Colectomy

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Colectomy
Intervention
Colonic pseudomembranes low mag.jpg
Micrograph of pseudomembranous colitis, an indication for colectomy. H&E stain.
ICD-9-CM45.8, 45.73
MeSHD003082
 
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Colectomy
Intervention
Colonic pseudomembranes low mag.jpg
Micrograph of pseudomembranous colitis, an indication for colectomy. H&E stain.
ICD-9-CM45.8, 45.73
MeSHD003082

Colectomy consists of the surgical resection of any extent of the large intestine (colon). It is also an occasional term used to describe removing the entire large intestine along with the rectum, but the appropriate term is proctocolectomy, where the whole large intestine and rectum are removed.

Indications[edit]

Some of the most common indications for colectomy are:

Basic principles[edit]

Traditionally, colectomy is performed via an abdominal incision (laparotomy), though minimally invasive colectomy, by means of laparoscopy, is growing both in scope of indications and popularity, and is a well-established procedure as of 2006 in many medical centers. Recent experience has shown the feasibility of single port access colectomy,[1]

Resection of any part of the colon entails mobilization and ligation of the corresponding blood vessels. Lymphadenectomy is usually performed through excision of the fatty tissue adjacent to these vessels (mesocolon), in operations for colon cancer.

When the resection is complete, the surgeon has the option of immediately restoring the bowel, by stitching or stapling together both the cut ends (primary anastomosis), or creating a colostomy. Several factors are taken into account, including:

An anastomosis carries the risk of dehiscence (breakdown of the stitches), which can lead to contamination of the peritoneal cavity, peritonitis, sepsis and death. Colostomy is always safer, but places a societal, psychological and physical burden on the patient. The choice is by no means an easy one and is rife with controversy, being a frequent topic of heated debate among surgeons all over the world.

Types[edit]

Laparoscopic surgery[edit]

Today more than 40% of colon resections in United States are performed via laparoscopic approach.[4]

History[edit]

Sir William Arbuthnot-Lane was one of the early proponents of the usefulness of total colectomies, although his overuse of the procedure called the wisdom of the surgery into question.[5]

References[edit]

  1. ^ Bucher P, Pugin F, Morel P (October 2008). "Single port access laparoscopic right hemicolectomy". International Journal of Colorectal Disease 23 (10): 1013–6. doi:10.1007/s00384-008-0519-8. PMID 18607608. 
  2. ^ Enersen, Ole Daniel. "Lane's operation". whonamedit.com. Retrieved 2009-07-19. 
  3. ^ Oakley JR, Lavery IC, Fazio VW, Jagelman DG, Weakley FL, Easley K (June 1985). "The fate of the rectal stump after subtotal colectomy for ulcerative colitis". Diseases of the Colon and Rectum 28 (6): 394–6. doi:10.1007/BF02560219. PMID 4006633. 
  4. ^ Simorov A, Shaligram A, Shostrom V, Boilesen E, Thompson J, Oleynikov D (September 2012). "Laparoscopic colon resection trends in utilization and rate of conversion to open procedure: a national database review of academic medical centers". Annals of Surgery 256 (3): 462–8. doi:10.1097/SLA.0b013e3182657ec5. PMID 22868361. 
  5. ^ Lambert, Edward C. (1978). Modern medical mistakes. Indiana University Press. p. 18. ISBN 0-253-15425-1. 

External links[edit]