Bowel resection (colectomy): what happens, risks and recovery

The commonest reasons are bowel cancer, complicated diverticular disease and severe inflammatory bowel disease. A Borders leaflet on total colectomy explains that extensive colon disease causing diarrhoea, bleeding or general illness can be risky to leave, and that drugs alone sometimes cannot restore health. The NHS says part or all of the bowel around a cancer may need to be removed.

Not every bowel problem needs an operation. Diverticular disease is often treated with medication and diet, many colitis flares settle with drugs, and small polyps can sometimes be removed through a colonoscope instead. Surgery is planned when these routes are unlikely to work or when cancer is the diagnosis, and it becomes urgent for bleeding, a hole in the bowel or obstruction.

• Right hemicolectomy removes the right side of the colon; sigmoid colectomy removes the lower left portion.

• Subtotal or total colectomy removes most or all of the large bowel and usually involves an ileostomy.

• The extent of surgery follows the position and spread of the disease.

Pre-assessment checks your heart, lungs and medicines and often includes a meeting with an anaesthetist. The Borders leaflet asks people to stop smoking, lose weight if appropriate and review tablets such as the pill, HRT, aspirin or warfarin, and describes a light low-fibre diet for five days beforehand. Milton Keynes leaflets describe a strong laxative the day before for left-sided operations, with fasting rules given in the appointment letter.

If a stoma is possible, a stoma nurse usually sees you before surgery and marks a spot on your abdomen. Many hospitals run an enhanced recovery programme that adjusts preparation so that you eat, drink and move early, which the Milton Keynes leaflets say can shorten the stay.

The operation is done under general anaesthetic. In open surgery the surgeon works through a vertical cut; the leaflets describe about 15 cm in one and about 20 cm in another. In keyhole surgery three or four small cuts allow a camera and instruments in, and the surgeon may switch to open surgery if it proves necessary.

The diseased bowel is cut out and the two healthy ends are stitched or stapled together, called an anastomosis. If the join is judged vulnerable, or if the rectum is removed, a loop or end of small bowel is brought out as an ileostomy. You wake with a drip, perhaps a catheter, a drain and pain relief by epidural or a drip, and the physiotherapists aim to get you up the next day.

The leaflets list chest infection, blood clots, bleeding, wound infection, abscess, temporary slow bowel function and damage to nearby organs. A leak from the join is the complication surgeons watch for most closely: it is uncommon but serious and can mean a further operation or a stoma. Milton Keynes notes that people who are very overweight, who smoke or who have other medical conditions are at greater risk.

None of the pages retrieved quote percentages for a leak, so no figure is given here. Ask your surgeon for numbers specific to the operation you are having, and for how your own health changes them.

Food is reintroduced in stages once the bowel wakes up; the Borders leaflet says people are usually eating and drinking normally after about four to six days. Small frequent meals are advised at first. Fatigue can last: the same leaflet describes resting two or three times a day for a month or more, with a return to a normal routine after about three months.

The Borders leaflet suggests driving after about six to eight weeks, once you can make an emergency stop without wound pain, and work within about eight weeks for a light job or twelve for a heavy one. Milton Keynes warns against heavy lifting for six weeks. GOV.UK expects you to stay off the road until you can control the vehicle safely, and your insurer may impose its own rules.

Leaflets tell you to contact your GP or the ward if you have leaking or discharging wounds, a fever or shivering, burning when passing urine, a productive cough, pain in the legs or chest, new abdominal pain, bleeding from the back passage or vomiting. Severe abdominal pain with a swollen belly, breathlessness or chest pain call for 999 or the emergency department; NHS 111 can direct you when unsure.

• Which part of the bowel is being removed and why?

• Is keyhole surgery suitable for me, and how often is it converted to open?

• Is a stoma likely, and for how long?

• What is my expected stay and what does enhanced recovery involve here?

• Who do I contact if I am worried after discharge?

Cancer surgery in the NHS follows urgent referral pathways, so waiting for an operation is usually short relative to routine surgery. Private care can offer a choice of surgeon and room, though complex cases and emergencies may be transferred to units with intensive care facilities. If you are insured, check whether stoma supplies, nursing and follow-up scans are covered.