What is Laparoscopic Colectomy

Laparoscopic colectomy is surgery to remove part or all of the large intestine (colon). This procedure may be used to treat several conditions, including:

• Inflammation and infection of the colon (diverticulitis).
• Tumors or masses in the colon.
• Inflammatory bowel disease, such as Crohn disease or ulcerative colitis. Colectomy is an option when symptoms cannot be controlled with medicines.
• Bleeding from the colon that cannot be controlled by another method.
• Blockage or obstruction of the colon.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines or dyes.
• Damage to other structures or organs.
• Leaking from where the colon was sewn together.
• Future blockage of the small intestines from scar tissue. Another surgery may be needed to repair this.
• Needing to convert to an open procedure. Complications such as damage to other organs or excessive bleeding may require the surgeon to convert from a laparoscopic procedure to an open procedure. This involves making a larger incision in the abdomen.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals, meals with high fiber, or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to clean out bacteria from your colon. Follow the directions carefully and take the medicine at the correct time.

General instructions

• You may be prescribed an oral bowel prep to clean out your colon in preparation for the surgery:
  • Follow instructions from your health care provider about how to do this.
  • Do not eat or drink anything else after you have started the bowel prep, unless your health care provider tells you it is safe to do so.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins to deliver fluid and medication.
• You will be given one of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• Small monitors will be connected to your body. They will be used to check your heart, blood pressure, and oxygen level.
• A breathing tube may be placed into your lungs during the procedure.
• A thin, flexible tube (catheter) will be placed into your bladder to drain urine.
• A tube may be placed through your nose and into your stomach to drain stomach fluids (nasogastric tube, or NG tube).
• Your abdomen will be filled with air so it expands. This gives the surgeon more room to operate and makes your organs easier to see.
• Several small cuts (incisions) will be made in your abdomen.
• A thin, lighted tube with a tiny camera on the end (laparoscope) will be put through one of the small incisions. The camera on the laparoscope will send a picture to a computer screen in the operating room. This will give the surgeon a good view inside your abdomen.
• Hollow tubes will be put through the other small incisions in your abdomen. The tools that are needed for the procedure will be put through these tubes.
• Clamps or staples will be put on both ends of the diseased part of the colon.
• The part of the intestine between the clamps or staples will be removed.
• If possible, the ends of the healthy colon that remain will be stitched (sutured) or stapled together to allow your body to pass waste (stool).
• Sometimes, the remaining colon cannot be stitched back together. If this is the case, a colostomy will be needed. If you need a colostomy:
  • An opening to the outside of your body (stoma) will be made through your abdomen.
  • The end of your colon will be brought to the opening. It will be stitched to the skin.
  • A bag will be attached to the opening. Stool will drain into this removable bag.
  • The colostomy may be temporary or permanent.
• The incisions from the colectomy will be closed with sutures or staples.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will receive fluids through an IV tube until your bowels start to work properly.
• Once your bowels are working again, you will be given clear liquids first and then solid food as tolerated.
• You will be given medicines to control your pain and nausea, if needed.
• Do not drive for 24 hours if you were given a sedative.

Laparoscopic Colectomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After your procedure, it is common to have the following:

• Pain in your abdomen, especially in the incision areas. You will be given medicine to control the pain.
• Tiredness. This is a normal part of the recovery process. Your energy level will return to normal over the next several weeks.
• Changes in your bowel movements, such as constipation or needing to go more often. Talk with your health care provider about how to manage this.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• Do not drink alcohol while taking prescription pain medicine.
• If you were prescribed an antibiotic medicine, use it as told by your health care provider. Do not stop using the antibiotic even if you start to feel better.

Incision care

• Follow instructions from your health care provider about how to take care of your incision areas. Make sure you:
  • Keep your incisions clean and dry.
  • Wash your hands with soap and water before and after applying medicine to the areas, and before and after changing your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Do not wear tight clothing over the incisions. Tight clothing may rub and irritate the incision areas, which may cause the incisions to open.
• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Activity

• Avoid lifting anything that is heavier than 10 lb (4.5 kg) for 2 weeks or until your health care provider says it is okay.
• You may resume normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Take rest breaks during the day as needed.

Eating and drinking

• Follow instructions from your health care provider about what you can eat after surgery.
• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine clear or pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.

General instructions

• Ask your health care provider when you will need an appointment to get your sutures or staples removed.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have more redness, swelling, or pain around your incisions.
• You have more fluid or blood coming from the incisions.
• Your incisions feel warm to the touch.
• You have pus or a bad smell coming from your incisions or your dressing.
• You have a fever.
• You have an incision that breaks open (edges not staying together) after sutures or staples have been removed.

Get help right away if:

• You develop a rash.
• You have chest pain or difficulty breathing.
• You have pain or swelling in your legs.
• You feel light-headed or you faint.
• Your abdomen swells (becomes distended).
• You have nausea or vomiting.
• You have blood in your stool (feces).