Colorectal Surgery - Colectomy (bowel resection)

Dr Arvanitis, MMC Dept of SurgeryAt Monmouth Medical Center, we know that it’s results that matter. That’s why we’ve become the regional leader in the treatment of high risk colorectal cancer.

It’s why we created the Patricia Burton Burton High Risk Colorectal Cancer Program, which offers the only high risk familial colorectal cancer registry in New Jersey. And why we built the state’s only Multidisciplinary Gastrointestinal Tumor Team to meet monthly to review ongoing cancer care.

The fact is that we do it better. And we can prove it.
We not only perform more laparoscopic colorectal resections than any hospital in the region, we also have the region’s lowest conversion rate from laparoscopic to open colorectal surgery (4% at MMC vs. 15% nationally). Just a few of the reasons why we’ve earned the coveted Thompson 100 Top Hospitals Performance Leaders award.

Colorectal Surgical Videos - listen to Dr. Michael Arvanitis narrate the surgical procedures.

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 Laparaoscopic Colectomy Performed?

"Laparoscopic" and "open" colon surgery simply describe the techniques asurgeon 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 which 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 outof 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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