Colon Surgery: Complications and Harmful Consequences

Introduction:

Ulcerative colitis (UC) is a chronic disease with significant morbidity that requires significant utilization of health-care resources. Ulcerative colitis is a disease in which inflammation of the colon occurs. The prevalence of ulcerative colitis has increased by 21 percent since 2001 in the United States. The natural history of ulcerative colitis suggests that many patients eventually require surgery for this disease. The urgency of the surgery or removal of colon (colectomy) depends upon the extent of disease and year of the diagnosis. According to the calculations made by the American Gastroenterological Association, the total direct cost of treating ulcerative colitis in the United States is worth $404.9 million. Colon surgery is performed in case of colon cancer, inflammatory bowel disease, and diverticulitis. Infections, bleeding, bowel construction, pouch dysfunctions, pouchitis, and sexual dysfunction are some complications of colon surgery. All patients that undergo surgery do not develop these complications. Colon surgery is a life-saving procedure.

What Is Colon Surgery?

Colon surgery, also known as colectomy, is a surgical procedure that involves removing all or part of the colon (large intestine). This procedure is usually done to treat conditions such as colon cancer, inflammatory bowel disease, diverticulitis, or blockages in the colon.

There are two types of colon surgery:

• Open Colectomy: This is a traditional surgical approach where the surgeon makes a large incision in the abdomen to access the colon.

• Laparoscopic Colectomy: This is a minimally invasive approach where the surgeon makes several small incisions in the abdomen and uses a special camera and instruments to remove the affected portion of the colon.

During the colectomy procedure, the surgeon removes the affected portion of the colon and may also remove nearby lymph nodes to test for cancer. The remaining portions of the colon are then connected back together, either by stitching them together or using a special surgical staple. After the surgery, the patient may need to stay in the hospital for a few days to recover. They may also need to follow a special diet and take medication to manage pain and prevent infections.

Why Is Colon Surgery Done?

The type of colectomy and extent of the surgery will depend on the underlying condition and its severity. In some cases, only a portion of the colon may need to be removed. While in others, the entire colon may need to be removed. It is important to discuss the potential risks and benefits of colon surgery with a healthcare professional before making any decisions about treatment.

Colon surgery, or colectomy, may be recommended for individuals with various conditions affecting the large intestine. Some of the common reasons for performing colon surgery include:

• Colon Cancer: Colectomy may be necessary to remove cancerous tumors from the colon.

• Inflammatory Bowel Disease (IBD): Colectomy may be recommended for individuals with severe cases of ulcerative colitis or Crohn's disease that do not respond to medication or other treatments.

• Diverticulitis: Colectomy may be necessary for individuals with severe, recurring diverticulitis that does not respond to other treatments.

• Colonic Obstruction: Colectomy may be necessary if there is a blockage in the colon that cannot be resolved by other means.

• Trauma or Injury: Colectomy may be necessary if the colon is damaged due to trauma or injury.

• Familial Adenomatous Polyposis (FAP): Colectomy may be recommended for individuals with this inherited condition, which causes the development of numerous polyps in the colon that can lead to colon cancer.

What Are the Harmful Consequences of Colon Surgery?

Colectomy, or the surgical removal of all or part of the colon, can be a lifesaving procedure for individuals with conditions such as colon cancer, inflammatory bowel disease, or diverticulitis. However, like any surgical procedure, colectomy carries certain risks and potential complications.

The following are the harmful consequences of colon surgery:

• Infection: Any surgery carries a risk of infection. This can range from a minor skin infection to a more serious infection of the surgical site, the blood, or other organs.

• Bleeding: During the colectomy procedure, bleeding can occur either during or after surgery. In some cases, further surgery may be required to stop the bleeding.

• Bowel Obstruction: Sometimes, scar tissue can form in the area where the colon was removed, leading to a bowel obstruction. This can cause abdominal pain, bloating, and constipation.

• Anastomotic Leak: This occurs when there is a leakage from the connection between the remaining portions of the colon or rectum and the anus. This can lead to infection, abscess formation, and in some cases, further surgery.

• Adhesions: After surgery, scar tissue can form around the surgical site. This scar tissue can cause the intestine to become twisted or kinked, leading to blockages or pain.

• Diarrhea and Bowel Dysfunction: Colectomy can cause changes in bowel movements, including diarrhea, constipation, or a combination of both. This can be temporary or long-term.

• Sexual Dysfunction: Colectomy can sometimes affect sexual function in men and women, leading to issues with erectile dysfunction or sexual arousal.

What Are the Complications of the Colectomy?

There are some early and late complications of the colectomy.

1. Early Complications

These complications occurs within 30 days of colectomy:

• Anastomotic leak (a condition in which the content of the gut leaks).

• Wound dehiscence (a condition in which surgery fails and wounds reopen).

• Pelvis sepsis (a condition in which the blood pressure fails and the body organs fail to receive sufficient oxygen).

• Perianal fistula (a condition in which tunnel develops inside the anus).

• Abscess formation (abscess is the collection of pus caused by bacteria).

• Anastomotic stricture which requires intervention (after surgery new connection between the stomach pouch and the small intestine may narrow).

• Small bowel obstruction (an obstruction in the small and large intestine).

• Infectious complications (urosepsis, pneumonia, and bacteremia).

2. Late Complications

These complications occurs after 30 days, but within 6 months of colectomy:

• Pouch dysfunction (pouchitis is an inflammation of the lining of a pouch that is surgically created in the treatment of ulcerative colitis and certain other diseases and causes pouch dysfunction).

• Pouch removal (a condition in which a pouch is removed).

• Pouchitis.

• Anastomotic leak.

• Wound dehiscence.

• Pelvic sepsis.

• Perianal fistula.

• Abscess formation.

• Anastomotic strictures requiring intervention.

• Small bowel obstruction.

Conclusion:

Colectomy can be a life-saving procedure for individuals with certain colon conditions. However, like any other surgery, it carries certain risks and potential complications. It is important to note that while these complications can occur, they are relatively rare, and many people who undergo colectomy experience no complications at all. It is important to discuss the potential risks and benefits of the procedure with a healthcare professional before making any decisions about treatment.