Laparoscopic surgery of the small bowel
Crohn’s disease, small bowel obstruction, carcinoid tumours, adenocarcinoma, benign tumours are some of the surgical conditions that affect the small bowel. Patient experiences symptoms such as abdominal cramping and pain, nausea, rectal bleeding and unexplained weight loss. Before the surgery CBC, C-reactive protein and BUN studies are conducted. A chest and abdominal radiographs are obtained. Chest radiographs will allow placement of the central venous catheter and abdominal radiographs help in the preliminary evaluation of the status of the bowel. Upper GI series is conducted along with x-rays after insertion of liquid barium into the intestines. Endoscopy is done with a thin tube and camera fitted at the end of a tube that is inserted down the throat for examination of the small bowel. Pictures are taken and transmitted to a computer for analysis.
As part of the digestive tract, the large intestine or colon stores food waste and soaks up water. A tubular muscle-like organ, it has a lining of cells and is approximately 6 feet in length. At the end of the colon is about 6 inches of rectum. A colectomy is performed to remove part of the colon or all of it.
There are several types of colectomies:
Low anterior resection – Removal of the sigmoid colon and part of the rectum
Right hemicolectomy – Partial or complete removal of the cecum and ascending colon
Left hemicolectomy – Partial or complete resection of the descending colon
Sigmoid colectomy – Complete or partial removal of the sigmoid colon
Abdominal perineal resection – The entire rectum and anus are removed along with a portion of the sigmoid colon
Some conditions that warrant a colectomy are polyps, cancer, diverticulitis, volvulus, IBD, bleeding, blockage and rectal prolapse. Colorectal diseases usually cause abdominal pain and bleeding from the rectum is observed. Diarrhoea, constipation, stool size changes, weight loss, vomiting, cramping and fever are also indications of colorectal disease.
A heart EKG, chest x-ray, relevant blood tests and physical examination are conducted before the surgery. Patients are advised to stop medications such as Coumadin or Plavix, which are essentially blood thinners.
Patient is administered general anaesthesia before the procedure. The technique of laparoscopic surgery is a minimally invasive surgery that involves the use of trocars that are passed through about 3 incisions. The incisions measure about 0.5 cms and are done after the abdomen is insufflated with carbondioxide. A camera is affixed to one of the trocars for internal visualization. One of the incisions is slightly enlarged and special instruments are inserted for the resection of the small bowel or to perform a colectomy. Patient’s vital signs are monitored all through the surgery.
Dr. Deepak scrupulously advises each and every patient on post-surgical care following surgery. Follow-up is a significant part of the routine.