Colectomy
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2008-06-23T10:15:33Z
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ICD9 = 45.8 |
ICD9_mult = {{ICD9proc|45.73}} |
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'''Colectomy''' consists of the [[surgery|surgical]] resection of any extent of the large bowel ([[colon (anatomy)|colon]]).
==Indications==
Some of the most common indications for colectomy are:
* [[Colon cancer]].
* [[Diverticulitis]] and [[diverticular disease]] of the large bowel.
* [[Physical trauma|Trauma]].
* [[Inflammatory bowel disease]] such as [[Ulcerative Colitis]] or [[Crohn's disease]].
* '''Prophylactic colectomy''' can be indicated in some forms of [[polyposis]], [[Lynch syndrome]] and certain cases of [[inflammatory bowel disease]] because of high risk for development of colorectal cancer.
* [[bowel infarction]]
==Basic principles==
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]] in many medical centers.
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 together both the cut ends (primary [[anastomosis]]), or creating a [[colostomy]]. 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 and [[laxative]]s (so-called "bowel prep").
An [[anastomosis]] carries the risk of [[dehiscence]] (breakdown of the stitches), which can lead to contamination of the [[peritoneal cavity]], [[peritonitis]], [[sepsis]] and [[death]]. [[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 [[general surgery|surgeon]]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]] 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]], which is preferred because it makes "takedown" (reoperation to restore normal intestinal continuity by means of an [[Anastomosis#Surgical_anastomoses|anastomosis]]) 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 colon or a resection of all of the colon without complete resection of the rectum.<ref>{{cite journal |author=Oakley JR, Lavery IC, Fazio VW, Jagelman DG, Weakley FL, Easley K |title=The fate of the rectal stump after subtotal colectomy for ulcerative colitis |journal=Dis. Colon Rectum |volume=28 |issue=6 |pages=394–6 |year=1985 |pmid=4006633 |doi=10.1007/BF02560219}}</ref>
==References==
<references/>
==External links==
* [http://www.omed.org/downloads/pdf/publications/how_i_doit/2007/omed_hid_removing_large_or_sessile_colonic_polyps.pdf "How I Do It" — Removing large or sessile colonic polyps]. 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.
{{Digestive system surgical procedures}}
[[Category:Surgery]]
[[Category:Surgical oncology]]
[[Category:Surgical procedures]]
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