A sigmoid colectomy is a surgical procedure that removes the sigmoid colon, an S-shaped segment of the large intestine located just before the rectum. This operation is often necessary to address various conditions affecting this part of the digestive system, aiming to alleviate symptoms, treat disease, and restore healthier bowel function.
Understanding the Sigmoid Colon
The sigmoid colon is the final section of the large intestine, connecting the descending colon to the rectum. Characterized by its S-shape, it is typically located in the pelvis and measures approximately 14 to 16 inches (35 to 40 cm) in length. Its primary function is to store fecal matter before elimination and absorb water and electrolytes, helping to form solid stool. The muscular walls use wave-like contractions to move stool towards the rectum.
Why a Sigmoid Colectomy is Needed
A sigmoid colectomy becomes necessary when diseases or conditions severely affect this part of the colon. Common reasons include severe or recurrent diverticulitis, an inflammation or infection of small pouches in the colon lining. If medical treatments fail or complications arise, removing the affected sigmoid colon can prevent further issues.
Colorectal cancer within the sigmoid colon frequently necessitates its removal, aiming to excise the cancerous segment along with surrounding lymph nodes to prevent disease spread. Large or numerous polyps that cannot be safely removed through less invasive endoscopic procedures also indicate the need for a colectomy. Inflammatory bowel diseases, such as Crohn’s disease or ulcerative colitis, may also require sigmoid colectomy if localized to this segment and unresponsive to medication.
How the Surgery is Performed
A sigmoid colectomy can be performed using two main surgical approaches: open surgery or laparoscopic surgery. Open surgery involves a single, larger abdominal incision, typically running from above the navel downwards, allowing the surgeon direct visibility and access.
Laparoscopic surgery, also known as keyhole or minimally invasive surgery, uses several small incisions. Through these cuts, a surgeon inserts a laparoscope (a thin tube with a camera and light) to view internal organs on a monitor, using specialized instruments to remove the diseased segment.
Regardless of the approach, the affected sigmoid colon is removed, and the remaining healthy ends are typically reconnected in a process called anastomosis. If immediate reconnection is not possible, a temporary or permanent colostomy may be created, where the bowel is brought through an abdominal opening to collect waste in an external bag. The procedure typically ranges from 90 minutes to several hours, depending on complexity and approach.
What to Expect: Preparation and Recovery
Preparation for a sigmoid colectomy involves several steps. Patients are often instructed to follow dietary restrictions, such as a clear liquid diet, and undergo bowel preparation using laxatives to clean the colon. Medication adjustments may also be necessary, and patients are advised to stop eating several hours before surgery.
Immediately following surgery, patients stay in the hospital for three to ten days, with laparoscopic procedures often allowing shorter stays. Pain management is provided, often through intravenous medication, and fluids are administered until oral intake is tolerated. Diet progresses gradually from liquids to soft foods.
During at-home recovery, activity restrictions are common, including avoiding heavy lifting for several weeks. Patients may experience changes in bowel habits, such as more frequent or loose stools, which usually improve over time, sometimes up to a year. Initial wound care and monitoring for symptoms like fever or severe pain are important.