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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

Total Colectomy

Removal of the entire colon — for disease that involves the whole colon — with the small intestine joined to the rectum, or brought out as a stoma when joining isn't safe.

Request a consultationSurgery is arranged with a coordinator by phone.
Setting
Operative
Anesthesia
General anesthesia, in the operating room
Back to work
2–8 weeks
Success rate
80–95%
Recurrence
5–15%

What it is

A total colectomy is a surgical procedure involving the removal of the entire colon. This procedure is typically recommended for patients with severe or extensive colon diseases that cannot be managed with less invasive treatments. The goal of a total colectomy is to eliminate the diseased portion of the colon, alleviate symptoms, and improve the patient's overall quality of life.

During the surgery, the colon is detached from the small intestine and rectum, then removed. After the colon is removed, the surgeon will connect the small intestine to the rectum (ileorectal anastomosis) or create an ileostomy, depending on the specific condition and the extent of disease. An ileostomy involves creating an opening (stoma) on the abdomen through which waste is eliminated into an external bag.

Total colectomy can be performed using open surgery or laparoscopically, depending on the patient's condition and the surgeon's expertise. Laparoscopic surgery involves smaller incisions, potentially leading to reduced pain and a faster recovery.

Am I a candidate?

Total colectomy may be recommended for patients with the following conditions:

  • Ulcerative Colitis: When medical treatments are ineffective or complications arise.
  • Crohn's Disease: In cases of extensive colitis with rectal involvement or when other treatments fail.
  • Familial Adenomatous Polyposis (FAP): To prevent the development of colorectal cancer.
  • Colorectal Cancer: When multiple neoplasms are present.
  • Toxic Megacolon: As an emergent intervention.

How it's done

  1. 1Under general anesthesia, usually through small keyhole (laparoscopic or robotic) incisions when the situation allows.
  2. 2The entire colon is freed and removed, from where the small intestine ends to the top of the rectum.
  3. 3The small intestine (ileum) is then joined to the rectum — an ileorectal anastomosis — or, when a join isn't safe or possible, it is brought out through the abdominal wall as a stoma (ileostomy).
  4. 4If a stoma is made, teaching on caring for it starts in the hospital; many stomas are temporary.
  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. Stoma teaching begins here if one was made.

  2. Home

    Expect frequent, loose stools — often 4 to 6 a day at first. That is life without a colon doing its water-absorbing job, 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.

  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

Potential risks and complications associated with total colectomy include:

  • Infection: Infections can occur at the surgical site or within the abdomen, requiring antibiotic treatment or further intervention.
  • Bleeding: Excessive bleeding during or after surgery may require blood transfusions or additional procedures to control the bleeding.
  • Anastomotic Leak: If an ileorectal anastomosis is performed, there is a risk of leakage at the connection site, which can lead to peritonitis and require further surgery.
  • Ileostomy Complications: If an ileostomy is created, complications such as stomal prolapse, retraction, herniation, or stenosis may occur.
  • Incontinence or Diarrhea: These can occur following surgery.

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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