Laparoscopic Colorectal Surgery

These are operations which often involve the removal of a part or sometimes the entire large bowel. The large bowel consists of the colon and the rectum and is illustrated in the diagram below.

Although these operations are often performed using the traditional ‘open’ method with a large cut across the abdomen, the laparoscopic (key-hole) method has the advantage of causing less post operative pain and patients are able to return to full activity in a shorter time.

The operation involves three or four small cuts in the abdominal wall through which the camera and operating instruments are inserted and then a moderate sized cut is made through which the resected bowel is removed. The two ends of bowel are then joined back with sutures or a special stapling device.

 

Before the operation

You will be seen in the clinic and will have opportunity to go through the details of the operation including the intended benefits, alternative procedures and potential risks.

Your general health will also be assessed (usually at a separate clinic appointment) with some simple tests and you will be reviewed by the anaesthetist either in this clinic or when you come in for your operation.

You will usually come into hospital a day before the operation.

Bowel preparation (cleansing with laxatives) is not usually required and you can usually eat and drink as normal until about six hours prior to the intended time of the operation. It may be recommended that you have a low residue diet for a couple of days before the operation.

 

After the operation

You will have a few small wounds on your tummy and one larger wound (about five cm, [two inches]); these will all have dressings over them. Any stitches or clips that do not dissolve will be removed after about a week (a community nurse will usually do this) 

You will have a tube in your bladder (catheter) to help to empty your bladder and ensure that the kidneys are working adequately immediately after the operation.

There will be a drip in one of the veins of your arm which will give you fluid and may be used for giving you pain relief. The other way that pain can be controlled is by using an epidural (tube into your back). The Anaesthetist will discuss these options with you before the operation.

You will usually be allowed to drink later in the day of your operation, gradually building up to a full diet over the next couple of days.

It is sometimes necessary to perform a stoma (bowel diverted to a bag on your skin) with some of these procedures. Most of these are temporary and can be ‘reversed’ at a later date. 

You will be able to get up and about the day after your procedure and should be home in about 3 - 5 days.

A follow up appointment will be arranged at the time of discharge.

 

Risks and Benefits of Laparoscopic Colorectal Surgery

The laparoscopic technique is technically more challenging, often takes a little more time to perform and requires specialised training and expertise.

The benefits of the laparoscopic technique are a shorter hospital stay (usually about 3 - 5 days), smaller scars and reduced pain.

There are risks associated with this procedure like any other surgical operation.

These include risk of anaesthetic and other general risks such as bleeding and infection.

There are also risks of a deep vein thrombosis with many surgical procedures but measures are taken to minimise this risk. These include special ‘anti-thrombosis’ stockings, an injection to thin the blood slightly to prevent it ‘clogging up’ and most importantly getting the patient to mobilise early after the operation which helps to keep the blood flowing through the legs and prevents thrombosis. The laparoscopic technique often allows the patient to mobilise quicker than with the traditional open technique and thus has an obvious advantage. Early mobilisation may also help to prevent chest infections and improve early return to normal bowel activity after the operation.

Sometimes it may technically not be possible or unsafe to complete the operation by the ‘key-hole’ approach and thus become necessary to convert to a more traditional open operation.

A relatively uncommon but serious complication of both open and key-hole bowel surgery is a leak from the anastomosis ‘joint’ where the two ends of bowel are joined together. This can lead to peritonitis and will usually require an operation to repair.

Haemorrhoidopexy

Stapled haemorrhoidopexy (PPH). Read what NICE has to say about this procedure by clicking here.

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