Colo-rectal surgery is performed at the most of cases by laparoscopy or robotic surgery and involves a resection of a segment of colon or rectum with subsequent anastomosis. This anastomosis can be protected by a temporary ileostomy in case of low rectal resection, of recently protected by a stent.
In case of malign pathology, a correct lymphadenectomy is very important, to optimize the postoperative chemotherapy result and the survival. The lymphadenectomy is a criteria of quality of the oncological surgery.
In case of benign pathology, the resection is limited to the affected segment, like in case of diverticular disease, where the segment of the resected colon is limited to the distribution of the diverticulum. In case of Crohn disease with stenosis on the last portion of the ileal loop, the ileo-colic resection is minimal in term of length, to preserve the maximum of the digestive tube in case of disease progression and later reoperation. For benign pathology, the lymphadenectomy is not essential.
-Consists of performing a resection of the left colon. This surgery is performed usually by laparoscopy.
-In case of malignancy the resection involves lymphadenectomy with the ligation of the inferior mesenteric artery and vein at their origins. A correct lymphadenectomy is very important for the oncological success of this surgery.
-In case of benign pathology, the most frequent being diverticular disease, the removed colon segment will respect the length of the associated area.
-In the event of a planned colectomy, an anastomosis is performed between in remnant colon and the rectum. In emergency setting, in selected cases, there is the possibility to perform a temporary colostomy in the left flank.
The postoperative attitude is the same regardless of whether the intervention consisted of ablation of the right colon or of the left colon.
• Day0-after the surgery, the oral alimentation with solid food is not authorized, only water.
• Day1- The patient is allowed to have a liquid or cream diet. The patient is also advised and helped to mobilize; the first mobilization will be carried out with an accompanying person (nurse or physiotherapist) to avoid vagal mechanisms which can produce a temporary loss of consciousness
• Day2- A blood sample is taken and if the result is satisfactory, the patient is authorized to have a light diet.
• Day3- If the patient resumed intestinal transit, and the light diet is supported the diet is extended. If the patient is in general good condition, the discharge can be authorized.
• Day4-I the control blood test showed abnormalities, a control blood test will be taken to monitor the dynamics of the abnormalities, especially the inflammatory syndrome. If the blood test is satisfactory, the discharge is authorized.
-The diet to be followed after returning home is low in fiber for 7 days.
Complications:
– Anastomotic leak- due to the problem of healing at the level of the anastomosis
– Hemorrhage- due to the vascular injuries during the surgery or in postoperative period due to the clip slippage on the mesenteric vessels.
– Ureteral injuries – usually in case of difficult dissection
– Prolonged ileus- due to an delay of the intestinal transit recovery that can need the placement of a nasogastric tube to aspiration and decompression of the digestive tube.
-Consists in removal of the right colon (caecum, ascending colon, and the right part of the transverse colon) and the distal part of the last ileal loop.
-In case of malignant pathology, the lymph nodes on the ileocolic vessels, right colic artery and right branch of the middle colic artery will also be removed. A correct lymphadenectomy is very important for the oncological success of the surgery
-In case of benign pathologies (adenomatous polyps, Crohn disease, cecal volvulus) the length of the bowel resected is adapted to the pathology.
-In the event of elective surgery, the anastomosis will be performed between the small bowel and the transverse colon. In case of emergency setting, for selected cases there is the possibility to create a temporarily ileostomy.
The postoperative attitude is the same regardless of whether the intervention consisted of ablation of the right colon or of the left colon.
• Day0-after the surgery, the oral alimentation with solid food is not authorized, only water.
• Day1- The patient is allowed to have a liquid diet. The patient is also advised and helped to mobilize; the first mobilization will be carried out with an accompanying person (nurse or physiotherapist) to avoid vagal mechanisms which can produce a temporary loss of consciousness
• Day2- A blood sample is taken and if the result is satisfactory, the patient is authorized to have a light diet.
• Day3- If the patient resumed intestinal transit, and the light diet is supported the diet is extended. If the patient is in general good condition, the discharge can be authorized.
• Day4-I the control blood test showed abnormalities, a control blood test will be taken to monitor the dynamics of the abnormalities, especially the inflammatory syndrome. If the blood test is satisfactory, the discharge is authorized.
-The diet to be followed after returning home is low in fiber for 7 days.
Complications:
– Anastomotic leak- due to the problem of healing at the level of the anastomosis
– Hemorrhage- due to the vascular injuries during the surgery or in postoperative period due to the clip slippage on the mesenteric vessels.
– Ureteral injuries – usually in case of difficult dissection
– Prolonged ileus- due to an delay of the intestinal transit recovery that can need the placement of a nasogastric tube to aspiration and decompression of the digestive tube.
I am an Digestive Surgeon specialized in advanced laparoscopic and robotic surgery with activity in the field of parietal, bariatric, colorectal and hepatobiliary surgery with an active interest for the academic aspect and for the research in the field of digestive surgery.
Av. de Broqueville 204, 1200 Woluwe-Saint-Lambert
