Laparoscopic Colorectal Surgery
What is laparoscopic colorectal surgery?
Traditional surgery involves a large cut in the abdomen and is associated with lot of morbidity and very slow and painful recovery. Laparoscopic colorectal surgery is a highly advanced, safe and effective alternative to both conventional and laparoscopic-assisted surgery. It offers greater vision, control and accuracy for surgeons.
In laparoscopic colorectal surgery 3-5 small tiny incisions are placed. Through these incisions or holes, the entire surgery is carried out with the help of telescope attached to camera and long thin instruments. It is associated with minimal pain and faster recovery.
The bowel or colorectal conditions treated by us are:
Types of colorectal surgeries done by our team
Cancer of Colon
Colon cancer is cancer of the large intestine (colon), which is the final part of your digestive tract. Most cases of colon cancer begin as small, noncancerous (benign) clumps of cells called adenomatous polyps. Over time some of these polyps can become colon cancers. Colon cancer can involve caecum, ascending colon, transverse colon, descending colon and sigmoid colon Patients usually present with blood in stools, alternating diarrhea or constipation, weight loss and fatigue. The patients are usually diagnosed with the help of colonoscopy and biopsy from growth. If the diagnosis is confirmed, then further tests including CT scan is done to stage the cancer. If the cancer can be surgically cured, then depending upon the site of growth, we can perform:
Laparoscopic Right Hemicolectomy
This is an operation which involves removing the right side of the large bowel (caecum, ascending colon, a part of transverse colon and small bowel) and subsequently joining the small bowel onto the remaining transverse colon. It is performed for cancer of caecum, ascending colon and hepatic flexure. The surgery. when performed laparoscopically yields excellent results in terms of faster recovery, minimal pain and significantly reduced incidence of adhesions.
Laparoscopic Left Hemicolectomy
This is an operation to remove the left side of the colon. In most of the cases of the cases it involves removal of descending colon, sigmoid colon, rectum and a part of transverse colon. The remaining part of transverse colon and rectum are then joined together to maintain the continuity of bowel. It is performed for patients with a cancer of the sigmoid colon or descending colon. The laparoscopic approach ensures quick recovery, less morbidity and early return to work. Even the quality of surgery is greatly improved due to better vision and lesser blood loss.
Rectum is the last several inches of the bowel and it finally leads to anal canal. While cancers of the colon and rectum are very similar, the surgery of cancer rectum is very challenging because rectum sits in a very tight space in the pelvic cavity.
The patients usually present with altered or change in bowel habits, weight loss, blood in the stool, abdominal pain and constant feeling of incomplete passage of stool. Patients are usually diagnosed with colonoscopy and biopsy. Once the diagnosis of cancer rectum is established, then further tests like CT scan are done to properly stage the cancer. If the cancer is found to be curable or even resectable, then depending upon the exact site and size of tumor, we can perform
Laparoscopic Anterior Resection
An anterior resection is the removal of the rectum and usually joining of the two remaining ends, very close to the anus. This surgery is usually done if the surgeon feels that complete excision of tumor has been done with preservation of anal sphincter (mechanism to hold stool and pass them when desired or appropriate). The surgery prevents the need of colostomy which can be sometimes troubling to the patient. The role and benefit of laparoscopic approach is highly magnified in this surgery because it becomes quite easy to join the two ends laparoscopically. In conventional surgery, because of poor space, it becomes difficult to join the bowel and patient may end up with colostomy.
Laparoscopic Abdominoperineal Resection
Abdominoperineal resection (APR) offers the best chance of cure for rectal tumors located extremely close to the anal sphincter. It is also done for patients having anal cancer which did not respond to chemotherapy or has recurred after chemotherapy or radiotherapy. In such cases, we remove both the tumor and the anal sphincter laparoscopically with excellent results. During the operation all of the rectum and anal canal are removed and since no distal margins are left, the bowels cannot be rejoined. The remaining bowel is therefore used to create a colostomy on the left side of the abdomen.
Diverticulitis of the colon
Diverticulosis is a benign condition characterized by multiple out pouches or tiny pockets in the lining of colon especially sigmoid colon. It usually occurs in old age due to severe constipation. They are usually unharmful but complications can occur in 20% of people with diverticulosis. One of these complications is rectal bleeding, called diverticular bleeding, and another is diverticular infection, called diverticulitis. The majority of patients can be managed without surgery but some patients might require surgery like severe diverticulitis that does not respond to medical treatment, patients with impaired immune systems, diverticulitis that recurs despite a high-fiber diet, peritonitis, fistula formation, or obstruction of bowel. Depending upon the type of complication, we perform various types of laparoscopic surgeries like excision of fistula, Hartmann procedure (removal of sigmoid colon with colostomy) and sometimes, left hemicolectomy in non- infected cases. Hartmann procedure is indicated for the treatment of diverticulitis of colon or gangrene or death of bowel due to volvulus of sigmoid colon. It is usually done as an emergency surgery when the colon is infected, perforated and unprepared. As a result, it becomes extremely unsafe to join the two ends of bowel.
Gastric balloon is a non-surgical procedure. It is a 20 minutes procedure which involves placement of a balloon into the stomach endoscopically. The balloon is then filled with 700 ml of normal saline.
The balloon is kept for a period of six months to one year depending upon the quality of balloon. The average weight loss is 10-12 kg over a period of 6-8 months.
How it works:
It is a purely restrictive procedure in which balloon occupies more than 60% of space in stomach. The intake of food is significantly reduced thereby causing weight loss.
It is good for patients who are overweight or class 1 obese and aim for 10-12 kg weight loss. Sometimes patients who are morbid or severe obese but are unfit for surgery can also be benefited with this procedure.
Advantages of intra gastric balloon
- Safest procedure with almost nil complication rate.
- Same day discharge.
- No nutritional supplements.
Laparoscopic Rectopexy for rectal prolapse
This is done for the condition known as rectal prolapse. Rectal prolapse is a condition when the rectum starts protruding or coming out through the anus. Rectal prolapse usually occurs as a result of pelvic floor weakness. Childbirth may be a contributing factor to the development of pelvic floor weakness in women. Chronic straining may also be responsible for the development of some cases in men and women. Our team has a vast experience of dealing with this condition laparoscopically. 3-4 tiny holes or incisions are made and the entire rectum is mobilized from its surrounding structures. The rectum is pulled up and fixed to tissues overlying the sacrum or lower spine bone with the help of mesh. The patient is usually discharged within 24-36 hours of surgery.
Laparoscopic Upper Gastro intestinal Surgeries
Laparoscopic upper gastro-intestinal surgery is a highly advanced, safe and effective approach to some of the medical conditions involving stomach, pancreas and common bile duct. It offers greater vision, control and accuracy for surgeons. The upper gastro intestinal conditions commonly treated by our team include:
- Gastric cancer and peptic ulcer disease
- Common Bile duct stones
- Pancreatic pseudocyst
- Achlasia cardia
- Gastro esophageal reflux disease and hiatus hernia
Benefits offered by Laparoscopic Approach
Laparoscopic surgery is performed by 3-5 tiny incisions or holes of approximately 0.5 cm in size. A long thin telescope connected to camera is inserted into abdomen. The surgeon performs entire surgery with long thin instruments by looking at the images being projected on the screen.
Apart from general advantages like less pain, faster recovery, lesser chances of wound infection and risk of hernia, the specific advantage of laparoscopy in upper gastrointestinal surgery is lesser chances of adhesions, lesser chances of bowel obstruction and lesser chances of bowel leak at anastomosis site.
Some of the common surgeries performed by our team
- Total or Partial Gastrectomy for gastric cancer and peptic ulcer disease
- Laparoscopic Cystogastrotomy for pseudopancreatic cyst
- Laparoscopic Heller’s Cardiomyotomy for Achalasia Cardia
- Laparoscopic Nissen’s Fundoplication for GERD and Achlasia Cardia
- Laparoscopic CBD( common bile duct) exploration for stones
Gastric cancer is a cancer of stomach which arises from the inner lining of the stomach. Surgery is the only realistic choice which can completely cure the cancer but provided the cancer is in early stages. Laparoscopic subtotal or total gastrectomy is the removal of all or part of the stomach via laparoscopic approach. This procedure can be performed for chronic non-healing ulcers, gastric outlet obstruction or cancer of the stomach. Cancers can develop anywhere in the stomach, but the most common sites are either at the entrance (proximal) or the outlet (distal) of the stomach. Cancers close to the outlet can be removed so that part of the stomach is left (partial gastrectomy). Cancers close to the entrance require the whole stomach to be removed (total gastrectomy). Laparoscopic approach ensures faster recovery, significantly reduced morbidity and rapid recovery. The entire surgery is carried out with 4-5 small ports making recovery exceptionally better and rate of complications markedly lower.
Achalasia cardia is a disease affecting the esophagus, food pipe which transmits food from mouth to stomach. Improper coordination of esophageal muscles to propel food and improper relaxation of lower part of esophagus to send food into the stomach is the pathology of disease. The main cause is still unknown. The main symptoms are difficulty in swallowing both food and water, weight loss and chest pain and reflux of food into the mouth. Oral medicines and endoscopic injections can provide a temporary relief but the definitive treatment is surgery. not to mention, laparoscopic approach the best approach. With the help of 4 tiny incisions, the lower end of esophageal muscle is partially cut along with wrap of the stomach (fundoplication). This relaxes the lower muscle permanently and fundoplication is done to prevent reflux
Pancreas is a very vital organ situated just below stomach and in close proximity to liver. The main function of pancreas is to secrete juices for the digestion of food and insulin for the maintenance of glucose levels. When pancreas get severely infected either because of slippage of gall stones into pancreatic duct or excessive alcohol intake, it is called pancreatitis. Pseudo pancreatic cyst is a sequalae of acute pancreatitis which results in formation of cysts containing fluid. It may be a small cyst to a very large cyst causing back pain, jaundice, vomiting due to pressure on surrounding organs. If these cysts persist for more than 6weeks and more than 6 cm in size, it requires either surgical or radiological intervention. Depending upon their size, location and symptoms our team offers various types of treatment. Treatment of pseudo pancreatic cyst:
- Endoscopic trans gastric drainage
- USG/CT guided percutaneous drainage
- Laparoscopic cysto-gastrostomy or cysto-jejunostomy