What is a total colectomy / excision of rectum and ileoanal reservoir – nonmalignant?

Dr. Coolen - Diagram showing parts of the bowel

Diagram showing parts of the bowel

A colectomy is the complete removal of the large bowel through a cut in the abdomen and then the formation of a pouch between the small bowel and anus to replace the rectum. A piece of the small bowel may be brought out through the wall of the abdomen as an ileostomy. This is usually temporary and allows the bowel contents to drain into a bag worn over the ileostomy until the bowel and pouch have healed.

My anaesthetic

This procedure will require an anaesthetic

What are the risks of this specific procedure?

There are risks and complications with this procedure. They include but are not limited to the

General risks:

  • Infection can occur, requiring antibiotics and further treatment.
  • Bleeding could occur and may require a return to the operating room. Bleeding is more common if you have been taking blood thinning drugs such as Warfarin, Asprin, Clopidogrel (Plavix or Iscover) or Dipyridamole (Persantin or Asasantin).
  • Small areas of the lung can collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
  • Increased risk in obese people of wound infection, chest infection, heart and lung complications, and thrombosis.
  • Heart attack or stroke could occur due to the strain on the heart.
  • Blood clot in the leg (DVT) causing pain and swelling. In rare cases part of the clot may break off and go to the lungs.
  • Death as a result of this procedure is possible.

Specific risks:

  • Leakage where the bowel was stitched or stapled back together for 1 in 22 to 1 in 20 people. This may need further surgery.
  • The ileo-anal pouch may become inflamed, causing bleeding and discharge. This may require drug therapy.
  • Bowel doesn’t function properly for 1 in 13 people, causing abdominal bloating, vomiting and cramps. Treatment is to deflate the bowel with suction, using a tube via the nose into the stomach or intestine. Further surgery may be required.
  • Excess fluid loss from the stoma, which may be replaced with fluids given via a drip into the vein.
  • The wound may become infected for 1 in 9 people. This is usually treated with antibiotics given via the drip or orally.
  • Urinary tract infection due to bacteria entering the urethra and bladder and causing inflammation and infection for 1 in 20 people. Mild cases may clear up without treatment. Antibiotics may be used to control the infection.
  • Infection could develop in the abdominal cavity. This may form an abscess that may need surgical drainage and antibiotics.
  • The blood supply to the stoma may fail and cause damage to the bowel. This may need further surgery.
  • Stoma prolapse – some of the bowel protrudes past the skin. For minor prolapses no treatment is needed. For more severe cases further surgery may be needed.
  • Parastomal hernia – the bowel pushes through a weak point in the muscle wall, causing pain and bulging of the skin near the stoma. Minor hernias may need no treatment, larger hernias may require further surgery.
  • Local skin irritation – reddening of the skin and a rash may occur in reaction to the glue used to attach the stoma bag. This is usually treated by changing the type of stoma bag.
  • Bleeding into the wound for 1 in 35 to 1 in 28 people. This will be monitored via the wound drain. A blood transfusion may be needed to replace blood loss. Further surgery may be necessary.
  • Damage to the ureter – the tube bringing the urine from the kidney to the bladder happens rarely. This may need further surgery.
  • A urinary bladder problem in which there is abnormal emptying of the bladder. It may empty without control or may not empty at all. It may be treated by inserting a tube (catheter) into the bladder to drain the urine away.
  • In some people, healing of the wound may be abnormal and the wound can be thickened, red and painful.
  • Sexual Dysfunction due to nerve damage which may be temporary or permanent. In men, this can be the inability to have and/ or maintain an erection. It may also cause inability to ejaculate.
  • Treatment may include counselling and medication. In women, it can cause pain during or after intercourse. Counselling and use of water-soluble lubrication during intercourse may help.
  • Change in bowel functioning. The stools may be much looser, smaller and more frequent. There may be leakage of faeces particularly at night. In most cases, stool frequency lessens and continence improves with time, without specific treatment.
  • Sometimes adhesions (bands of scar tissue) develop in the abdominal cavity and the bowel may block – this is a short and long-term complication, which may require further surgery.
  • Death due to surgery. The rate of risk is estimated at 1 in 16 to 1 in 20 people.