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TitleAn Internist's Illustrated Guide to Gastrointestinal Surgery - G. Wu, et al., (Humana, 2003) WW
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LanguageEnglish
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Total Pages357
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Page 1

Gastrointestinal
Surgery

Edited by

George Y. Wu, MD, PhD
Khalid Aziz, MBBS, MRCP
Giles F. Whalen, MD, FACS
Illustrations by Lily H. Fiduccia

An Internist’s Illustrated Guide to

Gastrointestinal
Surgery

An Internist’s Illustrated Guide to

Edited by

George Y. Wu, MD, PhD
Khalid Aziz, MBBS, MRCP
Giles F. Whalen, MD, FACS
Illustrations by Lily H. Fiduccia

Page 2

AN INTERNIST’S ILLUSTRATED GUIDE TO GASTROINTESTINAL SURGERY

Page 178

Chapter 15 / Colonic Resection 163

INTRODUCTION

Segmental colon resection is a relatively common general surgical operation. It is the
standard of care for colon cancer and is indicated for a variety of benign conditions to
be discussed later.

Patients requiring elective colonic resection will undergo a bowel prep that will be
performed at home, commencing 1 or 2 d preoperatively. Patients may expect a 4–10 d
hospital stay. The precise length of the hospital stay depends on a number of variables
including, operative technique, overall medical condition, motivation, and presence or
absence of complications.

When discussing colon resection with patients, two questions are commonly asked by
patients or family members. One is: will the patient require a colostomy? Second, what
effect will the operation have on the function of the bowel? The colostomy issue will be
addressed in the Subheading, “Indications.” Regarding the effect of colectomy on bowel
function, consider the following. The colon does absorb water, thus, converting liquid
stool in the right colon to solid stool by the time it reaches the descending and sigmoid
colon. The distal colon and rectum serve as “reservoirs” that allow storage of waste until
there is an acceptable time to defecate. Physiologic changes associated with colonic
resection will be discussed in subsequent Subheadings.

Most colon resections performed today are segmental colectomies involving removal
of 1–2 ft of colon. This is in contrast to a formal “hemicolectomy” where half of the colon

15 Colonic Resection
Robert A. Kozol, MD

CONTENTS
INTRODUCTION
INDICATIONS FOR PROCEDURE
CONTRAINDICATIONS
PROCEDURE
COMPLICATIONS
ALTERNATIVE PROCEDURES
COSTS
SUMMARY
REFERECES

163

From: Clinical Gastroenterology: An Internist's Illustrated Guide to Gastrointestinal Surgery
Edited by: George Y. Wu, Khalid Aziz, and Giles F. Whalen © Humana Press Inc., Totowa, NJ

Page 179

164 Kozol

is removed. Anatomical differences between various resections will be described and
diagrammed (Fig. 1).

INDICATIONS FOR PROCEDURE

Indications for colectomy include benign and malignant diseases (Table 1). The most
common benign conditions are diverticulitis, lower gastrointestinal (GI) hemorrhage,
ulcerative colitis, sigmoid volvulus, and penetrating trauma. The most common malig-
nant condition is adenocarcinoma of the colon.

Colectomy is the standard of care for adenocarcinoma of the colon. Most segmental
colectomies for carcinoma are performed with intent to cure the patient. Even with ad-
vanced (metastatic) disease, colectomy may be required to palliate bleeding or obstruction.

Fig. 1. “Normal” configuration of colon. (A) Ascending colon. (B) Transverse colon. (C) Descend-
ing colon. (D) Sigmoid colon. (E) Rectum. Some patients have significant redundancy in colon
length, with the length of the sigmoid colon having the greatest variation.

Table 1
Common Indication for Colectomy

Benign Conditions Malignant Conditions

- Diverticulitis - Adenocarcinoma
- GI hemorrhage - All other malignancies

(AVM or Diverticular) (lymphoma, sarcoma, and
- Ulcerative colitis so on are rare)
- Sigmoid volvulus
- Foreign body perforation
- Penetrating injury to colon
- Ischemic colitis

Page 356

Index 341

Vitamin deficiency,
bariatric surgery, 118–120
small bowel resection, 145, 146

W

Whipple procedure,
complications, 230
costs, 230
indications and contraindications,

228, 229
overview, 228, 230, 231
pylorus-sparing procedure, 230
standard procedure, 229, 230

Witzel jejunostomy, tube
placement, 135

Z

Zenker’s diverticulum,
botulinum toxin therapy, 18, 19
clinical presentation, 17
cricopharyngeal lysis management,

19, 20
evaluation, 18
pathophysiology, 17
surgery,

complications, 21, 22
costs, 22
endoscopy, 20, 21
open technique, 19

Zollinger Ellison syndrome, surgical
management, 83

Page 357

342 Index

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