When is colon resection (colectomy) contraindicated?

Updated: Apr 05, 2021
  • Author: David E Stein, MD, MHCM; Chief Editor: Vikram Kate, FRCS, MS, MBBS, PhD, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS, FFST(Ed)  more...
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Answer

Colectomy has no absolute contraindications, though the overall medical status of the patient and the indication for surgery should be evaluated on a case-by-case basis.

A patient with severe cardiac disease who has a large polyp in the cecum that is not amenable to colonoscopic removal is a classically difficult case. The physician has to weigh the risks and benefits of the surgical procedure against the projected outcomes of inaction. A patient with severe cardiac disease or one who cannot tolerate anesthesia may not be a candidate for surgery. It should be routine practice to discuss the potential outcomes with the patient and his or her family.

In terms of approach, laparoscopic colectomy has some relative contraindications. Intra-abdominal adhesions or scar tissue from previous abdominal surgical procedures may preclude a laparoscopic approach. In addition, a phlegmon due to perforated diverticulitis would make laparoscopic colectomy difficult to perform.

As for all laparoscopic abdominal operations, inability of the patient to tolerate insufflation is a contraindication for laparoscopic colon resection. Therefore, preoperative pulmonary function studies are prudent in patients suspected of having breathing difficulties.

The surgeon should also note whether the patient has a bleeding disorder or liver disease. Portal hypertension, though not an absolute contraindication, can result in massive hemorrhage intraoperatively, a dangerous and challenging situation to control even in the best of circumstances.

Finally, if a 15-cm tumor must be extracted or if a tumor is invading abdominal wall muscle of pelvic attachments, the decision whether to perform laparoscopy may depend on the individual surgeon’s skillset.


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