A colectomy is a resection of a part of the large intestine (colon). At the present this intervention is mostly performed by laparoscopy.
Anatomy: the colon exists out of 4 parts: the right colon (ascending part) (1) with at the base the caecum (with the appendix) (2); the transverse colon (3), the left colon (descending) (4) and the sigmoid (5).
- The rectum (6) and the anus (7)
The initial indications of colectomy were the benign diseases of the colon such as sigmoidal diverticulitis (fig B and picture) and the inflammatory conditions (Crohn's disease). The indications have been extended with the years to more malignant conditions of the colon (cancer) (fig C see picture) with regard to the evolution of the instruments, the improved techniques and skills of the surgeons, and the literature proving the efficacy of this treatment in cancer of the colon. The lesions are mostly localised in the region of the sigmoid and the rectal area, making a left colectomy the most frequent intervention.
The colon diverticles, essentially seen in the area of the sigmoid, are bulging of the mucosa through the wall of the colon (pict.A). They rarely appear before the age of 40 years, but do increase with aging. They are more often visible in men and are more frequent in obese and constipated patients. These deverticles can get infected: so-called acute diverticulitis mostly sigmoidal (fig. B and picture) with fever and elevated localised pain. The treatment is conservative with antibiotics. Recurrent diverticulitis can be indicated for surgical treatment (colectomy by laparoscopy).
(Click to enlarge)
A left colectomy necessitates 3 to 4 trocar holes with small incisions of 5 cm length. Discharge of the patient can be from 4 to 6 days after surgery.