Sigmoid colectomy

Overview

Sigmoid colectomy is surgery to remove the sigmoid colon, which is the lower part of the colon that connects with the rectum. It is a type of colectomy that removes one part of the colon instead of the entire colon. It also may be called a sigmoidectomy, sigmoid colon resection or sigmoid resection.

After the sigmoid colon is removed, the surgeon usually joins the remaining colon to the upper rectum. This connection is called an anastomosis. Sometimes, especially in emergency or complex cases, the bowel can't be reconnected safely, or the new connection needs protection while it heals. In those cases, the surgeon may create an opening in the stomach area, called an ostomy, so stool can leave the body. An ostomy may be temporary or permanent.)

Types

Sigmoid colectomy can be done as minimally invasive or open surgery. Minimally invasive approaches such as laparoscopic or robotic surgery are preferred when they can be done safely.

Generally, minimally invasive surgery creates less damage to the body than open surgery. It's linked to less pain, a shorter hospital stay and fewer complications. The best choice depends on the health issue being treated. Other factors can include previous surgery or inflammation, the surgeon's experience, available equipment, and factors related to your health.

Minimally invasive surgery for diverticulitis and related complications is linked to a shorter hospital stay, less pain and faster short-term recovery than open surgery. This is true for both laparoscopic and robot-assisted sigmoid colectomy.

• Robot-assisted sigmoid colectomy. Robot-assisted sigmoid colectomy also is minimally invasive, but the surgeon controls robotic tools and a camera from a console.
  • The robotic surgery system provides a magnified, high-definition, 3D view of the surgical site.
  • The surgeon controls mechanical surgical arms with high precision and a wide range of motion while seated at a control center near the operating table.
  • The surgeon is assisted by a team.
• Laparoscopic sigmoid colectomy. The surgeon makes several small surgical cuts, called incisions, in the stomach area.
  • The surgeon places small tubes, a camera and surgical tools through the cuts.
  • The surgeon completes the surgery through these small incisions.
• Open sigmoid colectomy. The surgeon operates through a larger incision in the abdomen. Open surgery may be needed in an emergency or when inflammation, scar tissue or other factors make a minimally invasive operation unsafe.

Studies have found similar rates of anastomotic leak, stoma formation and death with robotic and laparoscopic surgery. Some studies also have found that robot-assisted sigmoid colectomy is linked to faster return of bowel function, a shorter hospital stay and a lower chance of changing to open surgery. These advantages may be especially important in more complex operations. The right approach depends on the condition being treated, how complex the operation is and the surgeon's experience.

Why it's done

Sigmoid colectomy may be recommended when disease in the sigmoid colon causes ongoing symptoms or complications. It also may be recommended when part of the colon needs to be removed for another reason.

• Diverticulitis. A scheduled sigmoid colectomy, also called an elective sigmoid colectomy, may be considered for repeated attacks, ongoing pain or bowel symptoms that affect quality of life. The decision is based on your situation, not only on a set number of attacks.
• Complicated diverticulitis. Surgery may be considered after treatment of a diverticular abscess. It is usually recommended when diverticulitis causes an irregular passageway, called a fistula, between the bowel and another organ in the body. It also may be recommended when diverticulitis causes a narrowing, called a stricture, that causes symptoms. A blockage, called an obstruction, also may lead to surgery.
• Severe acute diverticulitis. Emergency surgery may be needed when there is widespread infection in the abdomen or when treatment without surgery does not work.
• Colon cancer. Sigmoid colectomy may be used to sigmoid colon cancer when the operation can remove the tumor and the surrounding tissue needed for cancer treatment.
• Sigmoid volvulus. A sigmoid volvulus happens when the sigmoid colon twists and causes a blockage. Surgery may be recommended after the bowel is untwisted because the twisting can happen again. Urgent surgery is needed when the bowel is damaged or can't be untwisted safely.

For diverticulitis, you and your care team review and talk about the possible benefits and risks of surgery. You also need to consider the chance that some symptoms may continue afterward. Making the decision with your care team is especially important when surgery is elective.

Risks

Sigmoid colectomy can cause complications. Risks include:

• Anastomotic leak. The new connection between the colon and rectum can leak. A leak may require antibiotics, drainage, another operation or an ostomy.
• Infection. Infection can occur at the surgical cut or inside the abdomen.
• Injury to nearby structures. Injury to the ureter, bladder or other nearby tissues is not common. The surgeon identifies and protects nearby organs and tissues during the operation.
• Ileus. The bowel can temporarily slow down or stop moving after surgery. This can delay eating and the bowel resuming work.
• Blood clots. Surgery increases the risk of blood clots in the legs or lungs. The healthcare team uses medicines and mechanical measures to lower this risk.
• Ostomy. A temporary or permanent ostomy, such as an ileostomy or colostomy, may be needed if the bowel can't be safely reconnected or if an anastomosis needs protection.
• Change to open surgery. A laparoscopic or robotic surgery sometimes needs to change to an open surgery if the surgeon can't continue safely through the small cuts. Whether open surgery is the best choice depends on factors such as inflammation, fistulas, scar tissue and how complex the operation is.

The healthcare team takes steps to lower risks. These may include antibiotics to prevent infection and measures to prevent blood clots. During surgery, the team also identifies nearby structures, checks blood flow to the bowel and tests the anastomosis for leaks.

How you prepare

• Your surgical team will give you instructions based on why you are having surgery and the type of surgery planned. Before surgery, you may need treatment for other health conditions or nutrition concerns. If you smoke, stop at least four weeks before surgery. If you drink large amounts of alcohol, stop drinking about four weeks before surgery.
• Your surgical team will tell you if you need bowel preparation before surgery. For some planned minimally invasive surgeries, preparation may include medicine to empty the colon and antibiotics taken by mouth. Practices differ, so follow your team's exact instructions.
• Bowel preparation can cause discomfort, fluid loss and dehydration. Follow your care team's instructions about what you may drink and when to stop eating or drinking before surgery.
• If your care team thinks you may need an ostomy, the team may arrange a visit with an ostomy nurse before surgery. The nurse can explain how an ostomy works and mark a place on your stomach area for the stoma.

What you can expect

What happens during and after sigmoid colectomy depends on the type of surgery. It also depends on whether surgery is planned or an emergency.

Before the procedure

• The healthcare team reviews the plan and prepares you before the surgery. Anesthesia is used during the operation, and you are closely monitored. You get antibiotics through a vein before surgery begins. The team also takes steps to reduce the risk of blood clots. A tube, called a urinary catheter, may be placed to drain your bladder during surgery.
• For a laparoscopic or robotic operation, you are positioned so the surgeon can reach the left side of the colon and pelvis. The surgeon makes several small cuts in your stomach area for the camera and surgical tools. In robotic surgery, the surgeon controls the camera and tools from a console.

During the procedure

The exact steps vary. A minimally invasive sigmoid colectomy usually includes these steps:

• The surgeon removes the diseased part of the sigmoid colon while protecting nearby structures. For diverticular disease, the surgeon removes the diseased part and creates the connection in healthy bowel. How much bowel is removed can vary when the reason for surgery is cancer.
• When it is medically safe, the surgeon joins the remaining colon to the upper rectum. This connection is called an anastomosis. Some sigmoid resections extend to the upper rectum. If your care team uses a term such as anterior resection, ask which parts of the colon and rectum are planned for removal and where the bowel will be reconnected.
• If the bowel can't be safely reconnected or the connection needs protection, the surgeon may create an ostomy. The ostomy may be temporary or permanent, depending on the reason for surgery and what the surgeon finds during the operation.

Sigmoid colectomy does not take the same amount of time for everyone. Surgery time depends on the type of surgery and how complex it is. Your surgeon can give you an estimate.

After the procedure

After surgery, the healthcare team watches your vital signs, pain, fluid balance and return of bowel function. Enhanced-recovery programs combine several methods to help you recover. These include pain treatment, early nutrition and early movement.

• Eating and drinking. Oral intake usually resumes within hours after colorectal surgery. Enhanced-recovery programs encourage eating soon after surgery, as tolerated. Your care team tells you when and what you can eat.
• Walking. You are encouraged to get out of bed and move on the day of surgery. You gradually move more during your hospital stay.
• Pain control. Your care team uses several methods to treat pain while limiting side effects that can slow recovery.
• Urinary catheter. After minimally invasive sigmoid colectomy without complications, the urinary catheter is usually removed within 24 hours.
• Hospital stay. How long you stay in the hospital depends on the operation and your recovery. After a straightforward planned minimally invasive sigmoid colectomy, some people may go home the same day or after one night. Others need a few days in the hospital, especially after a more complex operation or if complications occur. Your surgical team can tell you what to expect.

Recovery at home

• There is no single recovery timeline that applies to everyone after sigmoid colectomy.
• Recovery depends on whether surgery is open or minimally invasive, whether it is planned or urgent, the condition being treated, and whether complications occur.
• Your surgical team can give you a more specific timeline for returning to work, lifting and regular activities.
• Bowel habits may be different for a while, and some changes can last. You may have diarrhea, a sudden need to have a bowel movement or trouble emptying your bowel. Tell your healthcare team if symptoms continue or get in the way of daily life.
• If bowel symptoms continue, ask your care team whether changes to fiber or fluids may help. Your needs depend on your symptoms and medical situation.

Results

The goal of sigmoid colectomy depends on why you need surgery. Surgery may remove a part damaged by diverticulitis, relieve a blockage or fistula, prevent the sigmoid colon from twisting again, or remove a cancer in the sigmoid colon.

Elective sigmoid resection greatly lowers the chance of future attacks of diverticulitis, especially when symptoms affect quality of life. Diverticulitis can still return after surgery, but recurrence is not common.

Some people have ongoing or new digestive symptoms after colorectal surgery. If symptoms continue, your healthcare team can recommend treatment based on the cause.