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Subtotal colectomy, also called partial colectomy, is a surgical procedure that involves removal of the diseased part of your colon and a small segment of the surrounding tissues followed by a connection between the healthy ends of your colon to allow proper waste removal from your body. It is recommended for the prevention and treatment of gastrointestinal diseases that affect your colon.

The colon, also called the large intestine, is a long tube-like organ at the end of your digestive tract. It consists of four parts: descending colon, ascending colon, transverse colon, and sigmoid colon. The sigmoid colon leads to the rectum. The colon is involved in the reabsorption of fluids and provides passage for waste removal from your body. 

What are the Indications for Subtotal Colectomy/ Partial Colectomy?

Subtotal colectomy is recommended for the treatment and prevention of gastrointestinal disorders such as:

  • Colon cancer 
  • Colorectal polyps associated with primary tumour
  • As a revision surgery for a failed colostomy: a surgery that involves the creation of an opening in the abdomen to remove waste
  • Uncontrolled gastric bleeding
  • Bowel obstruction: a blockage in the colon
  • Diverticulitis/ sigmoid diverticular disease
  • Crohn's disease

Pre-operative Preparation for Subtotal/Partial Colectomy

You will be asked to come for a health check-up wherein your blood tests, blood pressure and other health parameters will be checked.

Your surgeon will give you specific instructions before your surgery. These include:

  • Discontinue certain medications.
  • Avoid eating and drinking several hours to a day before your procedure.
  • Take an oral bowel preparation which includes a laxative solution that causes diarrhoea to expel stools and empty your colon.
  • Take antibiotics to suppress the natural bacteria in your colon.

Procedure for Subtotal Colectomy/ Partial Colectomy

The procedure for subtotal colectomy/ partial colectomy is performed in the following manner:

  • You will be placed on the operating table with the help of stirrups. 
  • Your surgeon may place you in the lithotomy position. In this, your legs are separated and raised at an angle of 90 degrees from your hips.
  • You will be administered general anaesthesia, and also intravenous antibiotics through a vein in your arm.

Subtotal colectomy can be performed in two different ways. This depends on your health and your surgeon’s discretion.

Open Subtotal Colectomy

In the open subtotal colectomy, a single long incision is made in your abdomen to access your colon. Your surgeon uses surgical tools to separate your colon from the surrounding tissues, then cuts and removes it. 

Laparoscopic Subtotal Colectomy/ Minimally Invasive Colectomy

In laparoscopic subtotal colectomy, a few small incisions are made in your abdomen.

  • Your surgeon introduces a laparoscope: a thin tube with a camera attached to one end to view the interior organs and locate the colon.
  • Special surgical tools are inserted through the other incisions which help in cutting and removing the part of the colon and the surrounding diseased tissues.

After the colon is repaired or removed, your surgeon will reconnect your digestive system to allow excretion of body waste. This can be done through any of these approaches:

  • The remaining healthy ends of your colon can be sutured together. This is called anastomosis.
  • An opening can be created in your abdomen through which either your colon or the small intestine can be attached. The opening is called a stoma. For this, you may be required to wear a small bag on the outside of your body over the stoma, either temporarily or permanently, to collect stools.

Post-operative Care after Subtotal Colectomy/ Partial Colectomy

You will be required to stay in the hospital for a few days to a week after your subtotal colectomy to monitor your recovery.

You will be put on a liquid diet first which will be slowly replaced with solid food. In the beginning, you may be given intravenous nutrition through veins in your arms. 

You may require some time to regain your bowel function, after which you can resume oral consumption of food.

What are the Risks and Complications of Subtotal/ Partial Colectomy?

Subtotal colectomy may be associated with the following risks and complications:

  • Infection
  • Blood clots in the legs (deep vein thrombosis) and the lungs (pulmonary embolism)
  • Bleeding
  • Injury to surrounding organs such as the small intestines and urinary bladder
  • Tears in the sutures that reconnect the remaining parts of your digestive system

What are the Benefits of Subtotal/Partial Colectomy?

Subtotal colectomy performed through laparoscopic approach minimizes pain and discomfort. It has a shorter downtime and a quicker recovery period.

However, depending on the complexity of your case, your surgeon may transition the laparoscopic surgery into an open colectomy. 

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