Laparoscopic Colectomy

Dr Lockie is a Trained Cholectomy Specialist

About The Colon

The colon is the last part of the gastro-intestinal tract and its main function is to remove fluid and electrolytes from intestinal content to form a semi solid bowel motion, which is stored in the last part of the colon, until it can be evacuated at an appropriate time.

The colon which is around 1 meter long is predominantly fixed to the outermost parts of the abdominal cavity winding its way from the lower right side of the abdomen up into the upper portions and then across to the left before descending down into the pelvis where it becomes the rectum.

Advantages of Laparoscopy

Because the colon is not located at one particular point in the abdominal cavity to remove all or even part of the bowel requires access to a large part of the abdominal cavity and hence by traditional techniques requires a large incision or cut which may extend all the way from just below the breast bone to just above the pelvis.  Laparoscopic surgery generally allows access to the entire colon through multiple small incisions and by using special laparoscopic instruments all or part of the colon maybe removed and reconnected.

The 2 main diseases affecting the colon, which may necessitate its surgical removal, are bowel cancer and diverticular disease.  Both of these diseases may be diagnosed on colonoscopy, when it is performed to investigate symptoms such as abdominal pain, change in bowel habit or if blood is passed at the time of a bowel motion.

When a Colonoscopy is Required

Colonoscopy is also performed when an individual is at risk of developing bowel cancer such as when there is a strong family history of bowel cancer or if the patient is known to have polyps.  Most cancers develop from polyps and whilst most polyps can be removed at the time of colonoscopy, occasionally when they are very large the patient may have to have part of the bowel removed.

Diverticular disease, which is quite common especially as people get older for the most part, does not cause patients much problem.  Rarely does it require removal of the bowel unless secondary complications such as narrowing or severe infection occur.  Fortunately these complications are not common.

About A Colectomy

Surgically removing the bowel is known as a colectomy.  Most of the time the bowel can be rejoined which is known as an anastomosis, there are however some situations where there is a high risk that the join may leak and part of the bowel may have to be brought out onto the abdomen as a stoma.  Often if a stoma has to be performed it is only temporary and can be reversed by a second operation at a later date.  If you are going to have any bowel surgery it is important that you and your surgeon discuss these risks before your operation.  Our practice certainly considers this important.  It should be noted that the risk of leaking from an anastomosis or having a stoma are not related to whether the procedure is performed by traditional open or laparoscopic techniques and this has been proven in many studies.

A Combined Appraoch is Sometimes Required

Not all patients are suitable for a laparoscopic approach because of factors such as adhesions from previous surgery or infection, large or advanced bowel cancers, or cancers located low in the pelvis.  Often these factors can be identified prior to surgery but at other times they are discovered at the time of the surgery, in which case a traditional open approach may be taken.  In these situations often it is possible to do part of the procedure laparoscopically and part through a small open incision.  Because a small incision is virtually always required to remove the colon, sometimes a special larger port is placed through which the surgeon may place his hand but still work in a laparoscopic environment.  Hand assisted surgery may allow a colectomy to be performed in some situations not suitable for a pure laparoscopic approach, it is often quicker, and carries all the same benefits of a pure laparoscopic approach.

Overall the risks of laparoscopic or open colectomy are similar.  Laparoscopic colectomy has been shown however to result in less wound complications, shorter hospital stay, less pain relief requirements and a faster recovery and return to work and daily activities.  More recently studies have confirmed that in terms of treating bowel cancer, outcomes from laparoscopic colectomy are equivalent to traditional open techniques when performed by experienced laparoscopic surgeons.  It should be born in mind that laparoscopic colectomy is a technically challenging procedure and should only be performed by experienced and well trained laparoscopic surgeons specifically trained in laparoscopic colectomy.

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