Total abdominal colectomy

You will receive general anesthesia before your surgery. You will be asleep and unable to feel pain.

During the surgery:

• Your surgeon will make a surgical cut in your belly.
• Your surgeon will remove your large intestine. Your rectum and anus will be left in place.
• Your surgeon will connect the end of your small intestine to your rectum.
• Your abdomen will be closed, and your skin from the incision may be left open or closed.

Today, some surgeons perform this operation using a camera that is part of an instrument called a laparoscope. The surgery is done with a few small surgical cuts, and sometimes a larger cut so that the surgeon can also work by hand. The advantages of this surgery, which is called laparoscopy, are a faster recovery, less pain, and only a few small cuts.

The procedure is done for people who have:

• Crohn disease that has not spread to the rectum or the anus
• Some colon cancer tumors, when the rectum is not affected
• Severe constipation, called colonic inertia
• Severe bleeding of the lower gastrointestinal (GI) tract
• Poor blood supply to the colon, known as colonic ischemia

Total abdominal colectomy is a major surgery and can have complications. Your risk depends on your general overall health. Ask your surgeon about these possible complications.

Risks of anesthesia and surgery in general are:

• Reactions to medicines
• Breathing problems
• Bleeding, blood clots
• Infection

Risks of having this surgery are:

• Bleeding inside your belly.
• Damage to nearby organs in the body.
• Scar tissue may form in the belly and cause a blockage of the small intestine (this scar tissue is often called adhesions).
• Leakage of stool from the connection between the small intestine and the rectum. This can cause an infection or abscess. It can also turn into a fistula if the stool comes out of an opening in the skin.
• Scarring of the connection between the small intestine and the rectum. This can cause a blockage of the intestine.
• Wound breaking open.
• Wound infection.
• Hernia from the incision.

Before you have surgery, talk with your surgeon about the following things:

• Intimacy and sexuality
• Pregnancy
• Sports
• Work

Tell your surgeon or nurse if:

• You are or could be pregnant
• You are taking any medicines, including medicine, supplements, or herbs you bought without a prescription
• You have been drinking a lot of alcohol, more than 1 or 2 drinks a day

Planning for your surgery:

• If you have diabetes, heart disease, or other medical conditions, your surgeon may ask you to see the provider who treats you for these conditions.
• If you smoke, it's important to cut back or quit. Smoking can slow healing and increase the risk for blood clots. Ask your provider for help quitting smoking.
• If needed, prepare your home to make it easier to recover after surgery.
• Ask your surgeon if you need to arrange to have someone drive you home after your surgery.

During the week before your surgery:

• You may be asked to temporarily stop taking medicines that keep your blood from clotting. These medicines are called blood thinners. This includes over-the-counter medicines and supplements such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and vitamin E. Many prescription medicines are also blood thinners.
• Ask your surgeon which medicines you should still take on the day of surgery.
• Let your surgeon know about any illness you may have before your surgery. This includes COVID-19, a cold, flu, fever, herpes outbreak, or other illness. If you do get sick, your surgery may need to be postponed.

The day before your surgery:

• Follow your surgeon's instructions about what to eat and drink. You may be asked to drink only clear liquids, such as broth, clear juice, and water at some point during the day.
• You will be told when to stop eating and drinking. You may be asked to stop eating solid food after midnight, but you might be able to have clear liquids up until 2 hours before surgery.
• Your surgeon may ask you to use enemas or laxatives to clear out your intestines. You will get instructions on how to use them.

On the day of surgery:

• Follow instructions about when to stop eating and drinking.
• Take the medicines your surgeon told you to take with a small sip of water.
• Follow instructions on when to arrive at the hospital. Be sure to arrive on time.

You will be in the hospital for 3 to 7 days in most cases. By the second day, you will probably be able to drink clear liquids. You will slowly be able to add thicker fluids and then soft foods to your diet as your bowels begin to work again.

After this procedure, you can expect to have 4 to 6 bowel movements a day. You may need more surgery and an ileostomy if you have Crohn disease and it spreads to your rectum.

Most people who have this surgery recover fully. They can do most of the activities they were doing before their surgery. This includes most sports, travel, gardening, hiking, and other outdoor activities, and most types of work.

Ileorectal anastomosis; Subtotal colectomy

Horesh N, Emile S, Wexner SD. Colon and rectum. In: Tyler DS, Hayes-Dixon A, Hines OJ, et al, eds. Sabiston Textbook of Surgery. 22nd ed. Philadelphia, PA: Elsevier; 2026:chap 95.

Olortegui KS, Hyman N. Ileostomies, colostomies, and anastomoses. In: Chung RT, Rubin DT, Wilcox CM, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 12th ed. Philadelphia, PA: Elsevier; 2026:chap 119.

Updated by: Ann M. Rogers, MD, FACS, Professor Emeritus, Department of Surgery, Penn State College of Medicine, Hershey, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.