Large Bowel Resection
Numerous colon and rectal problems are amenable to laparoscopic resection. Problems related to Inflammatory Bowel Disease (such as Crohn’s Disease), Familial Polyposis, volvulus (twisting of the bowel), endometriosis, diverticular disease and other benign and malignant diseases of the colon can be treated with minimally invasive surgery. Laparoscopic colectomy for colorectal cancer is performed successfully at many institutions across the county.
The symptoms associated with benign and cancerous colon disease vary widely but include the following:
- Blood in stool
- Abdominal distention
- Abdominal pain
- Thinned (pencil-like) stools
Several studies or procedures can help your doctor make decisions:
- Endoscopy (video surveillance)
- Rule out cancer
- Evaluate for inflammation
- Diverticular disease
- Tissue biopsy
- Barium Enema
- Rule out cancer
- Kinking or twisting of the colon
- Stenosis or blockage
Laparoscopic colectomy is feasible for benign and cancerous lesions. Rectal cancers that are more than 5 cm above the end of the rectum may also be resected (low anterior resection) with preservation of continence. Patients with liver cirrhosis, problems associated with acute inflammatory bowel disease and problems with blood clotting make very high risk candidates for laparoscopy.
Open surgical procedures require an eight-inch incision on the abdomen. The laparoscopic approach involves making four half-inch incisions on the abdomen through which a camera and three instruments are placed. The colon to be resected is mobilized. One of the port sites is enlarged slightly, and the colon is removed.
The principles involved in removing portions of the colon are similar for many different operations involving benign and malignant disease. Procedures that may be performed laparoscopically include:
- Segmental colectomy
- Ascending colectomy (and ileocolectomy)
- Sigmoid colectomy
- Total abdominal colectomy
Patients recover much sooner after laparoscopic surgery. Generally, patients are discharged after only two to four days in the hospital. Return to activities can occur within three to seven days, compared to 2-4 weeks with an open approach. Wound infections and hernias occur less frequently with the laparoscopic technique. Also, much less pain has been reported with laparoscopic surgery.