Constipation – Partial Colectomy or Intestinal Resection Surgery

Overview

What is constipation? Constipation occurs when bowel movements become less frequent or harder to pass. In some instances, passing stool may become extremely painful, making it difficult or scary to go to the bathroom. Psychological impediments to passing stool can develop, further exacerbating the problem.

Constipation usually occurs when a patient changes their diet or routine, or when the they do not eat enough fiber. It may also be a symptom of more serious medical conditions such as diverticulitis, pelvic floor disorders in women, and functional gastrointestinal disorders, such as irritable bowel syndrome (IBS) and Crohn’s disease.

Why?

Living with constipation in your daily life can be debilitating and negatively impact your mental state and quality-of-life. Patients may suffer through bloating, pain, fear, and the negative social stigma attached to anorectal pathologies. It is important you see your doctor before these symptoms affect your daily activities, routines, and personal relationships.

Surgical intervention for constipation should absolutely be the last option you choose, once all other options have been exhausted (medicinal, sacral nerve modulation, etc.). Surgical interventional for constipation can be life-altering. However, if you do find yourself in a situation where you have intractable chronic constipation with no other recourse, surgery will have to be performed.

The most common surgical interventions performed for intractable chronic constipation are a partial colectomy (resection) and a subtotal colectomy (when the entire large intestine is removed minus the rectum). However, a colostomy (attaching the colon to a stoma and a pouch outside of your body that you’ll empty out) may be necessary for more severe cases (when there are not enough intestines left to attach to the rectum).

All surgeries, whether they be big or small, carry risks. For a colectomy these typically include:

What to expect prior to your surgery

You may need to take antibiotics before surgery. Routine blood work is usually not needed but may be ordered prior to surgery based on the patient's age and the presence of any existing medical problems.

Before your surgery, a nurse or doctor will plan the site, clean the affected area, and consult with you for any questions you may have. General anesthesia will then be administered under the supervision of an anesthesiologist and your surgeon.

The procedure itself usually takes less than an hour to perform, depending on the complexity of the condition. Typically, your doctor will give you a heads up on how long the procedure should last.

The procedure

A colectomy can be performed either laparoscopically or with open surgery. We strive to make our procedures as minimally invasive as possible, and thus we prefer to use laparoscopic intervention to treat this condition.

Your surgeon will make 3-5 small incisions along your belly to fit a laparoscope (small flexible camera used to see inside your belly) and other instruments. Your belly is then filled with gas to make the area easier to work in. The diseased part of your large bowel is then located using the laparoscope, and subsequently removed. The two remaining sections of the intestine are then attached to one another using sutures (this is called an anastomosis). Once the procedure is complete, the gas is sucked out of your belly and the small surface incisions are sutured up.

After the procedure

Recovery time for a partial colectomy will vary, but you should feel back to normal within a few weeks. Residual pain may last up to a week after surgery. Be sure to keep the incision area clean and dry to avoid the possibility of infection. Itchiness or soreness is common, however let your doctor know if you experience swelling or excessive pain.

You will need to arrange for a ride home the day of your surgery and we recommend someone stay with you for the first 24 hours at home. When you leave the facility after surgery, we will want you to go home and rest. Avoid making any other plans on the day of your surgery. Starting the following day, you can increase your activity as you feel up to it.

You will likely be given a prescription for pain medication following your surgery. The recovery nurse will discuss a pain control plan following surgery specific to you and your needs including activities like ice applied over incisions and a medication regimen. Oftentimes we will recommend taking Tylenol and Advil (same as Motrin, Ibuprofen) or Aleve in addition to the narcotic pain medication.