Subtotal / Total Colectomy (Open, Laparoscopic, Robotic)

Procedure Snapshot

• Indication: Toxic megacolon, ulcerative colitis, familial polyposis.
• Expected duration: ___
• Special instruments: Staplers, energy device, retractor.

Step Workflow

1. Mobilize colon from cecum to sigmoid.
2. Divide ileocolic, middle colic, left colic vessels.
3. Preserve small bowel & rectum (if subtotal).
4. Create end ileostomy or ileorectal anastomosis.

Key Pimp Questions

• Q: Toxic megacolon indication? Failure of medical therapy > 24 h (PMID 33389680).
• Q: Rectal stump management? Stapled and oversewn subcutaneously.

Critical Anatomy

• Landmarks: IMA/IMV, ureters, retroperitoneum.
• Danger zones: Pelvic autonomics.

Informed Consent Highlights

• Leak, stoma, bleeding, infection.

Post-op Considerations

• Fluid resuscitation; monitor stoma output.

References

• Chassin’s, Colon section; Clinical Scenarios, IBD.
• Chaparro 2021 (PMID 33389680).