Total Colectomy
What is Total colectomy?
A total colectomy is a surgical procedure involving the complete removal of the colon (large intestine), from the cecum to the sigmoid colon, typically performed to treat extensive colonic diseases. Depending on the approach, the rectum may be spared (with ileorectal anastomosis) or removed (as part of a proctocolectomy). A permanent or temporary ileostomy may be created to divert stool. In India, total colectomy is conducted in specialized colorectal surgery centers, offering high-quality care at affordable costs. For patients and families in India, understanding the procedure, costs, recovery, risks, and frequently asked questions (FAQs) is essential for informed decision-making and optimal outcomes.
Why do you need Total colectomy?
Total colectomy is indicated for:
- Inflammatory bowel disease (IBD): Ulcerative colitis (UC) or Crohn’s disease with pancolitis, unresponsive to medical therapy.
- Familial adenomatous polyposis (FAP): A genetic condition causing numerous polyps with high cancer risk.
- Colorectal cancer: Multiple synchronous tumors or extensive cancer across the colon.
- Severe constipation: Slow-transit constipation unresponsive to other treatments.
- Colonic volvulus or perforation: Emergency cases with obstruction or ischemia across the colon.
- Toxic megacolon: A life-threatening complication of UC or infection (e.g., C. difficile).
The procedure aims to remove diseased tissue, prevent complications (e.g., cancer, perforation), and manage symptoms. In India, hospitals like Apollo, Fortis, Medanta, and AIIMS specialize in total colectomy, using open, laparoscopic, or robotic-assisted techniques.
Why Do Total Colectomy Costs Vary in India?
Costs range from ₹3.5 lakh to ₹12 lakh:
- Procedure Type: Open with ileorectal anastomosis (₹3.5–7 lakh), with end ileostomy (₹4–8 lakh), laparoscopic/robotic (₹6–12 lakh).
- Hospital/Location: Higher in metro cities (Apollo, Fortis); lower in government hospitals (AIIMS, ₹1–4 lakh).
- Surgeon’s Expertise: Experienced colorectal surgeons charge more.
- Additional Costs: Diagnostics (CT, colonoscopy), ICU, stoma supplies (₹2,000–₹5,000/month), adjuvant therapy (₹1–3 lakh).
- Insurance: Covered for IBD, cancer, or emergencies; Ayushman Bharat offers subsidies.
Total Colectomy Procedure
The procedure is tailored to the condition, disease extent, and patient health:
- Before Surgery Evaluation:
- Diagnosis:
- Colonoscopy with biopsy confirms UC, Crohn’s, or cancer.
- CT scan assesses disease extent, complications (e.g., perforation), or metastasis.
- Blood tests evaluate inflammation (CRP, ESR), anemia, and surgical fitness.
- Bowel preparation (laxatives, enemas) clears the colon 1–2 days prior, unless contraindicated (e.g., obstruction).
- Antibiotics (e.g., metronidazole, ciprofloxacin) are given for infection or prophylaxis.
- An enterostomal therapist marks a stoma site, as an ileostomy may be needed.
- Diagnosis:
- Surgical Techniques:
- Total Colectomy with Ileorectal Anastomosis:
- Performed under general anesthesia, lasting 3–5 hours.
- The entire colon (cecum to sigmoid) is removed, sparing the rectum.
- The ileum is anastomosed to the rectum (ileorectal anastomosis).
- A temporary loop ileostomy may be created to protect the anastomosis, especially in emergencies or high-risk patients (e.g., UC patients with active inflammation).
- Total Colectomy with End Ileostomy:
- For cases where rectal preservation isn’t feasible (e.g., severe rectal involvement, emergency).
- The colon and rectum are removed (proctocolectomy), and a permanent end ileostomy is created to divert stool into a pouch.
- Takes 4–6 hours, often combined with perineal incision if the rectum is removed.
- Laparoscopic Total Colectomy:
- Minimally invasive, using 4–5 small incisions, a laparoscope, and instruments.
- Suitable for elective cases (e.g., UC, FAP), offering less pain and faster recovery.
- Takes 3–5 hours; conversion to open surgery is possible if complications arise.
- Robotic-Assisted Total Colectomy:
- Uses robotic systems (e.g., da Vinci) for enhanced precision, particularly in the pelvis.
- More expensive, available in centers like Apollo or Medanta.
- Total Colectomy with Ileorectal Anastomosis:
- After Surgery:
- ICU monitoring for 1–2 days manages pain, fluids, and bowel/stoma function.
- Hospital stay: 7–14 days (open), 5–10 days (laparoscopic/robotic).
- Pathology reports guide further management (e.g., chemotherapy for cancer, Crohn’s monitoring).
- Stoma care training is provided for ileostomy patients.
Recovery After Total Colectomy
- Hospital Stay: 7–14 days (open), 5–10 days (laparoscopic/robotic).
- Post-Surgery Care:
- Pain managed with medications (epidural, opioids, then NSAIDs).
- IV fluids and gradual oral intake resume within 3–5 days.
- Stoma care training for permanent or temporary ileostomy.
- Activity/Diet:
- Light walking in 1–2 days; strenuous activities avoided for 6–8 weeks (open) or 4–6 weeks (laparoscopic).
- Low-residue diet initially, progressing to high-fiber; 2–3 liters water daily to prevent dehydration.
- Follow-Up:
- Visits at 1–2 weeks, 4–6 weeks; cancer patients need CEA/CT every 3–6 months for 5 years.
- Temporary ileostomy reversal (if applicable) after 3–6 months if anastomosis heals.
Most resume normal activities in 4–8 weeks. Bowel function changes significantly (4–8 stools/day due to no colon), stabilizing over 6–12 months. Cancer survival: 70–90% (stage I–II), 50–70% (stage III).
Risks and Complications
- Surgical Risks: Bleeding, infection, anastomotic leak (5–15%, if ileorectal anastomosis), requiring reoperation.
- Stoma Issues: Prolapse, retraction, or hernia (if created).
- General Risks: Anesthesia reactions, blood clots, adhesions causing obstruction.
- Long-Term: Frequent stools (4–8/day), diarrhea, vitamin B12 deficiency (terminal ileum resection), cancer recurrence (5–15%), Crohn’s recurrence.
Report fever, severe pain, or no bowel/stoma output promptly.
Frequently Asked Questions (FAQs)
What causes the need for total colectomy?
Extensive UC, Crohn’s, FAP, multiple cancers, or emergencies like toxic megacolon.
Will I need a stoma?
Permanent ileostomy if rectum is removed; temporary ileostomy (20–40%) with ileorectal anastomosis.
Can it be done laparoscopically?
Yes, for elective cases, with faster recovery.
How soon can I resume activities?
4–6 weeks (laparoscopic), 6–8 weeks (open).
Is it covered by insurance in India?
Yes, for IBD, cancer, or emergencies; confirm with your provider.
Signs of complications?
Fever, severe pain, no bowel/stoma output, or dehydration.
Will I have normal bowel function?
No colon leads to 4–8 stools/day; adaptation occurs over 6–12 months.
Lifestyle changes post-surgery?
High-fiber diet, hydration, B12 supplementation, regular follow-ups.
Conclusion
Total colectomy effectively treats extensive colonic diseases, with patients adapting to significant bowel changes over time. India’s top hospitals (Apollo, Fortis, AIIMS) offer affordable, high-quality care. Understanding the procedure, costs, recovery, risks, and FAQs helps patients approach total colectomy confidently. Consult a colorectal surgeon for personalized guidance and successful treatment.
Looking for Best Hospitals for Total Colectomy
Note: we are not promoting any hospitals
we are not promoting any hospitals we sourced all the details from google and hospitals website, please verify and start with your surgery here we go the list includes government, budget and superspeciality hospitals accreditation bodies are the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and the Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₹) | Maximum Price (₹) |
|---|---|---|
Agra |
3,00,000 |
9,00,000 |
Ahmedabad |
3,50,000 |
10,00,000 |
Ajmer |
3,00,000 |
9,00,000 |
Aligarh |
3,00,000 |
9,00,000 |
Allahabad |
3,00,000 |
9,00,000 |
Amritsar |
3,25,000 |
9,50,000 |
Aurangabad |
3,25,000 |
9,50,000 |
Bangalore |
3,50,000 |
10,00,000 |
Bareilly |
3,00,000 |
9,00,000 |
Belgaum |
3,25,000 |
9,50,000 |
Bhopal |
3,25,000 |
9,50,000 |
Bhubaneswar |
3,25,000 |
9,50,000 |
Bikaner |
3,00,000 |
9,00,000 |
Chandigarh |
3,50,000 |
10,00,000 |
Chennai |
3,50,000 |
10,00,000 |
Coimbatore |
3,50,000 |
10,00,000 |
Dehradun |
3,25,000 |
9,50,000 |
Delhi |
3,50,000 |
10,00,000 |
Dhanbad |
3,00,000 |
9,00,000 |
Durgapur |
3,00,000 |
9,00,000 |
Faridabad |
3,50,000 |
10,00,000 |
Ghaziabad |
3,50,000 |
10,00,000 |
Gorakhpur |
3,00,000 |
9,00,000 |
Guntur |
3,25,000 |
9,50,000 |
Gurgaon |
3,50,000 |
10,00,000 |
Guwahati |
3,25,000 |
9,50,000 |
Gwalior |
3,00,000 |
9,00,000 |
Hyderabad |
3,50,000 |
10,00,000 |
Indore |
3,25,000 |
9,50,000 |
Jabalpur |
3,00,000 |
9,00,000 |
Jaipur |
3,50,000 |
10,00,000 |
Jalandhar |
3,25,000 |
9,50,000 |
Jamshedpur |
3,25,000 |
9,50,000 |
Jodhpur |
3,00,000 |
9,00,000 |
Kanpur |
3,00,000 |
9,00,000 |
Kochi |
3,50,000 |
10,00,000 |
Kolkata |
3,50,000 |
10,00,000 |
Kollam |
3,25,000 |
9,50,000 |
Lucknow |
3,25,000 |
9,50,000 |
Ludhiana |
3,50,000 |
10,00,000 |
Madurai |
3,25,000 |
9,50,000 |
Mangalore |
3,25,000 |
9,50,000 |
Meerut |
3,00,000 |
9,00,000 |
Moradabad |
3,00,000 |
9,00,000 |
Mumbai |
3,50,000 |
10,00,000 |
Mysore |
3,50,000 |
10,00,000 |
Nagpur |
3,25,000 |
9,50,000 |
Nashik |
3,25,000 |
9,50,000 |
Navi Mumbai |
3,50,000 |
10,00,000 |
Noida |
3,50,000 |
10,00,000 |
Patna |
3,00,000 |
9,00,000 |
Pune |
3,50,000 |
10,00,000 |
Raipur |
3,25,000 |
9,50,000 |
Rajkot |
3,25,000 |
9,50,000 |
Ranchi |
3,00,000 |
9,00,000 |
Surat |
3,50,000 |
10,00,000 |
Thane |
3,50,000 |
10,00,000 |
Vadodara |
3,25,000 |
9,50,000 |
Varanasi |
3,00,000 |
9,00,000 |
Visakhapatnam |
3,25,000 |
9,50,000 |
Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.