Laparoscopic sigmoidectomy is a surgical procedure designed to address specific issues affecting the lower part of the large intestine. This technique offers a less invasive approach compared to traditional open surgery, allowing for the removal of diseased sections of the colon.
Understanding Laparoscopic Sigmoidectomy
A sigmoidectomy involves the surgical removal of a portion of the sigmoid colon, which is the S-shaped segment of the large intestine located just before the rectum and anus. This part of the colon functions to store fecal waste until it is ready for expulsion, while also absorbing water and electrolytes from the remaining food matter.
The term “laparoscopic” indicates that the surgery is performed using minimally invasive techniques. Unlike traditional open surgery, which requires a large incision, laparoscopic sigmoidectomy involves several small incisions. Through these small openings, a surgeon inserts a laparoscope, a thin instrument with a camera, to view the internal organs on a monitor, along with specialized surgical instruments. This approach aims to reduce trauma to the body, leading to less pain and a quicker recovery compared to open procedures.
Conditions Requiring the Procedure
Laparoscopic sigmoidectomy is commonly recommended for several medical conditions affecting the sigmoid colon. One of the most frequent indications is severe or recurrent diverticulitis, an inflammation or infection of small pouches (diverticula) that can form in the colon wall. When diverticulitis becomes chronic, causes complications like fistulas or peritonitis, or leads to strictures, surgery may be necessary.
The procedure is also performed for colon cancer, specifically when the tumor is located in the sigmoid colon. Large or precancerous polyps that cannot be effectively removed during a colonoscopy may also necessitate a laparoscopic sigmoidectomy. In some instances, it addresses conditions like bowel obstruction or perforation in the sigmoid colon.
The Surgical Process
The laparoscopic sigmoidectomy procedure begins with the patient positioned in a modified lithotomy position. After administering anesthesia, the abdomen is inflated with carbon dioxide gas to create a working space for the surgeon, a process known as pneumoperitoneum. This inflation helps lift the abdominal wall away from the internal organs, improving visibility.
Several small incisions are then made in the abdomen to insert the surgical instruments and a laparoscope, which transmits magnified images of the internal organs to a monitor. The surgeon uses these instruments to carefully identify and mobilize the sigmoid colon, detaching it from its surrounding tissues and blood vessels. This mobilization often involves dividing peritoneal attachments and carefully working around structures like the ureter to avoid injury.
Once the diseased segment of the sigmoid colon is isolated, it is cut and removed. The healthy ends of the colon are then reconnected, a process called anastomosis, to restore the continuity of the digestive tract. This reconnection can be achieved using a circular stapler. The removed colon segment is extracted through one of the small incisions.
Recovery and What to Expect
Following a laparoscopic sigmoidectomy, patients experience a shorter hospital stay compared to traditional open surgery, often ranging from three to five days. In the immediate post-operative period, pain management is a priority, and medication is provided to keep discomfort at a manageable level. Patients are encouraged to begin light activity, such as walking, within a day after surgery to aid recovery and prevent complications like blood clots.
Diet progression usually starts with clear liquids, advancing to a low-fiber diet for several weeks as bowel function returns. Full recovery, including a return to normal activities, can take approximately two to four weeks, though strenuous activities and heavy lifting are generally avoided for about six weeks. While recovery is generally faster with the laparoscopic approach, some common experiences include temporary changes in bowel habits, abdominal discomfort, and fatigue. Patients are advised to contact their doctor if they experience severe pain, fever, or persistent issues like severe diarrhea or constipation.