Colectomy, also known as colon removal or colon resection, is
the
surgical removal of the diseased part of the bowel, or large intestine.
The two remaining sections then are sewn together. This procedure
is recommended for blockage of the intestine due to scar tissue
or deformities; bleeding, infection or ulcers due to ulcerative
colitis, cancer, precancerous polyps, familial polyposis or traumatic
injury. Each year, more than 600,000 surgical procedures are performed
in the United States to treat a number of colon diseases. Although
surgery is not always a cure, it often is the best way to stop
the spread of disease and alleviate pain and discomfort.
The colon is the large intestine and forms the lower part of your
digestive tract. The intestine is a long, tubular organ consisting
of
the small intestine, the colon and the rectum, which is the last
part
of the colon. In most laparoscopic colon resections, surgeons operate
through four or five small openings (each about a quarter-inch
long) while watching an enlarged image of the patient's internal
organs on a television monitor. In some cases, one of the small
openings may be lengthened to 2 or 3 inches to complete the procedure.
Through the introduction of minimally invasive laparoscopic colon
surgery, surgeons can perform many common colon procedures through
these small incisions. Depending on the type of procedure, patients
may leave the hospital in one to three days and return to normal
activities more quickly than patients recovering from open surgery.
Patients undergoing traditional colon surgery often face a long
and
difficult recovery because "open" procedures are highly
invasive. In
most cases, surgeons are required to make a long incision. Surgery
results in an average hospital stay of five to eight days and usually
six weeks of recovery.
Although laparoscopic colon resection has many benefits, it may
not be appropriate for some patients. Candidacy for this procedure
is determined through careful medical evaluation by a surgeon
qualified in laparoscopic colon resection in consultation with
your primary care physician.
"Laparoscopic" and "open" colon surgery simply
describe the techniques a surgeon uses to gain access to the internal
surgery site. Most laparoscopic colon procedures start the
same way. Using a canula (a narrow tube-like instrument), the surgeon
enters the abdomen. A laparoscope (a tiny telescope connected to
a video camera) is inserted through the canula, giving the surgeon
a magnified view of the patient's internal organs on a television
monitor. Several other canulas are inserted to allow the surgeon
to work inside and remove part of the colon. The entire procedure
may be completed through the canulas or by lengthening one of the
small canula incisions.
Results may vary depending upon the type of procedure and patient's
overall condition. Common advantages are:
- Less postoperative pain
- Shorter hospital stay
- A faster return to normal diet
- Quicker return of bowel function
- Quicker return to normal activity
- Better cosmetic results
Most diseases of the colon are diagnosed with one of two tests:
a
colonoscopy or barium enema. These tests allow the surgeon to look
inside of the colon. Sometimes a CT scan of the abdomen will be
necessary. Prior to the operation, other blood tests, electrocardiogram
(EKG) or a chest X-ray might be required.
It is acceptable to shower the night before or morning of the
operation. The rectum and colon must be completely empty before
surgery. Usually, the patient must drink a gallon of a special
cleansing solution and may be required to undergo several days
of clear liquids, laxatives and enemas prior to the operation.
Oral antibiotics commonly are prescribed. Your surgeon or his/her
staff will give you instructions regarding the cleansing routine
to be used. Follow your surgeon's instructions carefully. If you
are unable to take the preparation or the antibiotics, contact
your surgeon. If you do not complete the preparation, it may be
unsafe to undergo the surgery and it may have to be rescheduled.
While many medications can be continued as usual, drugs such as
aspirin, anti-inflammatory, blood thinners and insulin are examples
of medications that may have to be decreased or temporarily stopped.
Ask your surgeon about any medications you currently are taking.
In a small number of patients, the laparoscopic method does not
work effectively. Factors that may increase the possibility of
choosing or converting to the "open" procedure may include
obesity, a history of prior abdominal surgery causing dense scar
tissue , an inability to visualize organs or bleeding problems
during the operation. The decision to perform the open procedure
is a judgment decision made by your surgeon either before or during
the actual operation. The decision to convert to an open or conventional
procedure is strictly based on patient safety.
As with any operation, there is the risk of a complication. However,
the risk of one of these complications occurring is no higher than
if the operation were performed with the conventional open technique.
There is a slight risk of bleeding or infection, which is present
with any operation and an even smaller risk of a leak where the
colon was connected back together. Injury to adjacent organs such
as the small intestine, ureter, or bladder or blood clots to the
lungs are possible complications as well. It is important for you
to recognize the early signs of possible complications. Contact
your surgeon if you notice severe abdominal pain, fevers, chills
or rectal bleeding.
After the operation, it is important to follow your doctor's instructions.
Although many people feel better in just a few days, remember that
your body needs time to heal. You are encouraged to be out of bed
the day after surgery and to walk. This will help diminish the
soreness in your muscles. You will probably be able to get
back to most of your normal activities in one to two weeks time.
These activities include showering, driving, walking up stairs,
work and sexual intercourse. If you have prolonged soreness, or
drainage from any of your incisions, and are getting no relief
from the prescribed pain medication, you should notify your surgeon.
You should call and schedule a follow-up appointment within
two weeks of your operation.
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When
small pockets first develop in the walls of the colon, most
people experience no discomfort. Only until mild pain and slight
tenderness surface — predominantly on the left side of the
lower abdomen — do most people learn they have diverticulitis,
as these pouches have become inflamed or infected.
As this pain
becomes more severe, frequent and accompanied by other symptoms
that usually include fever, nausea, vomiting, diarrhea, cramping
and constipation, many people are choosing to undergo advanced
minimally invasive surgery before this chronic form of diverticular
disease requires emergency attention.
This breakthrough colon resection
procedure involves removing a portion of the affected colon through
tiny incisions and then reconnecting both remaining ends. As a
result, patients experience less pain, heal better and recover
quicker than undergoing the traditional, open surgical method,
which could require a colostomy before the descending colon can
be rejoined during a second operation.
Many times, diverticulitis
can be effectively managed through increasing fiber in the diet
or antibiotic treatment, according to colorectal surgeon Roy Dressner,
D.O., who is among several specially trained practitioners performing
the advanced technique at The Center for Minimally Invasive Surgery
at Monmouth.
“But when symptoms persist for a prolonged time, we’re finding
that this new surgical procedure is emerging as an effective option,
particularly before the condition requires emergency surgery,” he says.
To
determine whether a patient is candidate for the surgery, a complete
medical history and a physical examination are conducted, including
any necessary diagnostic testing.
“When we recommend the surgery, patients usually are less hesitant to
undergo the procedure, particularly after we tell them about how
it is performed without open surgery,” says colorectal surgeon Glenn
Parker, M.D. “And
in most cases, patients can return home after a hospital stay of
several days.”
In an elective setting, it is now possible
to perform the procedure through a few small incisions, each measuring
about one-quarter inch in length, explains laparoscopic surgeon
Frank J. Borao, M.D., FACS, the center’s medical director. “This
type of surgery aims to keep attacks from coming back and to prevent
complications,” he
says, adding that the procedure also may be recommended for complications
of a fistula or intestinal obstruction.
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Colonoscopy is a safe and effective
means of examining the entire colon and rectum using a flexible
fiberoptic instrument and performed in the Medical Day Stay unit
at Monmouth Medical Center.
During colonoscopy the lining of the colon and rectum can be evaluated
for diseases including colitis, polyps, cancer, diverticulosis
and other abnormalities. Biopsies and removal of polyps can be
performed during this procedure.
A colonoscopy may be recommended for patients to screen for colon
polyps or cancer. It can be used to diagnose cause of bleeding,
changes in bowel habits or unexplained abnormal pain. It is also
used to monitor patients with a past history of colon polyps or
cancer.
To perform colonoscopy the bowel must first be cleansed of all
residue. This can be done with a "bowel prep" one day
prior to the procedure.
The patient is generally mildly sedated and the colonoscope is
then passed into the colon and gently advanced to the right side
of the colon where the small intestines enter. During the procedure
biopsies may be taken and polyps can be removed as necessary. The
entire procedure usually takes less than one hour and recovery
takes little time. Most patients can resume a normal diet later
in the day.
Colonoscopy is beneficial in removing polyps before they become
cancerous, therefore preventing cancers from occurring. The American
Cancer Society recommends that men and women at average risk begin
screening for colorectal cancer at age 50. People at higher risk,
such as those who have had colorectal polyps or inflammatory bowel
disease or those with a family history of colorectal cancer may
need to have colonoscopy done earlier and more often.
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The J- pouch procedure
is the common name used for the operation that removes the entire
colon and rectum, and replaces the rectum with a neorectum (a new
rectum). Developed in the 1970s, this surgery eliminates the need
for an external pouch to collect waste.
The neorectum is a pouch made from the last portion of the small
intestine (the ileum), which is connected to the anus. This connection
is called an anastomosis.
The two common indications for the J-pouch procedure are
familial polyposis and ulcerative colitis. People with familial
polyposis require a J-pouch procedure to prevent colorectal cancer
from developing in their polyps. People with ulcerative colitis
are generally "cured" of their colitis after the J-pouch
procedure, as well as eliminating their risk of colorectal cancer.
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The goal of surgical
management of rectal prolapse is to correct the anatomical defect
and to restore normal bowel function with a procedure that has
minimal morbidity and an acceptable recurrence rate.
Generally,
prolapse repairs are categorized into abdominal and perineal approaches.
Abdominal repairs may be performed with an open or laparoscopic
technique. These operations may be categorized as resection alone,
rectopexy with resection, and rectopexy alone. Perineal repairs
include perineal rectosigmoidectomy and Delorme repair.
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