotics can be habit-forming, have addiction potential, and cause constipation, so be careful – and use sparingly.
Tramadol
  • Tramadol (Ultram) is for severe breakthrough pain & often used in place of opioids
  • It is not a true narcotic but can be habit-forming with long-term use.
  • Avoid if history of seizures
Simethicone
  • Simethicone (GasX) 40 to 125 mg every 8 hours as needed for gas pain & bloating
  • Do not exceed 500mg in 24 hours; this is sold over-the-counter

Hygiene

  • You may shower and use soap and water on surgical site incisions, the day after surgery
  • Keep dressing clean and dry for 24 hours, you may replace as needed for drainage
  • Do not swim or soak; no hot tub, pool, beach, lake, etc. for at least 7 days

Constipation

  • Post-operatively & within 2 days, should be having regular, soft bowel movements (BMs)
  • Hydrate & drink plenty of water (8 –10 glasses per day)
  • PEG 3350 (Miralax) 17g by mouth each day for BMs each day

Other alternative recommendations, as needed – Use at least one if have not had a BM for 2 days:

  • Magnesium Hydroxide (Milk of Magnesia) 15 – 30 mL by mouth once a day, as needed
  • Magnesium Citrate 200 – 300 mL by mouth once a day, as needed
  • Docusate (Colace) 100mg by mouth twice a day, as needed

Activity

  • Ambulate and increase activity as tolerated post-operatively
  • Simply walking often improves mentation, decreases pain & bloating, and improves BMs
  • Avoid heavy lifting (greater than 20 pounds) until follow-up after laparoscopic and open surgeries
  • Avoid prolonged straining and strenuous activity until follow-up
  • Wear your abdominal binder after hernia repair
  • Resume all home medication as directed

Wound Care

  • The raised, firm area called a healing ridge is normal, and should resolve over time
  • Remove your dressings/bandages 2 days after surgery, unless told otherwise by Dr. Ford himself
  • You may shower and use soap & water on surgical site incisions, the day after surgery