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 What are the Laparoscopic Colon Surgery Procedures and  how is they done?

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?
In most laparoscopic colon surgeries, surgeons operate through 3 or 4 small openings. A small video camera is inserted for a magnified view of the patient's internal organs, the video is displayed on a television monitor. Several other surgical tools are inserted to allow the surgeon to work inside and complete the surgery. In some cases one of the small openings may be lengthened to 2 to 3 inches to complete the procedure.

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?
In general the hospital stay is usually a 2 to 3 day stay compared to a 5 to 7 day stay for an open procedure. The patient's are able to take liquids on the same day that their surgery is completed and they are usually discharged home 2 to 3 days following the procedure. 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
  • 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 usually a 2 to 3 day stay compared to a 5 to 7 day 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
  • Cancer treatment can be initiated sooner, i.e. 2 to 3 weeks following the surgery as opposed to 2 to 3 months following open procedure

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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This information is not intended to take the place of your discussion with your surgeon about your need for colon surgery. If you have questions about your need for a colon operation, your alternatives, the cost of the procedure, billing or insurance, or your surgeon's training and experience, do not hesitate to ask your surgeon or his/her office staff about it. If you have questions about the operation or subsequent follow-up, please discuss them with your surgeon before or after the operation. Terms of Use