A colectomy involves the surgical removal of a section of the large intestine, also known as the colon. While “colectomy” refers to the removal of any part of the colon, this article focuses on a specific type: the right colectomy. Understanding this procedure requires knowledge of the colon’s anatomy and function.
The Right Colon’s Role and Location
The large intestine, or colon, converts liquid waste into solid stool. It is approximately 5 to 6 feet long and is divided into several parts.
This section begins with the cecum, a pouch-like structure that connects the small intestine to the large intestine. The appendix, a small, finger-shaped organ, is attached to the cecum. Extending upwards from the cecum is the ascending colon, which travels along the right side of the abdominal cavity. The ascending colon is about 8 inches (20-25 cm) long and ends near the liver, where it makes a turn to become the transverse colon.
The right colon absorbs remaining water and electrolytes from partially digested food received from the small intestine, solidifying waste into stool. It also plays a role in housing beneficial bacteria that produce vitamins, like vitamin K and B vitamins, which can then be absorbed into the bloodstream.
Defining a Right Colectomy
A right colectomy is a surgical procedure specifically involving the removal of the right-sided portion of the large intestine. This typically includes the cecum and the ascending colon. In some cases, a portion of the transverse colon may also be removed. The goal is to excise diseased or damaged sections of the bowel.
After removal, the healthy ends of the small intestine (ileum) and the colon are reconnected. This reconnection, known as an anastomosis, restores the continuity of the digestive tract. The procedure aims to eliminate the problem while preserving healthy bowel as possible. The extent of the removal and reconnection depends on the specific condition being treated and the patient’s individual anatomy.
When a Right Colectomy is Necessary
A right colectomy is often performed to treat various medical conditions affecting the right side of the colon. Colon cancer is a frequent reason for this surgery, especially when tumors are located in the cecum or ascending colon. Removing the cancerous section, along with nearby lymph nodes, helps prevent the spread of the disease. Inflammatory bowel diseases, such as Crohn’s disease, can also necessitate a right colectomy if inflammation and damage are severe and localized.
Diverticulitis, an inflammation or infection of small pouches (diverticula), might also require surgery if it leads to complications like perforation or recurrent severe attacks. Large, non-cancerous polyps that cannot be removed safely during a colonoscopy may also lead to the need for a right colectomy. Other less common indications include severe bleeding, blockages, or injuries to the right colon that do not respond to other treatments. The decision for surgery is made after careful evaluation of the patient’s condition and the nature of the disease.
The Surgical Process
A right colectomy can be performed using two primary surgical approaches: open surgery or laparoscopic surgery. Open surgery involves a single, larger incision in the abdomen, allowing direct access to the colon. This traditional method provides a wide view of the surgical area and is often used for more complex cases or when extensive disease is present.
Laparoscopic, or “keyhole,” surgery is a less invasive technique that uses several small incisions. A thin tube with a camera (laparoscope) is inserted through one incision, providing a magnified view of internal organs on a monitor. Surgical instruments are then inserted through the other small incisions to perform the procedure. This approach typically results in less post-operative pain, smaller scars, and a faster recovery compared to open surgery. Both approaches involve identifying the affected segment of the right colon, carefully detaching it from surrounding tissues and blood vessels, and then removing it. The surgeon then reconnects the small intestine to the remaining colon, creating an anastomosis for normal bowel function.
Life After a Right Colectomy
Recovery begins immediately after surgery, typically involving a hospital stay of several days. Pain management is provided, and patients are encouraged to mobilize early by walking, which helps prevent complications and promotes bowel function. Diet progresses gradually from clear liquids to solid foods as the digestive system recovers.
After discharge, patients will continue recovery at home, which can take several weeks to months. Bowel habits may change initially, with more frequent or looser stools, as the body adjusts to the altered digestive pathway. Dietary adjustments, such as avoiding high-fiber or gas-producing foods temporarily, might be recommended to ease discomfort. Long-term follow-up with the surgeon and a gastroenterologist is important to monitor recovery, manage persistent symptoms, and address the underlying condition. Many individuals return to normal activities and diet as they fully recover.