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Beverly Hills · 435 N. Bedford Dr., Suite 308Mon–Fri 9:00 am – 5:00 pmMost PPO insurance accepted
Allen KamravaMD · MBA · FACS · FASCRS

Procedure

Operative

Subtotal Colectomy

Removal of most of the colon while keeping the rectum, with the small intestine joined to the rectum — for disease that involves the colon from end to end.

Request a consultationSurgery is arranged with a coordinator by phone.
Setting
Operative
Anesthesia
General anesthesia, in the operating room
Back to work
2-4 weeks
Success rate
Greater than 95%
Recurrence
Varies by disease

What it is

What is a Subtotal Colectomy?

A subtotal colectomy is the surgical removal of the majority of the colon, typically preserving the rectum. The procedure involves resection of the colon from the cecum to the sigmoid colon, followed by an anastomosis between the terminal ileum and the rectum (ileorectal anastomosis). It is performed for a variety of conditions that affect the entire colon, such as inflammatory bowel disease, familial polyposis syndromes, or severe constipation.

Am I a candidate?

Who is a Good Candidate for a Subtotal Colectomy?

Ideal candidates are patients with diseases affecting a large portion of the colon. This includes:

  • Ulcerative Colitis or Crohn's Disease: Patients with medically refractory pancolitis or complications such as toxic megacolon or dysplasia.
  • Familial Adenomatous Polyposis (FAP): Patients with this genetic syndrome require prophylactic removal of the colon to prevent the inevitable development of colon cancer.
  • Lynch Syndrome: Patients with this hereditary cancer syndrome may elect for a subtotal colectomy to reduce their risk of metachronous colon cancer.
  • Severe Slow-Transit Constipation: In rare, carefully selected cases, a subtotal colectomy may be performed for intractable constipation that has failed all other therapies.

How it's done

  1. 1Under general anesthesia, usually through small keyhole (laparoscopic or robotic) incisions when the situation allows.
  2. 2Most of the colon is freed and removed; the rectum is preserved.
  3. 3The small intestine (ileum) is joined to the rectum — an ileorectal anastomosis — preserving the normal route to the bathroom.
  4. 4In some situations a temporary stoma (ileostomy) protects the new connection while it heals.
  5. 5A hospital stay follows while the bowel wakes up and you get back to eating and walking.

What to expect

  1. Days 1–5

    In hospital — walking early, diet advancing as the bowel recovers.

  2. Home

    Expect frequent, loose stools — often 4 to 6 a day at first. That is the colon's absence, not a complication.

  3. First months

    Frequency settles gradually with diet adjustments and, for some people, anti-diarrheal medicine. Light activity and work usually resume within a few weeks; heavy lifting waits about six weeks.

  4. By one year

    In published series, most people settle to around three stools a day, and function keeps improving into the second year.

Risks & considerations

What are the Risks?

A subtotal colectomy is a major abdominal operation with potential risks, including:

  • Anastomotic Leak: The connection between the ileum and rectum can leak, leading to a serious pelvic infection that may require further surgery and a stoma.
  • Bleeding: Intra-abdominal bleeding can occur, sometimes requiring blood transfusions or reoperation.
  • Infection: Surgical site infections, including wound infections and intra-abdominal abscesses, are possible.
  • Small Bowel Obstruction: Adhesions from the surgery can lead to bowel blockages in the future.
  • Increased Stool Frequency: Removal of the colon results in more frequent and liquid stools, which can sometimes be difficult to manage.

The risks that matter

Every operation carries a long list of possible complications. These are the ones that are serious enough — and common enough — to understand in real numbers before you decide.

Anastomotic leak (ileorectal connection)

observational

Where the join between the small intestine and the rectum doesn't fully seal, letting intestinal contents escape and cause infection in the pelvis or abdomen.

about 6-11%— from roughly 1 in every 10-20 operations in the largest series to about 1 in every 5 in the highest-reporting smaller ones
Why it happens
This connection joins small intestine to rectum and must heal in a demanding environment — often in patients whose underlying disease or medications already impair healing. Even in expert hands a fraction won't seal fully. It is inherent to the operation, not a sign that anything was done carelessly.
If it happens
It's watched for closely afterward with exams, blood tests, and a CT scan if there's any concern. Treatment ranges from antibiotics and a drain to a return to the operating room and, sometimes, a temporary ileostomy to let the join rest and heal.
How we lower the odds
A tension-free, well-perfused connection tested during surgery; optimizing nutrition and, where possible, reducing immune-suppressing medications beforehand; and using a temporary diverting ileostomy in higher-risk situations — in the largest series, leaks were 1% with diversion versus 4% without.

Lowering the odds is not the same as removing them. Even when everything is done right, this can still happen — that is the nature of the operation, not a failure of your care.

Source: Cleveland Clinic series of 823 ileorectal anastomoses, presented at the American Society of Colon & Rectal Surgeons Annual Scientific Meeting; Ocaña J, et al., Journal of Coloproctology (2022).

Sources

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