Professor MD MD hc Guido Schumacher
Partial or full colectomy surgery can be performed due to several reasons: removal of primary or secondary cancer tumor of bowel, inflammatory diseases of bowel, or other bowel diseases, bleeding, obstruction of bowel.
In most cases, bowel is removed because of bowel cancer that is one of the most widespread cancer in both women and men. Average age of patients with cancer of bowel is 70 years. The risk of developing it are higher among people with inflammatory diseases of bowel, such as Crohn’s disease and chronic colitis, polyps, and those who have bowel cancer in family medical history. The symptoms of disease depend on localization of tumor in the vowel, and sometimes they can manifest into rectal bleeding, blood in stool, constipations or diarrhea (sometimes constipations or diarrhea occur by turn in one person), obstruction of bowel, bowel perforation, and weight loss without causes, pains and spasms in the lower abdomen, fatigue or weakness.
The most widespread indication for bowel cancer is surgery for tumor removal. The decision which type of surgical treatment should be chosen depends on the size and localization of tumor. Sometimes full or partial bowel resection can be performed. In case of partial resection, only a cancer-affected segment of bowel is removed: intestine, sigmoid bowel, blind gut, or segmented intestine. In most cases, sigma is removed (lower part of bowel that leads to rectum). Removal of this bowel section is called sigmoidectomy. When the blind gut (upper part of bowel connecting it with intestine where appendix is located) is removed, it’s called cecectomy. If the tumor is so big that surgical access to it is obstructed, a patient needs to go through neo-adjuvant treatment that combines radiation therapy and chemotherapy. The main aim of this treatment is to reduce the size of tumor and reduce the scope of surgical invasion.
Partial or full colectomy surgery is performed under general anesthesia, which means that patient is asleep and doesn’t feel painful sensations. The surgery can be made by open or laparoscopic method. The type and scope of operation is defined by the size of tumor, its localization and characteristics. During an open operation, a surgeon makes a surgical cut 25 cm long in the central part of abdomen, separates bowel from the upper part of rectum up to connection with intestine from the back wall of abdominal cavity and ceases blood supply of this area. Surgeons perform resection of not malignant tumor only – they remove some part of healthy bowel tissue in order to prevent reoccurrence of tumor. When it comes to a big bowel tumor, surgeon also removes adjacent lymph nodes to prevent spreading ot malignant tumor cells through the lymph system. All removed bowel segments and lymph nodes are sent to a pathologic laboratory to define the following optimal treatment tactics. When resection is performed, doctors define the type and amount of required anastomoses. In some cases, anastomosis of distal part of intestine and rectum is performed with the help of stitches or special surgical bows. Sometimes there’s a necessity to put distal part of intestine out and connect it together with a special pouch (ileostomy). Further on, during additional surgeries ileostomy is closed and the rest two parts of intestine are connected. If doctors deal with elderly patients or patients with serious chronic diseases, there’s need to output the end portion of bowel – colestomy. Finally, surgeon washes patient’s abdominal cavity, puts stitches and bows and inserts drainage tubes into the abdominal cavity.
In case of laparoscopic operation, a surgeon makes two-three small incisions in the abdomen and inserts a laparoscope with a lamp and optic camera on its end into the abdominal cavity together with special laparoscopic surgical instruments. The operation is transmitted on special big monitors – they show the operated area. In order to ease access to abdominal cavity, it’s inflated with CO2 gas. Just like during an open surgery, during the final part of operation, a surgeon will define necessary anamostosis, ileostomy or colostomy. Although laparoscopic method is preferable from cosmetic standpoint and due to the fact it requires shorter recovery period, this type of operation isn’t suitable for all patients. In some cases, surgeons have to resolve to an open operation during laparoscopic surgery. That happens rarely, but can be obligatory to solve the problem with bowel entirely.
Average duration of surgery is 2-3 hours.
Just like any other surgical invasive procedure, full and partial colectomy has its risks and possible complications that should be taken into consideration when doctors and patients take the decision concerning treatment. In order to reduce the risks and possibility of complications to minimum, a patient should provide doctor and anesthesiologist with all relevant information concerning his medical state. Possible complications during surgery and post-surgical period include: infections, bleeding, thrombembolia, blood clotting, lung inflammation, damage to adjacent organs, problems with anamostosis, etc. The main risk factors for these complications are older age and chronic diseases.
Since there are many risks connected with full and partial colectomy, this operation is recommended to be performed in a big multi-disciplinary center that can provide highly professional treatment of any complications and outcomes. German medical centers perform hundreds of thousands operation annually. Thanks to skillfulness and experience of leading surgeons of medical centers combined with years of practice, many patients requiring this kind of surgery go through operations successfully and without negative outcomes. German medicine is considered to be one of the most advanced in the world.
In order to define certain localization and size of tumor, the following examination should be performed:
Sometimes additional checks can be required.
In a week before the operation, a patient should cease taking blood thinners, such as aspirin or coumadin to avoid excessive bleeding during surgery. Before the operation, bowel should be emptied with the help of laxative medications. If a patient has caught infection or cold, he should inform the surgeon about it. Food intake should be ceased at least 6 hours before the operation.
After bowel removal operation, a patient will be moved to the intense care unit where he or she will gradually wake up after anesthesia. After that, a patient will be delivered to the surgical department to recover. While being in this department, a patient can start standing from the bed, sit on a chair and start walking – medical personnel will help with that. This promotes faster recovery and helps to prevent complications caused by long-term lying, such as blood clotting, lung inflammation and so on. If necessary, a patient will be administered pain killers and antibiotics. These can be taken for up to a week.
Average time of hospitalization after bowel resection is about 10 days and depends on complications, patient’s overall health, quality of recovery and many other factors.
Right after the operation, a patient can eat soft foods. In 4 days after operation, normal diet can be restored. Full recovery takes a few weeks. During the first 6-8 weeks a patient should avoid physical loads, however, some minor physical activity is recommended.
If a patient goes through bowel resection because of malignant tumors, he or she should also be examined by an oncologist. He will assign further post-surgical treatment and make sure that no reoccurrence happens.