Some of the following surgical procedures are featured in the Video Gallery.
Colectomy (Bowel Resection)
What is Colectomy?
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.
About Laparoscopic Colectomy
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.
Are You a Candidate for Laparoscopic Colon Resection?
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.
How is Laparoscopic Colectomy Performed?
"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.
What are the Advantages of the Laparoscopic Approach to Colectomy?
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
How is the Need for Surgery Determined?
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 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.
What if the Surgery Cannot be Completed Laparoscopically?
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.
What are the Potential Complications?
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.
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 two weeks of your operation.
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Resection to Treat Diverticultis
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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Laparoscopic J Pouch Procedure
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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Abdominal Perineal Resection
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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