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Colectomy consists of the surgical resection of any extent of the large intestine (colon). It is also an occasional term used to describe removing the entire large intestine along with the rectum, but the appropriate term is proctocolectomy, where the whole large intestine and rectum are removed.

Indications

Some of the most common indications for colectomy are:

Colon cancer
Diverticulitis and diverticular disease of the large intestine
Trauma
Inflammatory bowel disease such as ulcerative colitis or Crohn's disease. Colectomy neither cures nor eliminates Crohn's disease, instead only removing part of the entire diseased large intestine. A colectomy is considered a cure for ulcerative colitis because the disease attacks only the large intestine and therefore will not be able to flare up again if the entire large intestine (cecum, ascending colon, transverse colon, descending colon and sigmoid colon) and rectum are removed. However, it does not always take away extra-intestinal symptoms.
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
Typhlitis

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^[update] in many medical centers. Recent experience has shown the feasibility of single port access colectomy,^[1]

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 or stapling 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; (i.e., no colectomy surgery can cure Crohn's disease, because the disease usually recurs at the site where the healthy sections of the large intestine were joined together. For example, if a patient with Crohn's disease has a transverse colectomy, their Crohn's will usually reappear at the resection site of the ascending and descending colons.)
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 laxatives (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 surgeons all over the world.

Types

Right hemicolectomy and left hemicolectomy refer to the resection of the ascending colon (right) and the descending colon (left), respectively. When part of the transverse colon is also resected, it may be referred to as an extended hemicolectomy^{[citation needed]}
Transverse colectomy is also possible, though uncommon.^{[citation needed]}
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) considerably easier.^{[citation needed]}
When the entire colon is removed, this is called a total colectomy, also known as Lane's Operation.^[2] If the rectum is also removed, it is a total proctocolectomy.
Subtotal colectomy is resection of part of the colon or a resection of all of the colon without complete resection of the rectum.^[3]

Laparoscopic surgery

Today more than 40% of colon resections in United States are performed via laparoscopic approach.^[4]

History

Sir William Arbuthnot-Lane was one of the early proponents of the usefulness of total colectomies, although his overuse of the procedure called the wisdom of the surgery into question.^[5]

References

^ Bucher P, Pugin F, Morel P (October 2008). "Single port access laparoscopic right hemicolectomy". International Journal of Colorectal Disease 23 (10): 1013–6. doi:10.1007/s00384-008-0519-8. PMID 18607608.
^ Enersen, Ole Daniel. "Lane's operation". whonamedit.com. Retrieved 2009-07-19.
^ Oakley JR, Lavery IC, Fazio VW, Jagelman DG, Weakley FL, Easley K (June 1985). "The fate of the rectal stump after subtotal colectomy for ulcerative colitis". Diseases of the Colon and Rectum 28 (6): 394–6. doi:10.1007/BF02560219. PMID 4006633.
^ Simorov A, Shaligram A, Shostrom V, Boilesen E, Thompson J, Oleynikov D (September 2012). "Laparoscopic colon resection trends in utilization and rate of conversion to open procedure: a national database review of academic medical centers". Annals of Surgery 256 (3): 462–8. doi:10.1097/SLA.0b013e3182657ec5. PMID 22868361.
^ Lambert, Edward C. (1978). Modern medical mistakes. Indiana University Press. p. 18. ISBN 0-253-15425-1.

External links

Saunders, Brian (2007). "Removing large or sessile colonic polyps". OMED 'How I Do It'.

UpToDate Contents

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1. 結腸切除の概要 overview of colon resection
2. 右および拡大右結腸切除：開放術 right and extended right colectomy open technique
3. 左結腸切除：開腹術 left colectomy open technique
4. 人工肛門造設または回腸瘻造設患者のマネージメント management of patients with a colostomy or ileostomy
5. 原発性大腸癌に対する切除術 surgical resection of primary colon cancer

English Journal

Infliximab in ulcerative colitis: real-life analysis of factors predicting treatment discontinuation due to lack of response or colectomy: ECIA (ACAD Colitis and Infliximab Study).

Fernández-Salazar L1, Muñoz F2, Barrio J3, Muñoz C4, Pajares R5, Rivero M6, Prieto V7, Legido J8, Bouhmidi A9, Herranz M10, Fernández N2, Sánchez-Ocaña R3, Joao D2, Santos F3.
Scandinavian journal of gastroenterology.Scand J Gastroenterol.2016 Feb;51(2):186-95. doi: 10.3109/00365521.2015.1070900. Epub 2015 Jul 22.
OBJECTIVE: To describe clinical practice with infliximab (IFX) in ulcerative colitis (UC); identification of predictive factors for IFX treatment discontinuation due to insufficient response and for colectomy.MATERIAL AND METHODS: Retrospective, multicentric and observational study including every U
PMID 26200929

Problems after restorative proctocolectomy: assessment and therapy.

Shen B1.
Current opinion in gastroenterology.Curr Opin Gastroenterol.2016 Jan;32(1):49-54. doi: 10.1097/MOG.0000000000000235.
PURPOSE OF REVIEW: Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice for patients with ulcerative colitis or familial adenomatous polyposis who require colectomy. Although the surgical procedure significantly improves the patients' quality of life, com
PMID 26628102

Failing to Prepare Is Preparing to Fail: A Single-Blinded, Randomized Controlled Trial to Determine the Impact of a Preoperative Instructional Video on the Ability of Residents to Perform Laparoscopic Right Colectomy.

Crawshaw BP1, Steele SR, Lee EC, Delaney CP, Mustain WC, Russ AJ, Shanmugan S, Champagne BJ.
Diseases of the colon and rectum.Dis Colon Rectum.2016 Jan;59(1):28-34.
BACKGROUND: Laparoscopic colorectal resection is an index case for advanced skills training, yet many residents struggle to reach proficiency by graduation. Current methods to reduce the learning curve for residents remain expensive, time consuming, and poorly validated.OBJECTIVE: The purpose of thi
PMID 26651109