Colectomy vs. Colostomy

If you are new to the world of IBD or are having to have a conversation about surgery for IBD it can be confusing when presented with so many similar sounding procedures. The most common confusion in this area is the difference between a colectomy and a colostomy. A colectomy simply means that surgery is required to remove part or all of the colon. A colostomy may follow a colectomy and is referred to as the opening to the outside of the body that allows stool to pass through usually into a bag. There are eight different types of colectomies and a few different ways to operate that we will explore together in this post. 

First up, the two main types of operation done during a colectomy:

• Laparoscopic Colectomy: In this procedure, small incisions are made in the abdomen and a probe with a lighted camera is inserted to be able to see where to cut. Small surgical tools can then be inserted to make the necessary incisions. The big pro to laparoscopically is usually less healing time, since the incisions are smaller. 
  
  
• Open Colectomy: An open colectomy is what most people think of when they think of abdominal surgery. This method consists of making a large incision and opening up the area to be able to operate. This may need to be done for several reasons including bowel perforation, emergency, or a much larger area to remove. Since this incision is much larger, it takes longer for the muscles to heal and is usually considered to be a more serious operation.      

Now that we understand how the procedures are done, let’s explore the types of colectomies: 

• Total Colectomy: As the name inferred this operation involves removing the entirety of the colon. After this operation, a colostomy bag is usually needed. The end of the intestine is then fitted to an ostomy (the opening in the abdomen) and a bag will be attached to catch all stools. After this operation, the ostomy is usually permanent. If so, the patient may need to have additional surgery to remove the rectum itself.
  
  
• Partial Colectomy: This involves only removing part of the colon and often ends in a resection. Resection refers to the end of the two parts of the colon that have been cut, and are then sewn together. This type of procedure depending on the length of the resection usually does not require a colostomy bag.
  
  
• Total Proctocolectomy: This surgery removes the colon and the rectum. In some cases, the small intestine can be attached to the anus to allow for excretion. For others, a temporary or permanent ileostomy may be needed. This can be the first step of a two-step process of receiving what is referred to as a J-pouch or Ileoanal anastomosis. The first surgery will remove the colon and anus while keeping the sphincter and shaping the small intestine into the first part of the ‘J’. They then add a temporary ileostomy to allow for healing. The second surgery often called a ‘take down’ will connect the ileostomy site to the j-pouch allowing for excretion through the anus.   
  
  
• Abdominal Perineal Resection: This is the removal of the ‘sigmoid’ colon, which is the part that attaches to the rectum. It involves removing the colon, rectum, and anus. For those undergoing this surgery, a permanent colostomy will be needed.
  
  
• Hemicolectomy: This involves removing the right or left portion of the colon. It often will end in resection, depending on how much is taken.
  
  
• Segmental Resection: This refers to the removal of a small part of the colon. This can be because of infection, a stricture, or inflammation in a certain part of the colon that is past steroidal healing. Those undergoing this surgery will usually not need a colostomy.    
  
  
• Low Anterior Resection: This surgery involves removing only the uppermost part of the rectum.
  
  
• Sigmoidectomy: Lastly, we have sigmoidectomy. This surgery involves removing the lowest part of the colon. Depending on how much is taken, resection is usually done to connect the healthy parts together.   

I hope this sheds some light on the different types of surgery for Crohn’s and ulcerative colitis. If surgery is right for you, be sure to speak to your surgeons about which procedure you are having done and ways to prepare for it. With your newfound knowledge, you can speak confidently to your health care providers and understand what will happen during your specific surgery. Don’t be afraid to ask questions and advocate for what is right for you in particular. Keep fighting all you lovely IBD warriors! Sometimes life can get exponentially better after these surgical procedures. Don’t give up hope! 

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