Total abdominal colectomy is the removal of the large intestine from the lowest part of the small intestine (ileum) to the rectum. After it is removed, the end of the small intestine is sewn to the rectum.

Ileorectal anastomosis; Subtotal colectomy

You will receive general anesthesia before your surgery. You will be asleep and unable to feel pain.

During the surgery:

• Your surgeon will make a surgical cut in your belly.
• The surgeon will remove your large intestine. Your rectum and anus will be left in place.
• Your surgeon will sew the end of your small intestine to your rectum.

Today, some surgeons perform this operation using a camera. The surgery is done with a few small surgical cuts, and sometimes a larger cut big enough for the surgeon to assist with the operation. The advantages of this surgery, which is called laparoscopy, are a faster recovery, less pain, and only a few small cuts.

The procedure is done for people who have:

• Crohn disease that has not spread to the rectum or the anus
• Some colon cancer tumors, when the rectum is not affected
• Severe constipation, called colonic inertia

Total abdominal colectomy is most often safe. Your risk depends on your general overall health. Ask your health care provider about these possible complications.

Risks of anesthesia and surgery in general are:

• Reactions to medicines
• Breathing problems
• Bleeding, blood clots
• Infection

Risks of having this surgery are:

• Bleeding inside your belly.
• Damage to nearby organs in the body.
• Scar tissue may form in the belly and cause a blockage of the small intestine (this scar tissue is often called adhesions).
• Leakage of stool from the connection between the small intestine and the rectum. This can cause an infection or abscess.
• Scarring of the connection between the small intestine and the rectum. This can cause a blockage of the intestine.
• Wound breaking open.
• Wound infection.

Always tell your provider what medicines you are taking, even medicines, supplements, or herbs you bought without a prescription. Ask which medicines you should still take on the day of your surgery.

Before you have surgery, talk with your provider about the following things:

• Intimacy and sexuality
• Pregnancy
• Sports
• Work

During the 2 weeks before your surgery:

• Two weeks before surgery, you may be asked to stop taking medicines that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), Naprosyn (Aleve, Naproxen), and others.
• Ask which medicines you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your provider for help.
• Always let your provider know about any cold, flu, fever, herpes breakout, or other illnesses you may have before your surgery.

The day before your surgery:

• Follow your provider's instructions about what to eat and drink. You may be asked to drink only clear liquids, such as broth, clear juice, and water at some point during the day.
• You will be told when to stop eating and drinking. You may be asked to stop eating solid food after midnight, but you might be able to have clear liquids up until 2 hours before surgery.
• Your provider may ask you to use enemas or laxatives to clear out your intestines. You will get instructions on how to use them.

On the day of your surgery:

• Take the medicines you were told to take with a small sip of water.
• You will be told when to arrive at the hospital.

You will be in the hospital for 3 to 7 days. By the second day, you will probably be able to drink clear liquids. You will slowly be able to add thicker fluids and then soft foods to your diet as your bowels begin to work again.

After this procedure, you can expect to have 4 to 6 bowel movements a day. You may need more surgery and an ileostomy if you have Crohn disease and it spreads to your rectum.

Most people who have this surgery recover fully. They are able to do most of the activities they were doing before their surgery. This includes most sports, travel, gardening, hiking, and other outdoor activities, and most types of work.

Galandiuk S, Netz U, Morpurgo E, Tosato SM, Abu-Freha N, Ellis CT. Colon and rectum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 52.

Raza A, Araghizadeh F. Ileostomies, colostomies, pouches, and anastomoses. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 117.