Colectomy
Know your options—a guide to minimally invasive procedures (MIP) for colectomy
What is colon surgery?
During colon surgery small length of affected and part of the unaffected colon on either side is removed through an incision in the abdomen. Sometimes, the nearby lymph nodes are also removed. In addition, your surgeon will check your intestine and liver to see the disease has spread. The two ends of the colon are then sewn back together.
Sometimes, the surgeon cannot reconnect the colon. In this case, a new opening, or stoma, leading to the outside of the abdomen is created. The intestine is then connected to the stoma, where a bag is attached to collect body waste. This is called a colostomy, and, in most cases, a colostomy is only temporary.
When is colon surgery needed?
60 to 70 million Americans are affected by digestive diseases, including cancer, inflammatory bowel disease and diverticular disease. In 2002, about 6 million people underwent a diagnostic or therapeutic procedure for colon disease including surgical treatment. Learn more about some of the specific diagnoses of colon disease.
Know your options: MIP for colon surgery
Advancing technology and research have transformed surgery for the treatment of colon cancer in recent years. In the past, most patients underwent "open" surgery for colon cancer. However, patients now have a second surgery option: laparoscopic surgery, also known as a Minimally invasive colon surgery. Minimally invasive colon surgery has been shown to be as effective as open surgery, while offering many benefits over the open procedure, including:
- A quicker recovery time
- A shorter hospital stay
- Less pain
- Less scarring
MIP for colon surgery
- Hospital stay = 5 days
- Pain medication = 3 days
- Scar 1/4 to 4 inches
- Recovery time = 4 weeks
Open surgery
- Hospital stay = 6 days
- Pain medication = 4 days
- Scar up to 12 inches
- Recovery time = 6 to 8 weeks
How does MIP for colon surgery work?
| Open colon surgery | Minimally invasive colon surgery |
|---|---|
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Know the risks
As with any surgical procedure, there are risks that accompany open and laparoscopic colon surgery. This is why it is important to weigh the benefits of the surgery against the risks.
Complications are unplanned events, such as excessive bleeding, infection, or reaction to anesthesia. Some of the risks can be seen in any type of surgery. Infection, deep or at the skin level, can occur. Infections can involve the abdominal incision. Deep infections, known as peritonitis can occur and may involve the abdominal cavity. These deep infections may require long-term antibiotics and perhaps additional surgery. Bleeding during or after the operation may require a blood transfusion or additional surgery. Painful or ugly skin scars are always a possibility.
Colon surgery problems that can occur include the following:
- Damage to the spleen
- Perforation of the stomach and/or intestines
- Injury to the urinary bladder and the connecting tubes
- Injury to the internal female organs including the uterus and ovaries
- Unexpected difficulties resulting in a temporary or permanent colostomy
- Hernias through the incision or incisions
- Abdominal wall disruption or breakdown that would require additional surgery
It is important to discuss possible risks and complications with your surgeon prior to your operation.
Complications from an open surgery include, but may not be limited to:
- Muscle stripping
- Organ failure
- Blood clotting
- Injury to blood vessels
Because of the larger incision, patients undergoing open surgery typically require a longer recovery period.
Some complications from MIP for colon surgery include, but may not be limited to:
- Bleeding
- Perforation of organs
- Injury to blood vessels
- Trocar injuries
- Infection
Talk to your doctor
Patients interested in minimally invasive colon surgery for colon cancer should find a surgeon who is experienced in minimally invasive colon surgery. Following is a list of questions you should discuss with your surgeon to determine whether he/she is qualified to perform the procedure and if you are a likely candidate for this type of surgery.
- Do you perform minimally invasive colon surgery?
- Are you board certified? Which board? Which state? (Surgeons should be certified by a national surgical board approved by the American Board of Medical Specialties.)
- How many laparoscopic colon surgeries have you performed overall? (Based upon the COST11 trial, pre-requisite experience should include at least 20 laparoscopic colorectal resections for benign colon disease or metastatic colon cancer before using the technique to treat curable cancer.)
- Have you received advanced training in laparoscopic surgical techniques?
- What have you seen in terms of patient outcomes with this procedure?
- What is the most common complication you have encountered with this procedure?
- Am I a candidate for a laparoscopic colon procedure?
- What are the benefits of minimally invasive colon surgery?
- What are the risks associated with this procedure?
- What will my recovery time be like following this procedure?
Colon cancer
Colon cancer is one of the most common types of cancer, but, if detected early, it also is one of the most treatable. Many scientific advances have been made in recent years, and now, more than ever, doctors are armed with the tools necessary to help you effectively combat this disease.
Understanding what colon cancer is, and knowing your treatment options, will help you take an active role in making decisions about your care.
Symptoms of colon cancer
Colon cancer does not always cause symptoms, especially at first. But sometimes there are symptoms, such as:
- Blood in or on the stool
- Unexplained and frequent pain, aches, or cramps in the stomach
- A change in bowel habits, such as having stools that are narrower than usual
- Unexplained weight loss
If you have any of these symptoms, talk to your doctor. These symptoms also may be caused by something other than cancer, but the only way to know what is causing them is to see your doctor.
Screening for colon cancer
When diagnosed and treated in the early stages, between 80 and 90 percent of patients with colorectal cancer return to their normal health. The key is early detection because it is treatable in its early stages. If everyone aged 50 and older had regular colorectal cancer screening tests, more than one third of deaths from this cancer could be avoided.
You should begin screening for colorectal cancer soon after turning 50 and continue at regular intervals. However, you may need to be tested earlier or more often than other people if:
- You or a close relative have had colorectal polyps or cancer
- You have inflammatory bowel disease
Talk to your doctor about when you should begin screening and how often you should be tested.
Polyps
Non-cancerous colon polyps are mushroom-shaped abnormal growths that line the large intestine and protrude into the intestinal canal. Polyps are one of the most common conditions affecting the colon and rectum, occurring in 15 to 20 percent of adults.
Symptoms of polyps
Most polyps produce no symptoms and often are found incidentally during an endoscopy, or X-ray of the bowel. Some polyps, however, can produce bleeding, mucus discharge, alteration in bowel function, or in rare cases, abdominal pain.
Types of colon polyps
Enough is now known about polyps that physicians generally place patients in one of three categories:
- The "ordinary" polyp —
- Most sporadic polyps occur between the ages of 40 and 60. There may be only one or two present, and they may take 10 years or more to become cancerous. There is a hereditary link.
- Familial adenomatous polyposis (FAP) —
- This is a true hereditary condition in which the entire colon is studded with hundreds, even thousands, of polyps. They begin early, even under the age of 10 years. Virtually every patient with this condition will eventually develop colon cancer. The only known preventive treatment is surgical removal of the colon. Fortunately, the condition is not common.
- Lynch syndrome (hereditary non-polyposis colorectal cancer) —
- This disorder is more common than familial adenomatous polyposis, but less so than the ordinary polyp. There is a strong tendency for adenoma-type polyps to occur in close blood relatives, such as sisters, brothers, aunts, uncles and children. More polyps are seen, and they are seen at an early age. Polyps, and even cancer, occur at earlier ages: in the 40s, the 30s, and even in the 20s. In some families, there is also an increased incidence of breast, ovarian and other cancers. A family history of this type warrants very close surveillance of all direct blood relatives.
The importance of screening for polyps
Because non-cancerous colon polyps can develop into colon cancer, screening and early detection are important for helping people with colon polyps detect and treat them.
Screening for colon polyps is important for two reasons:
- Early detection and removal of colon polyps will prevent their subsequent development into colorectal cancer
- The detection of localized polyps, even in patients with no symptoms, will increase the surgical cure rate for colon polyps
Crohn's disease
Crohn's disease affects between 500,000 and 2 million individuals in the United States. It can occur anywhere in the digestive tract and may recur over the course of a lifetime. It is a chronic inflammation of the digestive tract, most commonly affecting the last part of the small intestine and/or large intestine (colon). Crohn's disease also may be called ileitis or enteritis.Diagnosis of Crohn's disease can be difficult because its symptoms are similar to those of other intestinal disorders, such as irritable bowel syndrome and ulcerative colitis.
Symptoms of Crohn's disease may include:
- Cramping
- Abdominal pain
- Diarrhea
- Fever
- Weight loss
- Bloating
- Anal pain or drainage
- Skin lesions
- Rectal abscess
- Fissure
- Joint pain
Bleeding may be serious and persistent, leading to anemia. Children with Crohn's disease may suffer delayed development and stunted growth. Nutritional deficiencies also may occur, caused by inadequate dietary intake, intestinal loss of protein or poor absorption.
Crohn's disease also may cause sores, or ulcers, that tunnel through the affected area into surrounding tissues, such as the bladder, vagina or skin. The areas around the anus and rectum often are involved. The tunnels, called fistulas, are a common complication and often become infected. Sometimes fistulas can be treated with medicine, but in some cases they may require surgery.
Causes of Crohn's disease
The exact cause of Crohn's disease is not known. It is not contagious, but does have a slight genetic tendency. About 20 percent of people with Crohn's disease have a relative, most often a brother or sister, and sometimes a parent or child, with some form of inflammatory bowel disease.
Crohn's disease is marked by an abnormal response by the body's immune system. The immune system reacts inappropriately, mistaking food, bacteria, and other materials in the intestine as foreign or invading substances. In the process, the body sends white blood cells into the lining of the intestines, where they produce chronic inflammation. These cells then generate harmful products that ultimately lead to ulcerations and bowel injury.
The importance of screening for Crohn's disease
Crohn's disease can be difficult to detect because symptoms may resemble those of irritable bowel disease or ulcerative colitis. A diagnosis of Crohn's disease is typically made using flexible sigmoidoscopy or colonoscopy.
Ulcerative colitis
Ulcerative colitis is an inflammation that occurs in the innermost lining (mucosa) of the colon and/or rectum, affecting between 500,000 and 2 million individuals in the United States, predominantly under age 30.
Tiny open sores, or ulcers, form on the surface of the lining of the colon and/or rectum, where they bleed and produce pus and mucus. The inflammation usually begins in the rectum and lower colon, but may also involve the entire colon.
Symptoms of ulcerative colitis may include:
- Rectal bleeding
- Abdominal pain
- Bloating
- Constipation or diarrhea
- Weight loss
- Fatigue
- Fever
In cases of severe bleeding, anemia also may occur. Children with ulcerative colitis may fail to develop or grow properly
The symptoms of ulcerative colitis tend to come and go, with fairly long periods between flare-ups, during which patients may experience no distress at all. These periods of remission can span months or even years, although symptoms do eventually return.
Causes of ulcerative colitis
Studies indicate that ulcerative colitis involves a complex interaction of factors including family genes, the immune system and something in the environment.
Foreign substances (antigens) in the environment may be the direct cause of the inflammation, or they may stimulate the body's defenses to produce an inflammation that continues without control.
Researchers believe that once the immune system of the patient with ulcerative colitis is "turned on," it does not know how to properly "turn off" at the right time. As a result, inflammation damages the intestine and causes the symptoms of ulcerative colitis.
Diverticular disease
Diverticula are pockets that develop in the colon wall, usually in the sigmoid, or left colon, but may involve the entire colon. They affect about 50 percent of Americans by age 60, and nearly 100 percent by age 80.
Infection can lead to complications, such as swelling or rupturing of the diverticula, abscesses, bowel blockage or leaks through the bowel wall. If one of the pockets becomes infected and inflamed, bacteria may enter small tears in the surface of the bowel, leading to small abscesses. In rare cases, the infection spreads and breaks through the wall of the colon, causing peritonitis or abscesses in the abdomen. Such infections are very serious and can be life-threatening unless treated without delay.
Screening for colon disease
The key to early detection of colon disease is your willingness to seek medical attention. Generally, a physician will first take a detailed medical history. Your medical history will identify the presence of risk factors for colon disease. If your physician suspects colon disease, you may undergo one or more of the following screening tests:
- Flexible sigmoidoscopy:
- This is a visual exam of the rectum and lower colon using a lighted, flexible endoscope. It allows for the direct detection of colon tumors. Sigmoidoscopy detects 70 to 85 percent of all advanced lesions in the entire colon. One clinical study of the effectiveness of sigmoidoscopy in detecting potentially cancerous polyps found that it reduced the risk of developing colon cancer by 70 percent.
- Colonoscopy:
- This procedure examines the entire five to six feet of the average colon. A physician inserts a long, flexible, lighted tube into the rectum and slowly guides it into the colon. The tube is equipped with a scope, or camera, that transmits an image of the inside of the colon so the physician can carefully examine its lining. The exam is usually done under sedation.
Often, if a physician sees a polyp during screening, he or she will remove it using the colonoscope. Clinical trials have shown that screening for and removal of polyps using colonoscopy lowers the incidence of colorectal cancer by 50 to 90 percent.
- Stool exams to detect occult (hidden) blood:
- Because large colon polyps and most colon cancers shed minute quantities of blood, examination of the stool for blood is an important procedure. This screening test is also known as a fecal occult blood test (FOBT). An analysis of the results of an FOBT screening shows that it can reduce mortality from colon cancer by 25 percent.
- Barium enema:
- This X-ray exam is an older exam that, at times, is still useful. Barium flows into the colon and X-rays are taken. The X-rays can outline the shadows of any signs of colon disease.
Currently, the American Cancer Society (ACS) recommends screening for colon disease using colonoscopy every 10 years, starting at age 50, for patients with no symptoms of colon disease. For patients who have symptoms of, or risk factors for, colon disease, more frequent screenings are recommended. In addition to a colonoscopy, the ACS recommends a FOBT every year, a flexible sigmoidoscopy every 5 years, or a DCBE every 5 years, starting at age 50.
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