Why have the surgery?
The large bowel, also known as the large intestine or colon, connects the small intestine to the anus. Normally, stool passes through the large bowel before leaving the body through the anus.
There are a few common reasons someone might have part of their large bowel removed. For example, someone who has a neoplasm, an abnormal mass of tissue that's sometimes cancerous, might have this surgery.
People who suffer from an inflammatory disease, such as diverticulitis, might have the surgery. Diverticulitis creates small, bulging pouches of the inner lining of the intestine that become inflamed and are generally in the colon. If a person develops serious complications from diverticulitis, such as a fistula, he or she might need surgery to correct the issue.
Additionally, if you have a perforation, or a hole that develops through the whole wall of your colon, your doctor might recommend removing part of it.
People who suffer from Crohn's disease, which causes inflammation or swelling in the digestive tract, or colitis, swelling of the colon, also might have the procedure. However, surgery does not eliminate Crohn's. People with Crohn's disease commonly need more than one operation because inflammation tends to return to the area next to where the diseased intestine was removed.
About two weeks before your surgery, your doctor will likely ask you to stop taking certain drugs. You will also be encouraged to eat high-fiber foods and drink plenty of water. A few days before surgery, you usually have to drink a laxative solution that helps clear out your colon. Your doctor also might recommend an enema.
To begin surgery, you will get anesthesia on the operating room table. You will usually have a breathing tube in your throat to help you breathe.
The way your surgery is performed will vary, depending on your surgeon and the technique that he or she uses. No one procedure is necessarily appropriate for all patients.
During an open surgery, your surgeon will make a cut in the middle of your abdomen that's about six or seven inches long. The medical team will place devices known as retractors inside of you to hold the abdominal wall open. Your surgeon will remove the diseased part of your colon. Most people have enough healthy large intestine to place the ends back together.
If you don't have enough healthy large intestine left, you will have a colostomy, a bag attached to the abdomen where the intestine drains. This isn't as common an approach as it used to be.
During a laparoscopic operation, your surgeon makes a few small cuts, rather than one large cut. The surgery itself is performed similarly, with a camera placed inside of you that helps your surgeon see where he or she needs to cut.
Does it hurt?
This is a major operation. However, the amount of pain you feel after surgery will depend on how extensive your surgery is. It will also vary person to person.
If you have an open surgery, you will be in a fair amount of pain for about three days. While in the hospital, nursing staff will likely give you pain medication through an IV and orally on a regular basis for a few days.
Patients who undergo laparoscopic surgery might not have as much abdominal pain, but it will depend on a variety of factors.
You will likely be prescribed pain medicine after leaving the hospital. It's up to you how often you take them, although you should follow the advice of your doctor when making decisions.
What are the risk factors?
Wound infection is a risk factor for this surgery, along with the typical risks of any surgery, which includes bleeding, infection, stroke and blood clots. Most wound infections clear up, but your doctor or nurse likely will have advice that will better ensure you don't suffer an infection.
You also could suffer injury to surrounding organs. Also, if you don't have good blood supply to your colon after surgery, it might not heal properly. And there's a slight risk that the area of your colon that's placed together after the diseased part has been excised could leak.
Other risks include bleeding inside your belly, bulging tissue through the surgical cut or scar tissue that forms and causes a blockage of your intestines.
What's the recovery time?
On average, people spend three to five days in the hospital, and then about a month recovering at home. You might recover more quickly through a laparoscopic surgery, but this point is debated among surgeons.
One thing people having this type of surgery worry about is whether they will need a colostomy. The number of people who need a colostomy after surgery has decreased over the past 20 years. Today, most people don't get one. And most patients who need a colostomy will only need it temporarily.
You should be able to shower after your skin wound heals, which takes about three days. You will be on light activity for about a month, although you will likely be allowed to walk for exercise. It's not recommended that you lift weights, do crunches or run for at least a month, although this will depend on your surgeon's preferences.
What's the follow-up?
You will see your doctor likely about two weeks after surgery and about a month later. You will likely have periodic doctor's visits after a month.
Whether you will have to undergo additional surgeries will depend on your diagnosis. It's important to ask your doctors and surgeons any questions you have. Because this is such a major surgery, it's important to be well-informed and research your options.
Sources: Dr. Gary Dunn; The National Cancer Institute; The National Library of Medicine; National Digestive Diseases Information Clearinghouse; the Mayo Clinic.