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Laparoscopic Colon Resection Surgery
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What is the Colon?
After food is chewed and swallowed, it passes to the stomach where digestion begins. The food moves to the intestines (long tubular organ). The first portion is called the small intestine where nutrients are absorbed. The remaining waste continues to the colon (large intestine) and rectum where water is absorbed. The waste is held here until it is expelled.
[back to top]What is Laparoscopic Colon Resection Surgery?
You may be asked to consider undergoing a surgical procedure. In the past, a large abdominal incision was made and resulted in significant pain after surgery. The average hospital stay is five to eight (5-8) days and recovery at home is six (6) weeks or more. With recent advances, the technique has been modified using a laparoscopic (advanced minimally invasive) approach that avoids the need for a large abdominal incision. Pain is significantly less. The length of in-hospital stay is 2-4 days and return to work can occur as early as 2-3 weeks. Your physician may recommend laparoscopic colon resection surgery.
In laparoscopic colon resection surgery, the patient is given general anesthesia. 3-6 small incisions are made in the abdomen. One is used for the laparoscope which is attached to a camera that sends images to a video monitor. The other incisions are used to insert instruments to hold or manipulate tissue in the abdomen. Carbon dioxide gas is inflated into the abdominal cavity to allow room to work and allow the surgeon to see. The diseased portion of the colon is identified and carefully dissected and removed. In some instances, one of the incisions may be lengthened. At the end of the surgery, carbon dioxide gas is removed.
What can I Expect to Happen Before Having Laparoscopic Colon Resection Surgery?
- Colonoscopy or barium enema tests. These tests permit the physician to look inside the colon (large intestine).
- CT scan of the abdomen may be ordered.
- Blood tests, electrocardiogram (EKG) or chest x-ray may be ordered.
Preparing for Surgery
- Shower/bathe the night before or morning of surgery.
- Follow the physician's or designee's instructons about the bowel cleansing routine (bowel prep). Tell the physician if the antibiotic or preparation has not be taken.
- Drink a large volume (gallon) of a cleansing solution to completely empty the rectum and colon.
- Drink clear liquids for several days.
- Receive laxatives and enemas before surgery.
- Take antibiotics by mouth as ordered.
- If the preparation is not taken, it may not be safe to undergo surgery. The surgery may be rescheduled.
- If taking medications daily, discuss with your physician prior to the morning of surgery the need to continue yours. Medications such as anti-inflammatory, aspirin, blood thinners, and insulin are examples of medications that may need to be decreased or temporarily stopped.
What are Expected Results After Having Laparoscopic Colon Resection Surgery Versus Having Large Abdominal Surgery?
- Decreased post operative pain
- Shortened hospital stay
- More rapid return to solid-food diet
- More rapid return to bowel function
- More rapid return to work
- Minimally sized incisions with a better cosmetic result
What are the Risks of Having Laparoscopic Colon Resection Surgery?
As with any surgery there are risks. The risk of one of these complications is usually no greater than if the surgery were done with the open technique. Complications that can occur are:
- Bleeding
- Infection involving the wound, blood or abdomen
- Injury to surrounding organs such as small intestine, ureter or bladder
- Leak where the colon was joined together
- Blood clots to the lungs
You should ask your surgeon any questions you have in regards to the risk and benefits of the procedure.
What Happens if Surgery Cannot be Performed by Laparoscopic Technique?
Sometimes it is not possible for the surgeon to use the laparoscopic technique because it may be difficult to see or handle organs safely. The surgeon decides to perform an open procedure either before or during the surgery. The surgeon may decide to convert the laparoscopic surgery to an open procedure in certain situations and for patient safety. Though very infrequent, when conversion to an open technique occurs, it should not be considered a failure of the procedure. Factors that might increase the possibility of changing to an "open" procedure are obesity, previous abdominal surgery causing dense scar tissue, inability to see organs or bleeding during surgery.
What can I Expect to Happen Before Having Laparoscopic Surgery?
- A thorough medical evaluation will be made by your physician. Several diagnostic tests may be needed. You may have blood tests, an electrocardiogram (ECG or EKG) or chest x-ray to check your heart and lungs. You and your physician will discuss whether or not this surgery will help you.
- Taking no food of liquids after midnight the night before the surgery. This decreases the risk of vomiting after you receive anesthesia.
- If taking medications daily, discuss the need to take them with your doctor prior to the morning of surgery (with a sip of water). If taking blood thinners, aspirin or arthritis medications, discuss the proper time to stop these before the surgery date (day).
- Speak with the anesthesiologist before surgery to discuss anesthesia and keeping you free of pain during surgery and pain management postoperatively.
- Arrange for someone to drive you to the hospital the day of surgery and take you home when you are discharged to go home from the hospital.
What can I Expect the Day of Surgery?
- Arrive at the hospital on the day and time you are instructed.
- Sign a written consent authorizing your physician to perform surgery.
- Receive a small needle/catheter in your vein to provide medication before, during and after your surgery.
- Receive preoperative medications as necessary.
- Undergo general anesthesia (asleep) prior to your surgery.
- Understand the procedure may last several hours.
- Going to the recovery room after surgery and having your blood pressure, pulse, and respirations closely monitored until you are fully awake.
- Going back to your room.
- Staying in the hospital the night of surgery and additional days as needed.
What can I Expect After Surgery?
- Engage in light activity at home.
- Experience mild post operative pain and having pain medication available as needed.
- Having a modified diet starting with liquids followed by gradually taking solid foods.
- Resume normal activities such as showering, stair climbing, working, lifting, driving and having sexual intercourse after discussing these with your physician.
- Call and schedule a follow-up appointment within one to two weeks after surgery. Schedule any additional follow-up appointments.
- Have any stitches removed depending upon the type your physician uses.
When Should I Call My Physician?
Make certain that you call your physician if you have any of the following symptoms:
- Worsening redness around the incisions
- Significant drainage from the incision sites
- Persistent fever over 101 degrees (Fahrenheit) or chills
- Persistent and/or productive cough
- Persistent nausea or vomiting
- Worsening testicular redness or pain (males)
- Prolonged soreness or no relief from prescribed pain medication
If you have any questions about the need for laparoscopic hernia repair surgery, alternatives, procedure cost, insurance or billing, physician training and experience, or have questions about surgery, you are encouraged to ask office staff or your physician.
Written by:
Horatio Asbun, M.D.
Director of Minimally Invasive Surgery Programs
John Muir Health
Jacklyn J. Schuchardt, RN, MSN, CNOR
Clinical Nurse Specialist, Surgery
John Muir Medical Center, Walnut Creek Campus
Walnut Creek, California
Diane M.Graham, RN, MSN, CNOR
Perioperative Clinical Nurse Specialist, John Muir Medical Center, Concord Campus, Concord, CA