Colon Surgery

After food leaves the stomach it travels through the small intestine, It then passes into the colon or large intestine. Here the liquid part of the food is reabsorbed. Near the end of the large intestine, the stool becomes more formed prior to going on to the rectum and out the anus.
Surgical problems of the colon present as: infection, bleeding, benign, premalignant, and cancers of the colon

Infection of the colon outside of travelers diarrhea (not a surgical condition) includes diverticulitis. Diverticulitis is an infection of the large intestine, more commonly in the "S" shaped sigmoid colon- the last part of the colon before it turns into the rectum. Small outpouchings in the colon wall occur over time. Once infected, they can lead to repetitive low grade pain, severe sepsis, and even perforation of the colon.

These conditions are diagnosed with physical examination, laboratories, and a CT scan of the abdomen and pelvis. In most cases, antibiotics by mouth are adequate treatment. In more sever cases, intravenous antibiotics in the hospital are administered. After several bouts, a prophylactic surgery to prevent further instances is recommended. Worst case scenario is the need for emergent surgery. Here the affected colon is removed and in most cases a temporary colostomy is made.

Diverticulosis refers to the outpouchings discussed above where instead of becoming infected, there is severe bleeding. Admission to the hospital and colonoscopy are urgent. Most cases of bleeding stop spontaneously. Others will require removal of part of the colon without a colostomy.

Benign Lesions of the Colon
During colonoscopy, benign polyps may be found. If the polyp is too large to remove through colonoscopy, surgical removal is done on an elective basis. Some polyps are biopsied and show changes that are not exactly cancer, however, are far from being normal. In these cases, the polyp is more likely to have a small amount of actual cancer elsewhere. These will also require removal of part of the colon.

Colon Cancer
One of the initial signs of colon cancer can be chronic anemia or blood in the stools. Colonoscopy then verifies the diagnosis. Once diagnosed, assessment of the tumor (T), nodal status (N), and metastases (M) is necessary. Prior to surgery, a chest X-ray and laboratories are used to look for spread to the lungs and liver, respectively. Many patients will also have an abdominal and pelvic CT scan to look at intra abdominal spread. Metastases to any of these organs indicates advanced disease requiring more intense treatment- like chemotherapy after surgery. The tumor is assessed once removed surgically. The surgeon localizes the tumor and removes normal tissue before and after the tumor to insure that all the local cancer is removed. At the same time, lymph nodes are removed. These will help to diagnose spread beyond the colon- even if it has not spread to other abdominal organs. Once the T, M, and N for a cancer is known the patient is given a stage for the cancer. Stage will then guide any further treatment beyond surgery.

Techniques of Colon Surgery
Removal of part of the colon in any case can be done with an incision that may be as small as an appendectomy scar (less than 3 inches). This "open" technique has been the standard until recently. The patient needs to clean out the colon prior to surgery as would be done prior to colonoscopy. The cleanout can be worse than surgery in many cases. After surgery, it will take days to a week for the intestines to start functioning again. Once bowel function returns, the patient goes home. Laparoscopy, similar to the what is used for removing gallbladders has made the surgery easier with less healing time compared to the open surgery. Studies have proven that laparoscopy is safe and successful in most cases, even when cancer is involved. The early benefits to the patient are less pain and time spent in the hospital. Discharge in three or four days is typical.  


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