Small Bowel and Colon Surgery Why Do I Need a Small Bowel Resection? A variety of conditions can damage your small bowel. In severe cases, your doctor may recommend removing part of your small bowel. Conditions that might require surgery include: -bleeding, infection, or severe ulcers in the small intestine -blockage in the intestines, either congenital (present at birth) or from scar tissue -noncancerous tumors -precancerous polyps -cancer -injuries to the small intestine -Meckel s diverticulum (a pouch of intestine present at birth) Diseases that cause inflammation in the intestines may also require surgery. Such conditions include: -Crohn s disease -regional ileitis -regional enteritis What Is a Small Bowel Resection? A small bowel resection is a surgery to remove a damaged section of your small intestines if you have intestinal blockages or other bowel diseases. Depending on the disease process, this can be performed in a traditional open fashion or laparoscopically.
What is Appendicitis Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen. The appendix doesn't seem to have a specific purpose. Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the navel and then moves. As inflammation worsens, appendicitis pain typically increases and eventually becomes severe. A blockage in the lining of the appendix that results in infection is the likely cause of appendicitis. The bacteria multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not treated promptly, the appendix can rupture. Although anyone can develop appendicitis, most often it occurs in people between the ages of 10 and 30. Standard treatment is surgical removal of the appendix. What Are the Signs and Symptoms of Appendicitis? Sudden pain that begins on the right side of the lower abdomen Sudden pain that begins around your navel and often shifts to your lower right abdomen Pain that worsens if you cough, walk or make other jarring movements Nausea and vomiting Loss of appetite Low-grade fever that may worsen as the illness progresses Constipation or diarrhea Abdominal bloating The site of pain may vary, depending on your age and the position of your appendix. When you're pregnant, the pain may seem to come from your upper abdomen because your appendix is higher during pregnancy. What are Complications of Untreated Appendicitis? Appendicitis can cause serious complications, such as: A ruptured appendix. A rupture spreads infection throughout your abdomen (peritonitis). Possibly life-threatening, this condition requires immediate surgery to remove the appendix and clean your abdominal cavity. An abscess, a pocket of pus, may form in the abdomen if the appendix bursts. In most cases, a surgeon drains the abscess by placing a tube through your abdominal wall into the abscess. The tube is left in place for two weeks, and you're given antibiotics to clear the infection. Once the infection is clear, you'll have surgery to remove the appendix. In some cases, the abscess is drained, and the appendix is removed immediately. What is a laparoscopic appendectomy? The laparoscopic surgical technique involves making several tiny cuts in the abdomen and inserting a miniature camera and surgical instruments. As many as three or four
! incisions are made. The surgeon then removes the appendix with the instruments, so there is usually no need to make a large incision in the abdomen. What is the benefit of laparoscopic appendectomy? Most cases of acute appendicitis can be treated laparoscopically. The main advantages are: -Less post-operative pain -Faster recovery and return to normal activity -Shorter hospital stay -Less post-operative complications -Minimally sized incisions/scars In most cases, patients can be discharged within 24 to 36 hours. What is a Colectomy? The colon (large intestine) is the last portion of your digestive tract. This part of the bowel works to soak up water and store food waste. The lining is made up of millions of cells. The colon in an adult is about 4 6 feet long. The rectum is the last 6 inches of the colon. A colectomy is surgery to remove all or part of your colon.
Right Hemicolectomy Part or all of the ascending colon and cecum are removed. The colon is then reconnected to the small intestine Left Hemicolectomy Part or all of the descending colon is removed. The transverse colon is then reconnected to the rectum Sigmoid Colectomy Part or all of the sigmoid colon is removed. The descending colon is then reconnected to the rectum Low Anterior Resection The sigmoid colon and a portion of the rectum is removed. The descending colon is reconnected to the remaining rectum Abdominal Perineal Resection Part of or all of the sigmoid colon and the entire rectum and anus are removed. A colostomy will be made. A colostomy creates an opening in your stomach wall so waste can pass from the body Why Would I need Surgery? This is done to remove the disease causing your symptoms, such as: Cancer
Polyps Irritable bowel disease Bleeding Blockage Diverticulitis Volvulus Rectal prolapsed For most people, this will cure the problem or at least greatly reduce their symptoms What Are Symptoms of Colorectal Disease? Symptoms of colorectal diseases include: Bleeding from the rectum Abdominal pain Change in bowel habits (new diarrhea, constipation, stool size, etc.), Weight loss, Anemia, Cramping Vomiting Fever among many others. Can Colectomy Be Performed laparoscopically? Yes! Laparoscopic surgery involves using multiple ports placed through 3 to 5 small incisions. These incisions are usually 0.5 cm. Carbon dioxide gas is then used to slowly inflate the abdomen. A thin scope is placed through one of the ports. This allows the surgical team to view the inside of the abdomen on a TV monitor. Specialized instruments are placed through the other ports to perform the operation. For colon surgery, one of the incisions is enlarged to remove the piece of colon. The procedure is p e r f o r m e d u n d e r g e n e r a l a n e s t h e s i a. What Are the Benefits of Lap Colectomy? Shorter hospital stay Shorter recovery time
Less pain from the incisions Faster return to normal diet Faster return to work or normal activity Better cosmetic healing What Tests Will You Need Before Surgery? -Confirmation of diverticulitis with blood tests and CT Scan are the most common -Colonoscopy will need to be performed prior to surgery to confirm the diagnosis and location of diverticulitis What is the Post Op Care? -Elective laparoscopic colectomy requires hospital admission for several days -Patients can return to most activities (except for heavy lifting, swimming), including a shower -The first 24 hours after surgery you will need to be on a liquid diet, then will increase to regular, but this may vary from one patient to the next -Pain, swelling and constipation can be experienced after surgery -You ll need to return to the office 7-10 days after surgery What Are Colonic Diverticula and Diverticulitis? Diverticula are small, bulging pouches that can form in the lining of your digestive system. They are found most often in the sigmoid colon. Diverticula are common, especially after age 40, and seldom cause problems. Sometimes, however, one or more of the pouches become inflamed and can perforate. That condition is known as diverticulitis.
What Are the Symptoms of Diverticulitis? -Pain, which may be constant and persist for several days. Pain is usually felt in the lower left area of the abdomen -Nausea and vomiting -Fever -Abdominal tenderness -Constipation or, less commonly, diarrhea What the the Risk Factors for Diverticulitis? -Aging -Obesity -Smoking -Lack of exercise -Diet high in animal fat and low in fiber -Certain medications: steroids, opiates and nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen What Are Complications from Diverticulitis? One out of four patients with diverticulitis develop complications, which may include: -An abscess, which occurs when pus collects in the pouch -A blockage in your colon or small intestine caused by scarring -An abnormal passageway (fistula) between sections of bowel or the bowel and bladder -Peritonitis, which can occur if the infected or inflamed pouch ruptures, spilling intestinal contents into your abdominal cavity. Peritonitis is a medical emergency and requires immediate care When Will You Need Surgery for Diverticulitis? You'll likely need surgery to treat diverticulitis if: -You have a complication, such as perforation, abscess, fistula or bowel obstruction
-You have had multiple episodes of uncomplicated diverticulitis -You are immune compromised What Tests Will You Need Before Surgery? -Confirmation of diverticulitis with blood tests and CT Scan are the most common -Colonoscopy will need to be performed prior to surgery to confirm the diagnosis and location of diverticulitis What Type of Surgery Do You Need? -There are two main types of sigmoidectomy procedures: Primary bowel resection The sigmoid colon is removed and then the healthy segments are connected. Bowel resection with colostomy If you have so much inflammation that it's not possible to rejoin your colon and rectum, the surgeon will perform a colostomy. An opening (stoma) in your abdominal wall is connected to the healthy part of your colon. Waste passes through the opening into a bag. Once the inflammation has eased, the colostomy may be reversed and the bowel reconnected.
What is the Benefit of Laparoscopic Sigmoidectomy? -Less scarring -Less pain -Faster recovery -Shorter hospital stay -Quicker return to normal activity What is the Post Op Care? -Lap sigmoidectomy without complications requires a couple of days of hospital admission -Patients can return to most activities (except for heavy lifting, swimming), including a regular diet and shower -Some pain, swelling and constipation can be experienced after surgery -You ll need to return to the office 7-10 days after surgery