Diseases of the colon and rectum that require surgery occur in more than 600,000 patients a year in the United States. These diseases include diverticulitis, ulcerative colitis, Crohn's colitis, colonic polyps and colorectal cancer.

The goal of colon surgery, or a colectomy, is to remove sections of the colon that are diseased and/or damaged, linking the remaining sections together. The traditional procedure for this type of surgery, known as the "open" method, requires the surgeon to make a long incision to reach the colon. Patients then are in the hospital for five to eight days, followed by recovery time at home of six to eight weeks.

A New Approach

While laparoscopic surgery has been routine for many procedures, such as gallbladder surgery, it is now gaining popularity for use in colon surgery. Doctors at John Muir Health have been using this technique for colon surgery regularly since 1992, with a total of more than 900 laparoscopic colon resections performed to date.

Samuel Oommen,M.D., colon and rectal surgeon on staff at John Muir Medical Centers in Walnut Creek and Concord, sees many benefits to this minimally invasive procedure, and would like to see more surgeons trained in the technique. One of the obstacles to the adoption of the technique has been the question of whether colon cancer can be adequately treated by laparoscopic surgery. To resolve this issue, the National Cancer Institute sponsored a study to determine the efficacy of laparoscopic colectomy for cancer. Dr. Oommen was one of the investigators in the study, published in 2004 in the New England Journal of Medicine. This landmark article concluded that the laparoscopic technique was equally effective as the open surgery for the treatment of colon cancer.

Better Recovery

Physicians favor laparoscopic colon surgery because of the many benefits that can improve the patient's experience. "When you see patients hours after the surgery standing up and walking, able to take a liquid diet with little to no pain, and able to go home in three or four days, it is very rewarding," Dr. Oommen said. The main benefits of laparoscopic colon surgery include:

• Faster recovery time and shorter time in the hospital
• Less post-operative pain
• Quicker return to normal activities
• Smaller scars

A Kinder Cut Makes a Big Difference

In laparoscopic surgery, the surgeon makes three to four halfinch incisions. Using a "cannula", the surgeon enters the abdomen. A laparoscope, which is a slender telescope connected to a video camera, is inserted through the cannula, giving the surgeon a magnified view of the patient's internal organs on a monitor. Other cannulas are inserted to allow the surgeon to introduce instruments and work inside to remove the diseased section of bowel and reattach the healthy segments. Research shows that when comparing the two types of colon surgery, laparoscopic surgery carries no higher risk in survival or recurrence than the open surgery.

At this time, only a small number of doctors throughout the United States perform laparoscopic colectomies, and fewer than 30 percent of all colon resections are done using this technique. Dr. Oommen and John Muir Health colleague Ran S. Kim, M.D., are helping to train surgeons from around the country through a preceptorship at John Muir Medical Center, Concord Campus.

What To Know About Colon Cancer

The American Cancer Society recommends that adults begin colorectal screening at age 50. Frequently, there are no symptoms, but the following changes might be important to discuss with your doctor:

• A change in bowel habits
• Blood in the stool
• A feeling that the bowel doesn't completely empty
• Abdominal gas, bloating, fullness or cramps
• Unexplained anemia

With screening and early diagnosis, the mortality rates from colon cancer have dropped, and it is one of the most treatable cancers if diagnosed early. Your physician can provide more information on risk factors, screening options and treatment options, including minimallyinvasive surgery.

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