COLECTOMY
A colectomy is a surgical procedure used to remove all or part of your colon. The colon, also known as the large intestine, is a long hollow tube at the end of the digestive tract where the body makes and stores stool. There are several types of colectomy operations:
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Total colectomy: involves removing the entire colon.
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Partial colectomy: involves removing part of the colon and can be further categorized by the specific segment removed (left or right hemicolectomy, sigmoid colectomy).
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Hemicolectomy: involves removing the right or left portion of your colon.
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Proctocolectomy: involves removing both the colon and rectum.
A colectomy can be necessary to treat or prevent diseases and conditions that affect your colon, such as:
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Colon or rectal cancer
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Inflammatory bowel diseases, such as Crohn's disease or ulcerative colitis
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Diverticulitis, a condition in which small, bulging pouches (diverticula) in the digestive tract become inflamed or infected
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Bowel obstruction
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Preventive surgery to remove precancerous polyps
The surgery can be performed in two ways, depending on your condition:
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Open colectomy: Your surgeon makes a long incision in your abdomen to remove part of the colon.
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Laparoscopic colectomy: Your surgeon performs the operation through several small incisions in the abdomen.
Colectomies are often done laparoscopically or robotically
After a colectomy, the surgeon attaches the remaining parts of the digestive system to allow waste to leave the body. This may involve creating an opening (stoma) on the outside of the body for waste to pass through, a procedure known as an ostomy. But this is often temporary and can be reversed later.
Anesthetic Implications for Colectomy
Anesthesia type: General anesthesia. +/- epidural. Regional block
Airway: ETT
Preoperative:
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The patient may have had a bowel prep and may be dehydrated
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Patients may have dehydration, electrolyte abnormalities, or anemia
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Patients with IBD may have inflammatory lung involvement
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Patients with IBD may have hepatic involvement and altered drug metabolism
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In case of bowel obstruction, RSI induction is advisable
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Full stomach precautions if acute abdomen
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Hemodynamic instability is more common in cases of sepsis and peritonitis
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Vomiting and gastric suctioning can cause metabolic alkalosis
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Hemoconcentration from dehydration may mask anemia in these patients
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Low albumin levels affect the free drugs in the blood
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GI malabsorption can impair coagulation system.
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Avoid nitrous oxide
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If there's a bowel obstruction and abdominal distension, it might limit the movement of the diaphragm. This can negatively influence the functional residual capacity (FRC)
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There's a risk of metabolic acidosis in patients who are experiencing diarrhea or undergoing bowel preparation
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Consider pre-hydration measures for hypovolemic patients
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ERAS protocol
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Consider preop acetaminophen/gabapentin /celecoxib
Intraoperative:
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A nasogastric tube may be placed at the surgeon's request (for distention or vomiting)
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Muscle relaxants are administered
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Large fluid shifts are common (blood loss, third-spacing, insensible losses)
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Goal directed fluid therapy
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Manipulation of necrotic bowel or bowel rupture can cause hemodynamic instability
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Position: Supine with both arms tucked to sides. May need steep Trendelenburg, reverse Trendelenburg, or lithotomy
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EBL depends on pathology, complexity and patient factors
Postoperative:
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Multimodal pain management
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Epidural anesthesia
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PONV prophylaxis
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May require ICU
Complications:
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Small bowel obstruction (SBO)
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Anastomotic leak
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Splenic injury
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Injuries to bowel or ureters
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Infection
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Bleeding
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Wound dehiscence
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Sepsis
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Septic shock
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Aspiration of gastric contents
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Atelectasis
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VTE
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PONV
Sources:
Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice.
Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.).
Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.