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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:

MIP for colon surgery

Open surgery

How does MIP for colon surgery work?

Side-by-side comparison
Open colon surgery Minimally invasive colon surgery
  • During traditional, or open, surgery the surgeon makes an incision up to 12 inches long from the upper abdomen to the lower abdomen in order to view the colon and remove the diseased portions.
  • Because of the nature of this procedure, patients often face a healing process that results in a hospital stay of at least a week, with recovery time ranging from six to eight weeks.
  • During minimally invasive colon surgery, the surgeon makes a series of small incisions, from one quarter of an inch to four inches, in the patient's abdomen.
  • A small video camera, or "scope," is placed in one of the incisions, providing the surgeon with a magnified view of the patient's internal organs on a television monitor.
  • Surgical instruments are placed in the other incisions, allowing the surgeon to work inside and remove portions of the colon.
  • Minimally invasive colon surgery, has been shown to be as effective as open surgery, while offering many benefits over the open procedure. These benefits include: less pain and scarring, a quicker recovery time, a shorter hospital stay and better cosmetic results

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:

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:

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:

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.

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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:

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:

Talk to your doctor about when you should begin screening and how often you should be tested.

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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 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:

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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:

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.

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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:

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.

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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.

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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:

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.

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.


©2005 Ethicon Endo-Surgery, Inc.
a Johnson & Johnson company

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