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Minimally Invasive Surgery - Surgery of the colon (large intestine)

There are benign and malignant (cancerous) diseases of the colon, for which surgery is needed.

The most common benign disease of the colon is called diverticulosis. Diverticulosis is the formation of small 1/8 inch pockets in the colon wall that happens to nearly half of all people by age 60 (show picture). Having them can mean that one can develop infections when these pockets get clogged with stool and they burst. This is called diverticulitis. Most often, the diverticula burst and cause infection right next to them. Patients with diverticulitis have fever, significant pain and will often need intravenous antibiotics. Most of the time, it is successfully treated in this way. However, this problem can happen multiple times to the point where part of the colon needs to be removed to prevent it from happening again. The most common place for this to happen is in the sigmoid colon—the part of the colon just before the rectum (see picture). Once it has been decided that surgery is needed to prevent future attacks of infection, it can be planned. Before surgery a colonoscopy is mandatory to ensure there is no polyp or cancer. The operation itself is performed with a few small ½ inch incisions across the abdomen. The diseases part of the colon is removed and the ends are reconnected. In specific situations, a temporary bag may be necessary for safety reasons. Regardless, the operation is usually performed laparoscopically and a small 3 inch incision is made to be able to remove the diseased part of the colon. Most patients are able to eat within 2 – 3 days and are often home by the 4th or 5th day after surgery. Pain is significantly less, as is the risk of infection of the wound and developing a hernia of the incision.

Polyps are overgrowths of the lining of the colon which can turn into cancer—depending on the type. These are typically removed during colonoscopy. On occasion, they cannot be removed this way and must be treated as if they harbor a small cancer. Likewise a true cancer of the colon will also need to be removed—if caught early enough. Once these have been seen, patients are evaluated by their surgeon to ensure there has been no spread of the cancer. Then the operation can be performed laparoscopically in many cases. Similary to diverticulitis, the section of the colon containing the poly or cancer is removed and the two ends are reconnected. In specific situations, a temporary bag maybe necessary for the safety of the patient. The benefits of laparoscopy allow the patient to experience less pain, recover faster and leave the hospital sooner compared to conventional surgery.

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