What is Open Colectomy

Open 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.
• Bleeding from the colon.
• 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.
• Whether you are pregnant or may be pregnant.
• Whether you smoke or use tobacco products. These can affect your body’s reaction to anesthesia.

What are the risks?

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

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• Pneumonia.
• The incision opening up.
• Tissues from inside the abdomen bulging through the incision (hernia).
• Reopening of the colon where it was stitched or stapled together.
• A blood clot forming in a vein and traveling to the lungs.
• Future blockage of the small intestine from scar tissue.

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 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.

Bowel prep

In some cases, you may be prescribed an oral bowel prep to clean out your colon. If so:

• Take it as told by your health care provider. Starting the day before your procedure, you may need to drink a large amount of medicated liquid. The liquid will cause you to have multiple loose stools until your stool is almost clear or light green.
• Follow instructions from your health care provider about eating and drinking restrictions during bowel prep.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines or vitamins. This is especially important if you are taking diabetes medicines, blood thinners, or vitamin E.
  • 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.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider.

General instructions

• Bring loose-fitting, comfortable clothing and slip-on shoes that you can put on without bending over.
• Make sure to see your health care provider for any tests that you need before the procedure, such as:
  • Blood tests.
  • A test to check the heart’s rhythm (electrocardiogram, ECG).
  • A CT scan of your abdomen.
  • Urine tests.
  • Colonoscopy.
• Plan to have someone take you home from the hospital or clinic.
• Arrange for someone to help you with your activities during your recovery.

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.
  • Hair may be removed from the surgical area.
• An IV tube will be inserted into one of your veins. The tube will be used to give you medicines and fluids.
• You will be given a medicine to make you fall asleep (general anesthetic). You may also be given a medicine to help you relax (sedative).
• 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 inserted through your nose and into your stomach (nasogastric tube, or NG tube). The tube is used to remove stomach fluids after surgery until the intestines start working again.
• An incision will be made in your abdomen.
• Clamps or staples will be put on your colon.
• The part of the colon between the clamps or staples will be removed.
• The ends of the colon that remain will be stitched or stapled together.
• The incision in your abdomen will be closed with stitches (sutures) or staples.
• The incision will be covered with a bandage (dressing).
• A small opening (stoma) may be created in your lower abdomen. A removable, external pouch (ostomy pouch) will be attached to the stoma. This pouch will collect stool outside of your body. Stool passes through the stoma and into the pouch instead of through your anus.

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 may continue to receive fluids and medicines through an IV tube.
• You will start on a clear liquid diet and gradually go back to a normal diet.
• Do not drive until your health care provider approves.
• You may have some pain in your abdomen. You will be given pain medicine to control the pain.
• You will be encouraged to do the following:
  • Do breathing exercises to prevent pneumonia.
  • Get up and start walking within a day after surgery. You should try to get up 5–6 times a day.

Open 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 the procedure, it is common to have:

• Pain in your abdomen, especially along your incision.
• Tiredness. Your energy level will return to normal over the next several weeks.
• Constipation.
• Nausea.
• Difficulty urinating.

Follow these instructions at home:

Activity

• You may be able to return to most of your normal activities within 1–2 weeks, such as working, walking up stairs, and sexual activity.
• Avoid activities that require a lot of energy for 4–6 weeks after surgery, such as running, climbing, and lifting heavy objects. Ask your health care provider what activities are safe for you.
• Take rest breaks during the day as needed.
• Do not drive for 1–2 weeks or until your health care provider says that it is safe.
• Do not drive or use heavy machinery while taking prescription pain medicines.
• Do not lift anything that is heavier than 10 lb (4.3 kg) until your health care provider says that it is safe.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change 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) or staples in place. These skin closures may need to stay in place for 2 weeks or longer.
• Avoid wearing tight clothing around your incision.
• Protect your incision area from the sun.
• 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.

General instructions

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider when you may shower.
• Take over-the-counter and prescription medicines, including stool softeners, only as told by your health care provider.
• Eat a low-fat and low-fiber diet for the first 4 weeks after surgery.
• 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 incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You have a fever or chills.
• You do not have a bowel movement 2–3 days after surgery.
• You cannot eat or drink for 24 hours or more.
• You have persistent nausea and vomiting.
• You have abdominal pain that gets worse and does not get better with medicine.

Get help right away if:

• You have chest pain.
• You have shortness of breath.
• You have pain or swelling in your legs.
• Your incision breaks open after your sutures or staples have been removed.
• You have bleeding from the rectum.