Laparoscopic Colectomy

Laparoscopic colectomy is an operation in which the diseased part of the large bowel (colon) is removed through a few small incisions in the abdominal wall, with the help of a camera. It is commonly known as “keyhole surgery”. Instead of a large incision as in open surgery, a few small entry points, usually 0.5–1 cm in size, are used.

In the operation, it is usually not the whole large bowel but only the diseased part that is removed. The remaining healthy ends are joined together; this is called an anastomosis (joining of the bowel ends). Thanks to the small incisions, pain after the operation is generally less and in most patients the return to daily life takes less time.

Laparoscopic colectomy can be used in the treatment of various diseases affecting the large bowel. The main reasons are:

• Colon cancer (large bowel cancer): the part of the bowel containing the tumour is removed together with the surrounding lymph nodes.
• Diverticulitis (inflammation of small pouches in the bowel wall): in recurrent cases or cases with complications, the diseased part may be removed.
• Inflammatory bowel diseases: in inflammatory diseases such as Crohn’s disease or ulcerative colitis, surgery may be needed when there is no response to medication.
• Large polyps that cannot be removed endoscopically: for polyps that carry a risk of becoming cancerous and cannot be removed during colonoscopy, the relevant part of the bowel may be removed.
• Some other conditions such as bowel obstruction or bleeding.

The keyhole method may not be suitable for every patient. Factors such as previous abdominal operations, extensive adhesions inside the abdomen or the stage of the disease affect the choice of method. Which method is suitable for you is decided together with your doctor after assessing your examination and test results.

The operation is performed under general anaesthesia (you are fully asleep). Carbon dioxide gas is introduced into the abdomen to create a working space; this allows the surgeon to see the organs clearly.

• A few small incisions are made in the abdominal wall, and a camera (laparoscope) and special surgical instruments are inserted through them.
• The camera image is magnified and displayed on a screen; the surgeon carries out the operation guided by this image.
• The diseased part of the large bowel is freed from the surrounding tissues and, after its blood vessels have been safely sealed, removed.
• The remaining healthy bowel ends are joined together (anastomosis).

In some cases it may not be safe to join the bowel ends straight away. In this case a temporary or permanent stoma (bringing the bowel out through an opening in the abdominal wall, commonly called a “bag”) may be needed. If this is a possibility, your doctor will discuss it with you in detail before the operation.

If it is considered necessary during the operation for reasons of visibility or safety, the keyhole method may be converted to open surgery. This is not a failure but a decision taken for patient safety.

As with any surgical procedure, laparoscopic colectomy carries some risks. Most of these are rare and a large proportion can be treated:

• Bleeding and the need for a blood transfusion
• Wound infection or infection inside the abdomen
• Anastomotic leak (leakage from the joined bowel ends); this may require a further procedure
• Injury to surrounding organs (such as the small bowel, bladder or ureter)
• Blood clot formation in the leg veins and a clot travelling to the lungs
• Delayed return of bowel movement (temporary sluggish bowel)
• Risks related to anaesthesia
• The need to convert to open surgery

If symptoms such as fever, increasing abdominal pain, redness and discharge at the incision sites, vomiting or inability to pass wind or stool occur after the operation, it is important to contact your doctor or the hospital without delay.

Today, many centres use an approach called ERAS (enhanced recovery after surgery). The aim of this approach is to minimise the stress of the operation on the body and to support recovery. Simply put, it includes steps such as shortening long fasting times before the operation, getting up early after the operation, starting to eat and drink early and controlling pain effectively.

After colectomy by the keyhole method, the hospital stay is usually a few days; this period may vary according to the disease, the extent of the operation and your general health. After discharge:

• It is recommended that you avoid heavy lifting and strenuous exercise in the first weeks.
• Eating is usually returned to normal gradually; it is important to follow the advice of your doctor and, if necessary, a dietitian.
• Follow the plan you have been given regarding care of the incision sites and follow-up appointments.

If the operation was carried out because of cancer, the removed tissue is sent for pathology examination. Depending on the result, whether additional treatment (for example chemotherapy) is needed is assessed together with the relevant departments, and a regular follow-up plan is drawn up.