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Hemicolectomy

Published by Bupa's health information team, July 2009.

This factsheet is for people who are planning to have hemicolectomy, or who would like information about it.

Hemicolectomy is a surgical procedure to remove either the left or right side of the colon. It's often carried out to treat a number of conditions including colon cancer and Crohn's disease.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

About hemicolectomy

Your large bowel, also known as your colon, is part of your digestive system. The large bowel receives digested food from the small bowel. As the food passes through the large bowel, water and salt are absorbed and a solid stool forms. The stool is stored in the rectum until it's ready to be released.

Hemicolectomy is a procedure to remove part of your colon. If the left side of the colon (also known as the descending colon) is removed it's known as a left hemicolectomy. Right hemicolectomy is when the right side of your colon (also known as the ascending colon) and the caecum is removed. After the section of colon is removed, the two cut ends are joined together. This is known as an anastomosis. Occasionally, you may need to have a temporary stoma if the two ends can't be rejoined. This is where the bowel is brought to the surface of the abdomen and the waste is collected into a bag. The stoma is likely to be temporary and you will have another operation to reverse the stoma.

Hemicolectomy is often carried out to treat a number of conditions including:

  • colon cancer
  • inflammatory bowel diseases such as Crohn's disease
  • diverticular disease (small bulges or pouches, called diverticula, in the wall of the bowel)

What are the alternatives?

Some conditions, such as Crohn's disease and diverticular disease are usually treated without surgery. If your symptoms don't respond to medical treatment, or if complications develop, your doctor may recommend surgery. In conditions such as bowel cancer, surgery may be combined with other anti-cancer treatments such as radiotherapy and chemotherapy.

Preparing for your operation

Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

Hemicolectomy usually requires a hospital stay of between five and 12 days and it's done under general anaesthesia. This means that you will be asleep during the operation. You may also be given an epidural to help with pain relief after your operation.

Typically you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours before the operation.

Take all your normal medicines before going into hospital, unless your doctor advises you to do otherwise. You should also take all your normal medicines into hospital.

For a left hemicolectomy you may be asked to arrive at the hospital two days before the operation. For a right hemicolectomy you will usually be asked to come in the day before.

At the hospital your nurse will check your heart rate and blood pressure, and test your urine. You may be asked to take a laxative and not eat any solid foods on the day before surgery to make sure your bowels are empty. This can vary and your surgeon will explain how you should prepare. Occasionally, you may need a drip in your vein to prevent you from becoming dehydrated.

On the day of your operation, your surgeon will ask you to sign a consent form if you haven't already done so. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

Your nurse will prepare you for theatre. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anti-clotting medicine called heparin as well as, or instead of, stockings.

If you're likely to have a stoma, you will be visited by a specialist nurse who will discuss this will you. He or she will mark a site on your abdominal wall for the stoma to be placed.

About the operation

The operation usually takes between two and four hours. There are several different hemicolectomy techniques. Your surgeon may use laparoscopic (keyhole) surgery or open surgery. He or she will explain the options available to you.

During the operation, your surgeon will remove the diseased section of your colon. He or she will then join the two cut ends of your colon back together.

Occasionally, your bowel may need to be brought out onto the skin of your abdomen to give the new join time to heal. This procedure is called a colostomy if it involves the large bowel and an ileostomy if it involves the small bowel. The opening of the bowel is known as a stoma. A bag or pouch is connected to the stoma to collect faeces outside your body. You will usually have an operation to rejoin the bowel a few months later.

An epidural may be inserted at the end of the operation. This involves inserting a thin tube into a small space in your spine, just below the spinal cord. There is a continuous flow of local anaesthetic into the tube to help control any pain after the operation.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off. You will be given painkillers to help relieve any pain during your stay in hospital.

You won't be able to drink for one or two days after the operation so you will have a drip inserted into a vein in your hand or arm to give you fluids.

You may also have a fine tube placed into your stomach through your nose. This will help to empty your stomach for the first couple of days after the operation. This will be taken out once you start drinking. You will be able to take small sips of water after one or two days and this will be increased until you can eat a light meal.

A small tube, known as a catheter, will be put into your bladder to drain urine into a collecting bag for the first few days after the operation. This is inserted during the operation.

You may have a drainage tube at the site of the operation to drain any fluid and prevent infection.

You will be given regular pain relief and may have an epidural in your back. This gives good pain relief after your operation, but can have some side-effects including loss of strength or control of your muscles.

The day after the operation you will be helped out of your bed and seated in a chair. The nurses will help you move around and wash. They may also need to change your dressing. You will be able to do more for yourself when you feel better.

It may take a while for your bowels to get back to normal. Your nurse will ask you when you have passed wind. You may have to wait three to four days before you open your bowels and you may have diarrhoea to begin with.

You will probably be ready to go home between five and 10 days after your operation. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Your nurse will give you some advice about caring for your healing wounds before you go home. If you have a stoma, your nurse will help you learn how to manage the bag. You may be given a date for a follow-up appointment.

Recovering from hemicolectomy

If you need them, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice.

You may feel tired for some time after your operation. A short sleep during the day can help with this. You can gradually increase the amount of activity that you do.

Most people can return to work when they feel better and if they don't need any further treatment. This will also depend on the type of job that you do. To help promote your recovery, it's important that you:

  • don't stay in bed for too long. This can reduce circulation and increase your risk of developing a thrombosis,
  • don't bend or strain
  • don't do any vigorous activity (or work) for the first six weeks
  • don't drive until you can do an emergency stop without pain

What are the risks?

Hemicolectomy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted but mostly temporary effects of a successful procedure, for example feeling sick as a result of the general anaesthetic.

Side-effects of hemicolectomy surgery are uncommon. In a right hemicolectomy the surgeon will also remove a section of the small bowel and the valve that separates the small bowel from the large bowel. This can cause diarrhoea and occasionally you may have a problem absorbing vitamin B12. Left hemicolectomy can also affect the reabsorption of fluids and your bowel may be looser than before. You may also find that you need to move your bowels more frequently.

Complications

This is when problems occur during or after the procedure. Most people aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis).

There is a risk of wound infection with any operation that involves opening the bowel. This may occur in hospital or after you go home. The wound will become swollen, red and tender to touch. You may also have sweats or fever. If you experience any of these symptoms it's important that you seek medical help. A wound infection can be treated with antibiotics, although it may be necessary to release infected fluid (an abscess) from the wound.

The surgical joining of you bowel can leak. This is known as anastomotic leak and can cause pain, swelling and sometimes infection. You may need further surgery and possibly a stoma to treat it.

Other complications of hemicolectomy are uncommon, but can include the following.

  • Swelling or hernia in the line of the wound. You may need an operation to repair it.
  • Chest infection. This is a much greater risk in smokers and is treated with antibiotics and chest physiotherapy.
  • Ileus (paralysis of the bowel). Sometimes the bowel is slow to recover from the surgery and doesn't contract normally. This is known as an ileus and can cause you to feel bloated, vomit, and have problems moving your bowels. It's treated by placing a tube in your stomach to keep it empty and by giving fluids through a drip until you recover.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

Related topics

Further information

Sources

  • The bowel. Cancer Research UK. www.cancerhelp.org.uk, accessed 3 March 2009
  • Which surgery for bowel cancer? Cancer Research UK. www.cancerhelp.org.uk, accessed 6 April 2009
  • Laparoscopic left hemicolectomy. Association of Laparoscopic Surgeons of Great Britain & Ireland. www.alsgbi.org, accessed 6 April 2009
  • Surgery for large bowel cancer. Macmillan Cancer Support. www.macmillan.org.uk, accessed 6 April 2009
  • Personal communication, Mr Stephen Pollard, MA, MS, MB, BS, BSc, FRCS. Consultant Surgeon, 11 May 2009

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: July 2009

 

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