Definition and Overview
A laparoscopic colectomy is a minimally invasive surgical procedure that removes the colon or a part of it. It is also referred to as colon resection or bowel resection. There are many types of the procedure according to which part of the colon is removed. These include:
Right hemicolectomy – All or part of the ascending colon as well as the cecum are removed. Afterwards, the colon is reconnected to the small intestine.
Left hemicolectomy – All or part of the descending colon is removed. Afterwards, the transverse colon is reconnected to the rectum.
Sigmoid colectomy – During a sigmoid colectomy, all or part of the sigmoid colon is removed. The surgeon then reconnects the descending colon to what remains of the rectum.
Who Should Undergo and Expected Results
A laparoscopic colectomy surgery is performed when the diseased part of the colon has to be removed due to:
Obstruction or blockage in the colon
Irritable bowel disease
For most patients, colon removal is enough to cure their medical condition and resolve the following symptoms:
Abnormal stool size
When compared to traditional open abdominal surgery, a laparoscopic colon removal surgery offers:
Faster colectomy recovery time
Shorter in-hospital stays
Less pain and bleeding from the incisions
However, not all patients are considered as good candidates for the procedure. Patients who have had previous abdominal surgery, are obese, or have advanced disease of the heart, lung, or kidney may not be qualified to undergo a laparoscopic procedure. In some situations, cancer can also be a disqualifying factor. Doctors will make a careful assessment of each patient and will order evaluative tests before recommending the surgery.
How is the Procedure Performed?
A laparoscopic colectomy is performed under general anaesthesia and requires the continuous monitoring of the patient’s blood pressure and breathing throughout the procedure.
It begins with the surgeon making several small incisions in the patient’s abdomen. One of these incisions is used to insert a tiny video camera while the others are for other special surgical tools that will be used to perform the procedure. The surgeon will also inflate the abdomen using carbon dioxide gas.
With visual guidance from a video screen, the surgeon uses the inserted tools to free the colon from the tissues that are holding it in place. The surgeon then suctions the colon through one of the inserted tubes to operate on it from outside the patient’s body. This may involve removing any diseased parts and repairing the remaining parts. If the surgeon only plans to remove a small part of the colon, he can also perform the procedure without bringing the colon out. The exact manner through which the procedure is performed depends on each individual situation or case.
Once the colon is repaired, the surgeon reinserts it into the patient’s body and reconnects it to the surrounding organs. There are many ways to reconnect the colon to allow the body to expel waste materials. These include:
Reconnecting the two remaining ends of the colon, which will restore normal bowel function.
Connecting the colon or small intestine to an abdominal opening (stoma). This will require patients to wear a bag outside of the opening to collect their stool.
Connecting the colon or small intestine to the anus. This becomes necessary when the rectum is also removed. This procedure allows patients to expel waste as normal, but they tend to have more frequent and watery stools.
After the procedure, the patient is taken to a recovery room until the anaesthesia wears off and then transferred to a regular hospital room where he will stay until he regains bowel function. Patients usually stay in the hospital for a couple of days up to a week. In general, however, colectomy recovery is shorter if the patient undergoes a laparoscopic procedure.
During the colectomy recovery period, patients are not able to eat solid foods at first. They will initially receive nutrition intravenously, before slowly transitioning to clear liquids. After a few days, the intestines are expected to recover and be able to digest solid foods.
After being discharged from the hospital, patients will still need to recover at home. It may take weeks before they can return to their normal activities.
Possible Risks and Complications
A colon resection surgery comes with certain risks. A patient’s overall risk of complications will depend on the state of his health prior to the procedure.
Potential complications of a colectomy include:
Deep vein thrombosis, or blood clot formation in the legs
Pulmonary embolism, or blood clot formation in the lungs
Injury to the bladder, small intestines, or other organs near the colon
It is also possible for the sutures connecting the colon to the other digestive organs to tear. This will require another procedure to repair the problem.
Generally, the risk of bleeding and infection is lower for laparoscopic colectomy patients due to the smaller incisions that are used during the procedure.
“Laparoscopic colectomy.” The Ohio State University, Center for Minimally Invasive Surgery. http://cmis.osu.edu/patient-care/colon/lapcolon/
Ahad S, Figueredo EJ. “Laparoscopic colectomy.” MedGenMed. 2007; 9(2): 37. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1994841/
Jaap Bonjer H, Deijen CL, Abis GA, Cuesta MA, et al. “A randomized trial of laparoscopic versus open surgery for rectal cancer.” The New England Journal of Medicine. 2015; 372:1324-1332. http://www.nejm.org/doi/full/10.1056/NEJMoa1414882#t=article