Procedure Introduction
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 is often the best way to stop
the spread of disease and alleviate pain and discomfort. Under
the traditional "open" style of surgery, patients
often face a long and difficult recovery because the procedures
are highly invasive. In most cases, surgeons are required to
make a long incision. Open surgery results in an average hospital
stay of 5-8 days and usually 6 weeks of recovery.
Now, a new technique known as minimally invasive laparoscopic
colon surgery allows surgeons to perform many common
colon procedures through small incisions. Depending on the type
of procedure, patients may leave the hospital in a few days
and return to normal activities more quickly than patients recovering
from open surgery. The New England
Journal of Medicine has concluded that: Laparoscopic
Surgery a Good Alternative for Some Colon Cancer Patients:
The study reported that patients with colon cancer experienced
similar rates of cancer recurrence whether they were treated
with laparoscopically assisted surgery or conventional open
abdominal surgery (open colectomy) in a large randomized clinical
trial. The trial’s investigators concluded that laparoscopically
assisted surgery is an acceptable, less invasive alternative.
However, they caution that not all patients with colon cancer
will be appropriate candidates for the laparoscopic operation.
Source: New England Journal
of Medicine, May 13, 2004. What
is Laparoscopic Colon Resection?
In most laparoscopic colon resections, surgeons operate
through 4 or 5 small openings (each about a 1/2 inch) 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.
If the cancer is larger, the doctor will perform a partial
colectomy (removing the cancer and a small amount of healthy
tissue around it). The doctor may then perform an anastomosis
(sewing the healthy parts of the colon together). The doctor
will also usually remove lymph nodes near the colon and examine
them under a microscope to see whether they contain cancer.
Resection and colostomy: If the doctor is
not able to sew the 2 ends of the colon back together, a stoma
(an opening) is made on the outside of the body for waste
to pass through. This procedure is called a colostomy. A bag
is placed around the stoma to collect the waste. Sometimes
the colostomy is needed only until the lower colon has healed,
and then it can be reversed. If the doctor needs to remove
the entire lower colon, however, the colostomy may be permanent.
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How is Laparoscopic
Colon Resection Performed?
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.
What
Preparation is Required?
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.
Preparing for surgery:
- 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 large volume (gallon)
of a special cleansing solution. (S)He may be on several
days of clear liquids, laxatives and enemas prior to the
operation.
- Antibiotics by mouth are commonly 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.
- Most medications can be continued as usual. Ask your surgeon
if you may continue yours. Drugs such as aspirin, anti-inflammatory,
blood thinners and insulin are examples of medications that
may have to be decreased or temporarily stopped.
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What Can I Expect After
Surgery?
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
2 weeks after your operation.
Advantages
of Laparoscopic Colon Resection
Results may vary depending upon the type of procedure and
patient's overall condition. Common advantages are:
- Less postoperative pain
- May shorten hospital stay
- May result in a faster return to solid-food diet
- May result in a quicker return of bowel function
- Quicker return to normal activity
- Better cosmetic results
What Happens if the
Operation Cannot be Performed or Completed by the Laparoscopic
Method?
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
- inability to visualize organs
- 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 (conventional)
procedure is strictly based on patient safety.
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