(Sub-)Total Colectomy with Ileostomy or Ileo-Rectal Anastomosis (Open, Laparoscopic)

Abstract

This chapter describes the detailed steps for a (sub-)total abdominal colectomy, which involve resection of the entire or the majority of the intra-abdominal colon. Under optimal elective circumstances and when the residual colorectum is to be preserved, the terminal ileum may be anastomosed to the distal sigmoid or rectum. In emergency situations or as first part of a three-stage proctocolectomy, an ileostomy is created. The decision about restoration of continuity, timing, a staged approach, and the platform (open versus minimally invasive) may vary depending on the disease and treatment specifics. The chapter includes the indications, preoperative preparation, pitfalls and danger points, postoperative care, and complications of the procedure. Details of operative strategy and operative technique are included.