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Q: Colectomy Recovery Time and Risks ( Answered 5 out of 5 stars,   3 Comments )
Subject: Colectomy Recovery Time and Risks
Category: Health > Conditions and Diseases
Asked by: insertwittynamehere-ga
List Price: $20.00
Posted: 20 Mar 2003 15:04 PST
Expires: 19 Apr 2003 16:04 PDT
Question ID: 178873

My good friend's father recently had a colectomy and is recovering
poorly.  It has been two weeks and he is still unable to eat - he
vomits everything.  All of his vital signs are fine (i.e. no fever, no
bleeding, heart is fine, breathing is fine etc.)  The doctor is
surprised by the long recovery - he says that his intestines are still
"asleep" and need to wake up.  I am looking for statistical
information on colectomy recovery time (I do not know the exact type
of colectomy that was performed and I don't believe that it was
laproscopic) and problems associated with the surgery. Can intestines
fall asleep as the doctor tells us? Is this normal? What happens if
they do not wake up?

Thanks for your help.
Subject: Re: Colectomy Recovery Time and Risks
Answered By: pinkfreud-ga on 20 Mar 2003 16:26 PST
Rated:5 out of 5 stars
The average time spent in the hospital after an open colectomy (as
distinguished from a laparascopic colectomy) is approximately eight to
ten days:

"Proctocolectomy means that the entire colon and rectum are removed...
The average hospital stay is 10 days."

FAP Support Group

"The Barcelona surgeons treated 219 patients, of whom 111 had LAC and
108 had conventional open colectomy (OC), which requires a foot-long
incision. LAC patients had an average hospital stay of five days,
compared to eight days for the OC (Open Colectomy) patients."

Health Scout

However, the progress of recovery can vary greatly from patient to
patient. One thing that affects recovery time is the patient's state
of health before the surgery; a person who is malnourished or gravely
ill when surgery is performed (which is not uncommon with this type of
surgery) often has a much longer recuperation.

The condition you describe, where the intestines are said to be
"sleeping," may be postoperative ileus (also known as paralytic ileus,
adynamic ileus, or intestinal volvulus). I have gathered some
information on postoperative ileus so that you can get an overview of
the situation. Keep in mind that Google Answers is not a source of
authoritative medical advice, and the material I'm presenting here
should not be considered a diagnosis of your father's condition.


Here is a description of the symptoms which characterize postoperative

"The Postoperative Ileus Screening Tool can be used to identify
patients with ileus occurring after surgery.


(1) nausea and vomiting

(2) failure to advance diet

(3) lack of bowel sounds

(4) abdominal distention

(5) increased length of stay

(6) abdominal X-ray evidence of ileus"

Medical Algorithms Project


"Paralytic ileus (also called adynamic ileus) is one type of
intestinal obstruction... The incidence of paralytic ileus is high in
comparison to physical obstruction but generally the prognosis is
better. Paralytic ileus is frequently encountered when nursing
patients on surgical wards following an operation. It is also a major
cause of obstruction in infants and children, where it is sometimes
referred to as pseudo-obstruction (Barr, 1998). Peristalsis ceases and
stagnation occurs in both the small and large bowel producing severe
nausea and vomiting. There is abdominal distention and a reduction or
absence of bowel sounds."

Nurse Minerva


"Ileus is a partial or complete non-mechanical blockage of the small
and/or large intestine... non-mechanical obstruction, called ileus or
paralytic ileus, occurs because peristalsis stops. Peristalsis is the
rhythmic contraction that moves material through the bowel. Ileus is
most often associated with an infection of the peritoneum (the
membrane lining the abdomen). It is one of the major causes of bowel
obstruction in infants and children.

Another common cause of ileus is a disruption or reduction of the
blood supply to the abdomen. Handling the bowel during abdominal
surgery can also cause peristalsis to stop, so people who have had
abdominal surgery are more likely to experience ileus. When ileus
results from abdominal surgery the condition is often temporary and
usually lasts only 48-72 hours.

Patients may be treated with supervised bed rest in a hospital, and
bowel rest--where nothing is taken by mouth and patients are fed
intravenously or through the use of a nasogastric tube. A nasogastric
tube is a tube inserted through the nose, down the throat, and into
the stomach. A similar tube can be inserted in the intestine. The
contents are then suctioned out. In some cases, especially where there
is a mechanical obstruction, surgery may be necessary."

Health A to Z


I've found several articles that discuss the use of the drug  ADL
8-2698 (whose trade name is Alvimopan) in reducing postoperative
ileus. Although this study did not involve patients who had undergone
a total colectomy, the results may be applicable:

"Postoperative ileus is a common reason for prolonged hospitalization
after major abdominal surgery. The matter is complicated by the use of
opioids to treat postoperative pain, since these drugs delay the
recovery of gastrointestinal function. ADL 8-2698 is an
investigational opioid antagonist that seems not to reverse the
analgesic effects of opiates. It was studied in patients who underwent
a partial colectomy or a total abdominal hysterectomy. As compared
with placebo, ADL 8-2698 shortened the times to the first passage of
flatus, the first bowel movement, and hospital discharge.

These findings demonstrate a novel approach to helping patients
recover more quickly after major abdominal surgery. Postoperative pain
is blocked centrally, but the effects of opioids on the bowel are
inhibited with a local antagonist."

New England Journal of Medicine

Here you will find an abstract of the study mentioned in the article
above (the full text of the article may be purchased from the journal
for $10):

New England Journal of Medicine

More on this subject:

"Delay in return of gastrointestinal function & resumption of oral
intake can prolong length of hospital stay and can be aggravated by
postoperative opioid analgesia. Major causes of ileus include surgical
manipulation of bowel & stimulation of opioid receptors by endogenous
& exogenous opioids. Gastrointestinal consequences can be moderated by
administration of oral naxolone, but significant absorption attenuates
the efficacy of systemically administered opioids. An investigational
drug called ADL 8-2698, is a selective opioid antagonist with limited
oral absorption, minimal access across the blood-brain-barrier &
prolonged duration of action."

The Journal Club

Here's an unusual and simple approach to the problem of postoperative

"Gum chewing after undergoing laparoscopic colectomy for colorectal
cancer speeds recovery from postoperative ileus, claim researchers in
the Journal of the American College of Surgeons. Not only did patients
have a quicker first passage of flatus and have their first defecation
almost three days earlier if they chewed gum, they were in hospital
for less time than other patients, reports the team from Gunma
University School of Medicine in Japan.

'Gum chewing should be added as an adjunct treatment in postoperative
care because it might contribute to shorter hospital stays,' say
Takayuki Asao and colleagues."



Search terms used:

postoperative ileus
paralytic ileus
adynamic ileus
intestinal volvulus
after colectomy
average recovery time
average hospital stay


I know how frustrating and frightening it can be, both for the patient
and for the family, when recovery from surgery is slower than
expected. I cannot tell you that there is nothing to worry about, but
I can definitely say that there is every hope that your father's team
of physicians may be able to help him pull through this. Your question
has special significance to me, since I have been in a situation very
much like your father's. In July 1972, at the age of 24, I underwent
an open colectomy. I had been told to expect a hospital stay of a
week, but postoperative ileus complicated matters considerably.
Although my recovery was slowed by ileus, I left the hospital six
weeks later, and now -- another 31 years down the line -- here I am
researching a question that mirrors my own experience.

If you have any questions about what I've written, or if you'd like
more details about any aspect of my answer, please request
clarification; I'll be glad to do everything I can to help.

Best wishes to you and to your father.

insertwittynamehere-ga rated this answer:5 out of 5 stars and gave an additional tip of: $10.00
Thank you very much for the quick and detailed answer - exactly what I
was looking for.

Subject: Re: Colectomy Recovery Time and Risks
From: pinkfreud-ga on 20 Mar 2003 16:39 PST
Thank you *very* much for the five-star rating and the generous tip.
If you need any more information about colectomy or ileus, please ask.
As I mentioned above, I have been through this particular medical
ordeal, and I would like to do anything I can to help others who are
in this situation.

Subject: Re: Colectomy Recovery Time and Risks
From: pinkfreud-ga on 20 Mar 2003 16:43 PST
Upon rereading your question, I realize that the person experiencing
the medical difficulties is your friend's father, rather than your
father. I apologize for having misworded my answer in this respect.

Subject: Re: Colectomy Recovery Time and Risks
From: surgeon-ga on 21 Mar 2003 13:09 PST
two weeks is unusually long for postoperative ileus. It can happen,
depending on the patient's other medical conditions, such as diabetes,
etc. But when it goes that long, it may be time to investigate other
possibilities, such as occult infection or mechanical obstuction. I'd
assume that by now he's had a CAT scan, using contrast material in the
intestine. That would be the best way of making the distinction.

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