My GI doctor has spoken to me about having a subtotal colectomy done. This was close to a year ago. I didn't have the surgery done, but am now considering it. The problem is that I'm not sure exactly what a subtotal colectomy surgery entails. Could you tell me more about the surgery?

S.A.M.

A colectomy is an operation in which surgeons remove part of the large intestine (colon). How much of the colon is removed -- and just where it is removed from -- depends on what condition is troubling you. For example, if a person has cancer in the right side of the colon, then the right segment of the colon is removed. Generally the amount of colon removed will depend on the way the blood supply to the areas of the colon is arranged in a specific patient. In some colectomies, such as those to remove a part of the left colon in diverticulitis, only a short segment of colon is removed.

Your colon begins on the right side (at the end of the small intestine) and continues across the abdomen (the transverse colon) to the left side, which connects to the rectum. If the right colon is removed, then some of small intestine and transverse colon may also be taken out. If the left colon is removed, then a part of the transverse may also be removed. It is generally preferable to leave the rectum in place since it performs the important function of storing stool. If the rectum has to be removed, as is the case in some patients with ulcerative colitis, surgeons often build a new rectum using other intestinal segments.

If a colectomy is done on a nonemergency basis, doctors make every effort to reconnect the remaining colon together, thus avoiding a colostomy. Besides the obvious inconvenience, a colostomy would require another operation at a later time to reconnect the bowel.

Keep in mind that regardless of what procedure is done, most patients will lead normal lives after a colectomy. That is because the small intestine -- not the colon -- is responsible for performing most of the bowel's vital functions. Since the main action of the colon is to absorb water from the stool, one change that patients may experience is softer, more frequent stools. This is rarely a problem that requires a lifestyle change. I encourage you to spend more time with your surgeon discussing the reason for your proposed operation, along with the various surgical options available to you.