Colectomy

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Colectomy consists of the surgical resection of any extent of the large bowel.

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.

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 together both the cut ends (primary anastomosis), or creating a colostomy. Several factors are taken into account, including: * Circumstances of the operation (elective vs emergency); * Disease being treated; * Acute physiological state of the patient; * Impact of living with a colostomy, albeit temporarily; * Use of a specific preoperative regimen of low-residue diet and laxatives (so-called "bowel prep").

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.