Digestive Diseases: Laparoscopic Surgery
and Hand-Assisted Laparoscopic Surgery
Though many gastrointestinal disorders can be treated successfully with lifestyle changes or medications, some conditions may require surgery.
Laparoscopic surgery and hand-assisted laparoscopic surgery (HALS) are, "minimally invasive" procedures commonly used to treat diseases of the gastrointestinal tract. Unlike traditional surgery on the colon or other parts of the intestines where a long incision down the center of the abdomen is required, laparoscopic surgery requires only small "keyhole" incisions in the abdomen. In the case of hand-assisted surgery, a 3-4 inch incision is also used to allow the surgeon's hand access to the abdominal organs. As a result, the person undergoing the procedure may experience less pain and scarring after surgery, and a more rapid recovery.
Conditions laparoscopic surgery (laparoscopy) treats
Laparoscopy can be used to treat the following conditions
- Crohn's disease unresponsive to medical therapy or causing a blockage
- Colorectal cancer
- Diverticulitis with recurrent attacks or failure of medical therapy
- Familial polyposis, a condition causing multiple colon polyps that puts you at higher risk of colorectal cancer, which then requires total colonectomy (removal of the colon)
- Bowel incontinence
- Rectal prolapse
- Ulcerative colitis unresponsive to medical treatment
- Colon polyps that are too large to remove by colonoscopy
- Chronic severe constipation that is not successfully treated with medication may require shortening the length of the colon by removing a part of the colon using surgery.
How is the laparoscopy procedure performed?
Three or more small (5-10 mm) incisions are made in the abdomen to allow access ports to be inserted. The laparoscope and surgical instruments are inserted through these ports. The surgeon then uses the laparoscope, which transmits a picture of the abdominal organs on a video monitor, allowing the operation to be performed.
Laparoscopic intestinal surgery can be used to perform the following operations:
- Proctosigmoidectomy. Surgical removal of a diseased section of the rectum and sigmoid colon. Used to treat cancers and noncancerous growths or polyps, and complications of diverticulitis.
- Right colectomy or Ileocolectomy. During a right colectomy, the right side of the colon is removed. During an ileocolectomy, the last segment of the small intestine - which is attached to the right side of the colon, called the ileum, is also removed. Used to remove cancers, noncancerous growths or polyps, and inflammation from Crohn's disease.
- Total abdominal colectomy. Surgical removal of the large intestine. Used to treat ulcerative colitis, Crohn's disease, familial polyposis and possibly constipation.
- Fecal diversion. Surgical creation of either a temporary or permanent ileostomy (opening between the surface of the skin and the small intestine) or (colostomy (opening between the surface of the skin and the colon). Used to treat complex rectal and anal problems, including poor bowel control.
- Abdominoperineal resection. Surgical removal of the anus, rectum and sigmoid colon. Used to remove cancer in the lower rectum or in the anus, close to the sphincter (control) muscles.
- Rectopexy. A procedure in which stitches are used to secure the rectum in its proper position. Used to correct rectal prolapse.
- Total proctocolectomy. This is the most extensive bowel operation performed and involves the removal of both the rectum and the colon. If the surgeon is able to leave the anus and it works properly, then sometimes an ileal pouch can be created so that you can go to the bathroom. An ileal pouch is a surgically created chamber made up of the lowest part of the small intestine (the ileum). However, sometimes, a permanent ileostomy (opening between the surface of the skin and the small intestine) is needed particularly if the anus must be removed, is weak, or has been damaged.
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