The Medical Minute: Laparoscopic colorectal surgery

By David B. Stewart

Laparoscopic surgery is a technique of modern surgical treatment that allows access to the abdominal cavity through multiple small incisions. A camera, called a laparoscope, lets the surgeon see the abdominal organs, and using special instruments that are inserted through small plastic ports called trocars, permits the surgeon to perform the same operation that traditionally was completed through a much larger incision. This provides for less postoperative pain, a faster recovery, and often a shorter hospital stay, while at the same time not compromising the quality or outcome of the surgery. Laparoscopic surgery has become a common approach for benign diseases of the colon and rectum and has developed an increasing role in the treatment of cancers of the colon, rectum, and anus.

Colorectal cancer – a common but potentially preventable problem

Cancers of the colon and rectum are, unfortunately, common and represent the second most common cause of cancer death in the United States. It is estimated that there will be approximately 150,000 new cases of colorectal cancer diagnosed in the United States annually, and there will be approximately 60,000 deaths from colorectal cancer each year. For most people, colorectal cancer starts off as a benign polyp. If polyps are found on screening colonoscopy before they become cancer, they can be removed, preventing the need for surgery and the risk of death from colorectal cancer. However, some polyps are too large to remove through colonoscopy, and other polyps have cancer within them and require additional treatment. Other patients have established cancers at the time of their colonoscopy. This group of patients requires surgery for adequate treatment.

The laparoscopic approach to colorectal cancer

The goal of colorectal cancer surgery is to remove the portion of bowel that contains the polyp or cancer and to remove the lymph nodes that drain that portion of the intestine to discover whether cancer has spread to the nodes and therefore would require chemotherapy after surgery. It is this removal of the colon and its lymph nodes that provide a stage for the patient’s cancer, telling the surgeon how advanced the cancer may be. Laparoscopic surgery for colorectal cancer follows the same principles as open surgery. The amount of bowel removed is based upon the surgeon’s knowledge of the primary blood vessels that serve the affected portion of the colon or rectum. Since the lymph nodes of interest follow the course of these blood vessels, it is important that the surgeon remove all of the nodes based upon the blood supply, so that a patient with a cancer does not receive a lower stage than they actually are. These principles allow for an accurate determination of the need for chemotherapy and a more precise prognosis.

How is laparoscopic surgery performed?

When the patient is asleep, multiple small incisions are created on the abdominal wall, most of which are 5 millimeters in size. Carbon dioxide gas is used to inflate the abdominal cavity, allowing the surgeon room to see and work. A camera is inserted, and special instruments allow the bowel to be handled gently and the blood vessels and lymph nodes to be detached along with the colon. One of the incisions, usually in the lower abdomen and in a discrete location, is enlarged to 4 to 6 centimeters in length. The segment of bowel with the disease is removed through this incision. The remainder of the surgery usually can be completed by closing this incision and continuing with a laparoscopic approach.

After surgery

Patients usually can begin eating solid food the first day after surgery and begin walking and being more active at that time. Supportive devices, such as bladder catheters, also can be removed this early. Once the patient has the return of bowel function, which is often on the second or third day after surgery, patients usually can be discharged home. In general, patients do not require any longer than one week of prescription pain medication and have almost no activity restrictions after discharge. The incidence of wound complications, such as infections and hernias, also is lessened due to the small size of the incisions.

What if I need colorectal surgery?

The most important decision regarding choosing a surgeon for colorectal disease is to choose someone with experience and specialization in the area of colorectal disease. Colorectal surgeons undergo additional training to learn the proper treatment of diseases such as colorectal cancer, and they undergo board certification as a mark of that training. Colorectal surgeons undergo rigorous instruction in the area of laparoscopic colorectal surgery, so that they are both safe and proficient in treating patients with these problems.

For more information, please visit Penn State Hershey Colon and Rectal Surgery online.

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Dr. David B. Stewart, assistant professor of surgery, Division of Colon and Rectal Surgery, Penn State Milton S. Hershey Medical Center
 

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Last Updated April 02, 2009