A glance of colonectomy...
Every year, there are more than 600,000 cases of colonectomy in USA. Although not all surgeries can be cured, it is the most effective method to stop disease progress and relieve pain for patients.
In a normal colonectomy, the recovery time is very long and the healing is difficult due to surgery’s great bodily invasion. With long operation wounds, it usually takes patients around 1 week or more of hospitalization and about 6 weeks to recover their strength.
What is colon?
Colon or large intestine is the last part of gastrointestinal tract. Food is digested and absorbed mostly in small intestine, and the residue shall pass through colon to absorb water and to be discharged outside through anal orifice.
What is endoscopic colonectomy?
This is the least invasive intervention which permits surgeons to remove a part of colon via small 1.5 cm incisions. Endoscope is connected with video camera to transfer pictures and magnify on screen, and tools are inserted into other holes to perform surgery. According to each disease nature, surgeons can make an entero-entero anastomosis to defecate via anus orifice or make artificial anus (opening intestines outside abdominal wall)
Advantages of endoscopic surgery?
• Least pain after operation.
• Fast recovery.
• Short Hospitalization period (5-6 days)
• Intestinal peristalsis is recovered quickly and normal eating can be back soon.
What do you need to prepare prior to endoscopic surgery?
Colon is needed to be cleaned at least 2 days prior to surgery. Patients only drinks milk on day 1 and sugar solution on day 2. The measures to clean bowels can be enema or purge solution usage according to docotors’ indication.
Fast absolutely and clean the whole body with disinfectant soap the night before operation. Stop drugs of pain-killers, anti-inflammation and anti blood-clot.
Inform your doctor if your bowels are not clean (still passing stool) or any your discomfort before surgery.
If surgeons change to open surgery?
In few cases, endoscopic surgery can not be performed and surgeons have to change to a conventional operation. This can be decided during the operation to ensure safety for patients. It’s not a complication of surgery. Affecting factors are:
• Past history of abdominal surgery and it causes much adhesion inside.
• Anatomy details are not distinguished.
• Bleeding much before operation.
• Big size mass.
What happens after surgery?
• Possible pain in operation wound or abdominal can occur for 1 week after operation.
• Possible nausea or vomit 1 to 2 days after operation
• Try to walk the 1st day after operation
• Drink water and eat liquid foods when you feel hungry,
• Able to take a bath and dressing change everyday
• Back to normal daily activities after 5 days to 1 week.
Potential risks and complications of surgery?
All kinds of operations have their own risks and complications, although they occur at a very low frequency. They can be:
• Leakage in intestine anastomosis (3-5%)
• Damage of intestines, bladder, ureters, blood vessels
• Other complications on heart, blood vessels and lungs…
Some complications are needed to be handled by 2nd operation or opening artificial anus …
Call your doctor if the following signs and symptoms occur after operation:
• Increased and prolonged abdominal pain
• Redness in operation wound and spreading with pain.
• Abdominal distension, with nausea, vomiting.
• Chills and high fever more than 38,5 degree Celsius
• Fluid-discharging from operation wound increases with bad smell.
a. Prevention of colorectal cancer
SCREENING AND MONITORING COLORECTAL CANCER
Risks of colorectal cancers?
Colorectal cancer is the second ranked cancer in USA. The disease risk in normal people is 5%, and increases by ages. This risk is even higher if there is a family member suffering from this disease or colorectal polyps or the sufferer is from breast cancer, uterine or ovarian cancer or ulcerative colitis.
What’s colorectal cancer screening and monitoring?
Many colorectal polyps and cancers are asymptomatic until tumours become quite big.
Screening is checking to know whether an asymptomatic individual suffers from disease or conditions which could develop to colorectal cancers by testing or paraclinical procedures. The purpose of screening is to detect the disease at an early or potential stage in order to prevent or eradicate it easily.
Colorectal cancer monitoring is applied for high-risk individuals or people who have past history of colorectal cancers. It’s performed by testing or testing procedures with the higher frequency than that of healthy people.
Why must the procedures above be performed?
Colorectal cancer is considered as a silent disease, because its symptoms are not shown in many people, such as bleeding or abdominal pain until the cancer develops to the untreatable stage. In fact, the ability of eradicating treatment is only 50% for symptomatic patients. Adversely, if detected in early stages before symptom development, the cure ability then is over 80%. Most colorectal cancers develop from benign polyps. If polyp is removed, the cancer can be prevented and major surgery is avoided.
When and how often are these procedures performed?
Screening: Individuals who are not in the group under high-risk of colorectal cancers: are supposed to have digital anorectal examination and blood occult test in stool every year at the age of 40, to have colosigmoidoscopy every 5 years at the age of 50 or elderly and alternatively to have double contrast barium enema every 5 -10 years, and colonoscopy every 10 years.
Monitoring: is performed for the high-risk groups as follows:
• Patients who are detected with pre-cancer polyps of colon and polypectomy must be performed with rechecking colonoscopy after first 1 to 3 years. Double contrast barium enema could be an alternative option but polypectomy couldn’t be performed on detecting.
• Relatives of cancer patients or pre-cancer polyp patients such as their siblings, parents and children have to be screened like other normal people but a start from the age of 40 or 5 years sooner than the age of the youngest diagnosed patients.
• Relatives of young patients or family with many generations suffering from cancer must be performed with all the colonoscopy every 2 years, starting from the ages of 20 – 30, and with yearly endoscopy at the age of 40.
• Patients with the family’s past history of heredity polyposis must be consulted to check genes. Patients with cancer-genes must be performed with yearly colosigmoidoscopy starting from pubertal ages to check whether the signs are presented or not. In case of polyposis, they need to be treated by pancolonectomy.
• Patients with past history of surgery for colorectal cancers must be performed with pancolonoscopy 1 year after surgery. If normal, they need to be checked within 3 years. Checking consists of assessment of all the colon: colonoscopy or colosigmoidoscopy accompanied with double contrast barium enema.
• Patients suffering from severe colitis for more than 8 years need to be performed with colonoscopy every 1 - 2 years.
• Patients with the breast cancer or genital cancer, who have the risk of colon cancer development up to 15% in life, need to be performed with colonoscopy every 5 years, starting from the age of 40.