Perhaps you or someone you know has been told by a doctor that they need to have a surgery called a 'proctocolectomy'. It's normal to feel a little scared and nervous when you hear this word. You probably have a lot of questions in your head, like "What is this surgery? Why do I need this? What will my life be like after this?" Don't worry. Let's talk about all this in a very simple, step-by-step way, just like you would talk to a friend.
Simply put, what is Proctocolectomy?
A proctocolectomy is a surgical procedure that removes part or all of your large intestine (colon) and rectum.
Now let's explain this a little more. Our digestive system has a part called the large intestine. It includes three parts: the colon, the rectum, and the anus. Think of it as a long tube.
- Colon: This is the largest part of this tube. It is here that the waste products left after we digest the food we eat are absorbed and transformed into a solid form, called stool.
- Rectum: This is the short part of the large intestine that temporarily stores stool before it leaves the body.
- Anus: This is the opening through which feces exit the body.
In proctocolectomy surgery, "procto" refers to the rectum and "colectomy" refers to the removal of the colon. So , proctocolectomy is a surgery that removes both the colon and rectum. Sometimes, if only the colon is removed, it is called a colectomy. If only the rectum is removed, it is called a proctectomy. Do you understand the difference?
Why do you need to have this kind of surgery?
Doctors only recommend major surgery like this if there is a serious reason. This surgery is usually performed if a condition in the colon or rectum prevents the colon or rectum from functioning properly, or if the condition is life-threatening.
Here are some of the main reasons:
- Inflammatory Bowel Diseases (IBD): These are conditions that cause long-term inflammation and sores in the intestines. Ulcerative Colitis and Crohn's Disease are the main examples. Some people have to have the diseased parts of their intestines removed when they can't be controlled with medication.
- Colorectal cancer and precancerous conditions: When cancerous cells develop in the colon or rectum, or when polyps that have the potential to become cancerous develop (conditions such as Familial Adenomatous Polyposis ), the best treatment is to completely remove the diseased areas.
- Other reasons:
- Ischemia occurs when blood flow to the intestine is lost and tissue dies.
- Complicated Diverticulitis conditions.
- Traumatic injury to the intestine due to a serious accident.
- Severe constipation that cannot be cured with medication.
The most important thing is that this surgery is being done to save your life and give you a better, more comfortable life.
How do you pass stool after surgery?
This is the biggest question on everyone's mind. After both the colon and rectum are removed, the normal path for stool to exit is gone. How do you defecate then?
The answer to this depends on the type of proctocolectomy you are having. Your doctor will determine the type of surgery that is best for you based on your medical condition and the reason for the surgery. Let's take a look at the types.
What are the types of proctocolectomy surgeries?
There are several ways to perform this surgery. Your doctor will choose the method that is best for you.
| Type of surgery | A simple explanation of what is happening |
|---|---|
| Proctocolectomy with Ileostomy (with ileostomy) | In this procedure, the colon and rectum are completely removed. Then, the last part of the small intestine, called the ileum , is brought out through the skin of the abdomen and an opening (stoma) is created. The stool comes out through this opening. A bag is attached to the outside of it. Some people have to wear this permanently, while others only temporarily. |
| Restorative Proctocolectomy with Ileoanal Pouch (Replacement surgery) | In this procedure, the colon and rectum are also removed, but the anus is left in place. Next, an internal pouch is created from the end of the small intestine (ileum). This pouch, like the original rectum, helps to hold stool for a while. This pouch is then connected to the anus (ileoanal anastomosis) . This allows you to have normal bowel movements. This can be done in one or two surgeries. |
| Subtotal Proctocolectomy (removing a part) | This involves leaving a portion of the colon or rectum. For example, a Hartmann's procedure removes only the last part of the colon (sigmoid colon) and the rectum. If this is done, the remaining healthy parts of the colon can be reconnected (anastomosis) , so you can have normal bowel movements. Sometimes a temporary colostomy (opening of the colon) may be placed until the wound heals. |
What should you do before surgery?
If it's not an emergency surgery, you'll have plenty of time to prepare.
- A few weeks in advance: Talk to your doctor about the surgery, its types, risks, and benefits. Ask any questions you have.
- Two weeks before: If you are taking blood thinners, your doctor will advise you to stop or reduce them. Also, try to keep your bowels healthy by eating lots of fiber and drinking plenty of water during this time.
- 24 hours before: The day before surgery, you will be given a bowel prep to completely clean out your intestines. You will only be allowed to drink clear liquids, such as water and soup, that day. You may also be given antibiotics to prevent infection after surgery.
What happens during the surgery?
When you go to the hospital, you will be put in a surgical gown. An IV catheter will be inserted into your vein and you will be given saline and any necessary medications. You will then be taken to the operating room.
The anesthesiologist will put you under general anesthesia. You will not feel anything during the surgery. You will be connected to a machine (ventilator) to help you breathe.
Open Surgery? Laparoscopic Surgery?
Nowadays, most proctocolectomy surgeries are performed laparoscopically . This means that instead of making a large incision in the abdomen, the surgery is performed through a few small holes, through which a camera and very small surgical instruments are inserted. This method allows for faster recovery, less pain, and smaller scars. However, this method is not suitable for everyone. In complex or emergency cases, traditional open surgery is required.
During the operation, the surgeon carefully removes the diseased colon and rectum. Then, as discussed earlier, an ileostomy/colostomy is created or the intestines are reconnected (anastomosis).
What happens after the surgery?
After the surgery, you will need to stay in the hospital for about a week. During this time, you will be gradually introduced to liquid foods and then gradually introduced to solid foods.
If you have an ostomy (ileostomy/colostomy), a Wound Ostomy Continence Nurse (WOCN) will help you. They will teach you everything you need to know about using the ostomy bag and keeping your stoma (opening in your stomach) clean. Even though it is a temporary ostomy, it will take several months before you can discuss the next steps (removing it or creating an internal pouch) with your doctor.
What are the risks and complications associated with this surgery?
As with any surgery, there are some risks involved, but these are very rare.
| Type of complication | Possible things |
|---|---|
| Common risks of surgery | Reactions to anesthesia, damage to surrounding organs, excessive bleeding, and infection. |
| Surgery-specific complications | - Intestinal obstruction: Scar tissue from surgery can cause the intestines to become blocked. - Nerve damage: Anal surgery can damage the nerves involved in sexual function or urination. These usually heal over time. |
| Ostomy (Ileostomy/Colostomy) Related Problems | - Skin allergies: The skin around the stoma can become red and sore from contact with stool. - Changes in the stoma: The stoma may sink inward from the skin level (retraction) or protrude too much (prolapse). - Phantom Rectum: Even if the rectum is removed, some people may still feel the urge to defecate. This will lessen over time. |
| Internal Pouch Related Problems | - Pouchitis: Inflammation of the inside of the newly created pouch. This is treated with antibiotics. - Anastomotic leak: A leak at the site of the intestinal connection. This is a rare but serious condition. - Temporary difficulty controlling bowel movements: In the early stages, it may be difficult to control bowel movements due to weak anal muscles. This will improve with exercise and time. |
How is the aftercare after surgery?
It can take several months to fully heal. During this time, it is very important to follow your doctor's instructions carefully.
- Wound care: The doctor or nurse will teach you how to clean the wound and change the dressing.
- Ostomy care: You will learn how to empty the ostomy bag several times a day and keep the skin around the stoma clean.
- Food: After you get home from the hospital, gradually introduce solid foods. Instead of eating a large meal at once, eat small amounts several times a day. Chew your food well.
- Hydration: This is very important. Since a large part of your colon has been removed, your body will absorb less water. So it's essential to drink plenty of water and fluids throughout the day.
When to see a doctor
After returning home from surgery, if you have any of the following symptoms , call your doctor immediately or go to the nearest hospital's Emergency Department (ETU).
- Symptoms of intestinal obstruction include constipation, abdominal pain, bloating, and nausea.
- Signs of an infectious condition such as severe abdominal pain, swelling, pus draining from the wound, and fever.
A proctocolectomy is a major operation. But it can help you get relief from a long-term condition and improve your quality of life. With today's technology, ostomy bags can be made invisible and very comfortable. Talk to your doctor about your options and make the decision that's best for you.
Take-Home Message
- A proctocolectomy is a life-saving surgery that removes the colon and rectum. It is often performed for serious conditions such as IBD and cancer.
- The method of bowel evacuation after surgery will vary. There are options such as an ileostomy (external pouch) or an internal pouch (internal pouch).
- Talk openly with your doctor about the type of surgery that is right for you and get all your questions answered.
- It takes time to recover from surgery. During this time, follow your doctor's instructions carefully, especially regarding food and fluid intake.
- Although living with an ostomy may seem challenging at first, with the right training and support, it can be a part of normal life.
- If you experience any unusual symptoms (severe pain, fever, nausea) after surgery, seek medical advice immediately.
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