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Large bowel resection

Before you agree to have an operation to treat large bowel disorders it is sensible to know all you can about it. The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your choice of treatment for large bowel disorders with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.
 
 

What is the problem?

You have a condition or disease in your large bowel, also known as your large intestine. The diseased area needs to be removed.
 

What is the large bowel?

This is the lower part of your bowel, beyond the appendix. It is about 140cm (5 feet) long. It starts in the right side of the tummy, where it is called the caecum. It runs in a large loop round the tummy and down into the pelvis as the colon. There it is called the rectum. It opens onto the skin at the anus. The large bowel is there to absorb water from the waste. The waste is runny when it enters the large bowel and becomes more solid after passing through it.
Large bowel resection

What has gone wrong?

There are a number of reasons why you may need an operation to have some of the large bowel removed.
 
  • A malignant tumour (carcinoma) is one of the most common reasons for bowel removal. This is a dangerous cancer that could spread throughout the body.  It may look like a cauliflower, a break in the bowel wall, called an ulcer, or just a narrowing in the bowel.
  • A tumour may be non-malignant (benign). These tumours consist of one or more polyps on stalks. If untreated they could become malignant. This is also very common.
  • Diverticular disease, where there are spasms of the bowel muscle with blowouts of the bowel lining, may also require this operation. The blowouts may form pus filled pockets, called abscesses, which can burst or cause the bowel to narrow.
  • There may be inflammation of the bowel lining, called inflammatory bowel disease or IBD.
  • The bowel may be twisted, called volvulus.
  • The blood supply to part of the bowel may be cut off or blocked, called an ischaemic bowel.
 
There could be other rarer conditions. Consult your specialist for details.
 
The diseased part of your large bowel has to be taken out, with a length of healthy bowel to limit the risk of the disease returning. The operation will vary, depending on which part of the bowel needs to be removed.
Large bowel resection 2
  • A hemicolectomy, is where half the colon is removed. This is fairly common. There is a right hemicolectomy and a left hemicolectomy.
  • The lowest part of the left colon near the rectum, is S shaped. It is called the sigmoid colon (the letter ‘S’ is sigma in Greek). Removing this part of the bowel is called a sigmoid colectomy.
  • Further down, the sigmoid colon becomes the rectum. Removing this part of the rectum is done from the front and is called an anterior resection of rectum.
  • Removing the whole of the large bowel, from the caecum down to the middle of the rectum, is called a total colectomy.
 
There are variations on all these operations. Each operation has its own special features.
Consult your specialist for details.
 
Nearly always, the remaining ends of the bowel can be joined together. If not, a new opening, called a stoma for waste from the bowel is made in the wall of your tummy. The waste runs into a special stick-on plastic bag.
 
If we use the colon to make the stoma, it is called a colostomy. If we use the small bowel, called the ileum, it is called an ileostomy.
 
Sometimes a temporary stoma is made, above a join in the bowel, until the join is thoroughly healed. The stoma would be closed off later, at a second smaller operation.
Large bowel resection 3

The aims

The aims are to remove the diseased part of your large bowel. If there is a tumour, nearby lymph glands are also taken out for examination under the microscope. The operation is usually done through a cut down the middle of your tummy (midline incision). An extra cut will be made if you need a stoma.
 

The benefits

The operation will rid you of the part of the bowel that is causing your symptoms. It will be designed to minimise the risk of the condition coming back.
 
For emergencies such as bowel obstruction, severe bleeding, a burst bowel, or a dead bowel, the operation should be life saving.
 

Are there any alternatives?

Tablets and medicines would not be helpful. Neither would x-ray and laser treatment.
 
Without an operation, x-ray treatment or chemotherapy for bowel cancer would not give such a good result.
 
Operations to bypass the diseased part of the bowel may be best if the condition would be dangerous to remove. An alternative is to make a stoma well above the condition.
 
If you are not fit enough for major surgery, simple trimming of a tumour with an electric knife (cautery) or a laser may give good relief from symptoms.
 
Sometimes part or all of the operation can be done using keyhole surgery. This would mean 4 or more inch (2.5cm) long cuts in the skin of the tummy wall, instead of one long one. A stoma may still be needed.
 

What if you do nothing?  

If you do nothing, your bowel symptoms will get worse.A tumour may completely block the bowel. It may spread into other parts of the tummy and pelvis, such as the bladder or vagina. It may press on the ureters, stopping the flow of urine from the kidneys to the bladder. It may press on the veins taking blood from the legs, causing them to swell. Malignant tumours are life threatening.
 
The other conditions are also serious and should not be left untreated.
 
Author: Mr Michael Edwards FRCSEng FRCSEd. Consultant general surgeon.
© Dumas Ltd 2006
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