Bowel Resection Surgery (Partial Colectomy)
Bowel resection is a surgical procedure in which a diseased part of the large intestine is removed. The procedure is also known as colectomy, colon removal, colon resection, or resection of part of the large intestine.
Bowel diseases and conditions can put your life at risk. They can also keep the colon or rectum from working as they should. This causes symptoms like pain and discomfort.
Bowel resection can be performed using an open surgical approach (colectomy) or laparoscopically.
Following adequate bowel preparation, the patient is placed under general anesthesia, which ensures that the patient is deep asleep and pain free during surgery. Because the effects of gravity to displace tissues and organs away from the site of operation are important, patients are carefully positioned, padded, and strapped to the operating table to prevent movement as the patient is tilted to an extreme degree. The surgeon starts the procedure by making a lower midline incision in the abdomen or, alternatively, he may prefer to perform a lateral lower transverse incision instead. He proceeds with the removal of the diseased portion of the large intestine, and then sutures or staples the two healthy ends back together before closing the incision. The amount of bowel removed can vary considerably, depending on the reasons for the operation. When possible, the procedure is performed to maintain the continuity of the bowel so as to preserve normal passage of stool. If the bowel has to be relieved of its normal digestive work while it heals, a temporary opening of the colon onto the skin of abdominal wall, called a colostomy, may be created. In this procedure, the end of the colon is passed through the abdominal wall and the edges are sutured to the skin. A removable bag is attached around the colostomy site so that stool may pass into the bag, which can be emptied several times during the day. Most colostomies are temporary and can be closed with another operation at a later date. However, if a large portion of the intestine is removed, or if the distal end of the colon is too diseased to reconnect to the proximal intestine, the colostomy is permanent.
Bowel Resection Surgeries
Colon surgery is done in one of three ways:
Open resection: A surgeon makes one long cut on the belly. He’ll use normal surgical tools to take out a portion of the intestine.
Laparoscopic resection: The surgeon makes two to four small cuts (incisions) on the belly. He inserts a thin tube with a tiny camera into one incision. This is called a laparoscope. It sends a picture to a monitor. The surgeon uses it to see inside the abdomen. He then passes small, special surgical tools through the other incisions to remove part of the intestine.
Robot-assisted laparoscopic resection: In this surgery, the instruments are attached to robots. The surgeon controls the robots to perform the surgery.
The type of surgery you’ll get depends on your condition. The location and size of the diseased or damaged colon are also factors. In some cases, your surgeon may need to change from a laparoscopic to open surgery during the procedure.
Laparoscopic bowel resection
The benefits of laparoscopic bowel resection when compared to open colectomies include reduced postoperative pain, shorter hospitalization periods, and a faster return to normal activities. The procedure is also minimally invasive. When performing a laparoscopic procedure, the surgeon makes three to four small incisions in the abdomen or in the umbilicus (belly button). He inserts specialized surgical instruments, including a thin, telescope-like instrument called a laparoscope, in an incision. The abdomen is then filled with gas, usually carbon dioxide, to help the surgeon view the abdominal cavity. A camera is inserted through one of the tubes and displays ../images on a monitor located near the operating table to guide the surgeon as he works. Once an adequate view of the operative field is obtained, the actual dissection of the colon can start. Following the procedure, the small incisions are closed with sutures or surgical tape.
All colon surgery involves only three maneuvers that may vary in complexity depending on the region of the bowel and the nature of the disease. These three maneuvers are:
retraction of the colon
division of the attachments to the colon
dissection of the mesentery
In a typical procedure, after retracting the colon, the surgeon proceeds to divide the attachments to the liver and the small bowel. Once the mesenteric vessels have been dissected and divided, the colon is divided with special stapling devices that close off the bowel while at the same time cutting between the staple lines. Alternatively, a laparoscopically assisted procedure may be selected, in which a small abdominal wall incision is made at this point to bring the bowel outside of the abdomen, allowing open bowel resection and reconnection using standard instruments. This technique is popular with many surgeons because an incision must be made to remove the bowel specimen from the abdomen, which allows the most time-consuming and risky parts of the procedure (from an infection point of view) to be done outside the body with better control of the colon.: