Treating colon diseases
There are many common colorectal health conditions that affect the colon and rectum. These include colon polyps and colon cancer, and irritable bowel conditions such as Crohn's disease and ulcerative colitis, and diverticulitis.1 Treatment for colorectal disease depends on your type of condition and may include lifestyle changes, drug/chemotherapy, and surgery.
When surgery is recommended
Be sure to talk to your doctor. Learn as much as you can about colorectal surgery options, preparing for surgery, and knowing what to expect afterward. The better informed you are, the more empowered you are on the path to better health.
A look at the different types of colorectal surgery
Options for colon surgery: traditional and minimally invasive.
Colorectal surgery, also called a colectomy, removes some or all of the colon (large intestine) and rectum. The surgery is done using a traditional open technique, or a minimally invasive method.
Open surgery — This is what most often comes to mind when we think of the word “surgery.” It involves making a large incision (approximately 10-inches long) in the abdomen to access the colon/rectum and perform the procedure. Because the incision cuts through skin and muscle, recovery can take weeks, even months, and is often painful.
Minimally invasive surgery (MIS) — There are two minimally invasive surgical approaches that are similar in technique and benefits. Both of these minimally invasive techniques eliminate the need for the large incision necessary in open surgery.
- Laparoscopic surgery: This technique involves making several (3 to 4) tiny incisions in the abdomen, each a half inch or less. Slender tubes are inserted into each incision. The surgeon then inserts a tiny video camera through one tube and special surgical tools through the other tubes. The video camera sends real-time video images to a television monitor in the operating room enabling the surgeon to see the patient’s internal organs and perform the procedure.
- Robotic-assisted surgery (RAS): As with laparoscopic surgery, RAS involves several tiny incisions and tubes for inserting a camera and surgical tools. The surgeon performs the procedure at a console while viewing 3-D video images and maneuvering robotic arms.
Less cutting of abdominal tissue with MIS procedures means patients are typically on the road to recovery much more quickly. For instance, compared to open surgery, laparoscopic surgery has been shown to result in:
- Shorter hospital stays – 2-1/2 days shorter on average2-15
- Quicker return to normal activities16
- Lower costs17
- Smaller scars – 10x smaller* average scar size16,18
- Less risk of infection19-21
- Less blood loss2,4,8,12,22,23
- And less pain24
*Based on calculations of average scar size for laparoscopic and open procedures.
Shorter hospital stays2-15
Quicker return to normal activities16,17
Smaller scars16,18
Less risk of infection19-21
Less blood loss2,4,8,12,22,23
Less pain24
The type of surgery that’s best for you depends on many factors, including your overall health, your disease, and your surgeon’s experience. Whether open or minimally invasive, there are possible complications with any surgical procedure such as25:
- Reactions to anesthesia
- Hemorrhaging from the site of surgery
- Blood clots in the leg, arm, lung, or other part of the body
- Wound infection
- Temporary inability to empty the bladder
In addition, possible complications or considerations specific to colorectal surgery include26:
- Leakage into the abdomen from the area reconnecting the bowel
- Injury to adjacent organs such as the bladder
- Hernia caused by belly tissue pushing through muscle
- A temporary or permanent ostomy* post-surgery
- Issues with an ostomy* such as infection, if applicable
*An ostomy is procedure that allows waste to be collected in a bag outside the body.
So talk to your doctor. Learn all you can about your options, the pros and cons, and what to expect before and after surgery.
Hear Brittany talk about her experiences with both MIS and open colorectal procedures.
“From having the minimally invasive surgery, I felt that I was able to feel like myself again. I was back in school, taking the stairs and the subway within two weeks.”
- Brittany, colon cancer survivor
Your doctor tells you that you may need an ostomy. What’s that?
Sometimes an ostomy is needed in addition to the primary surgery in order to allow the gastrointenstinal tract organs (colon, small intestine, rectum) to heal. The surgeon makes the ostomy by creating an opening (called a stoma) in the belly and connecting the healthy part of the digestive organ to this opening. A bag is attached to the belly opening on the outside of the body allowing stool and gas to exit.
That may sound scary. But remember — ostomies can be temporary — typically 3 to 6 months for cancer patients as an example.27
Once your intestines have healed, the surgeon will undo the ostomy and reconnect your normal digestive system which will return to its usual function over time. Less than 10% of colon cancer patients end up having a permanent ostomy.28
If such a “bowel redirect” is needed, you will have ongoing support from a specially trained ostomy nurse who will teach you how to care for your ostomy at home. Your ostomy nurse is your “go-to” resource for ostomy care and any questions you may have.
As with any procedure you may undergo, it’s essential that you talk to your doctor. Ask questions up front:
- Will I need an ostomy? If so, what type?
- How many ostomies have you performed?
- How often do you reverse ostomies for your patients?
- What does it take to reverse an ostomy and when will I return to normal function?
And ask your doctor about possible complications after surgery.29 These can include:
- Bleeding from the stoma
- Hernia
- Narrowing of the stoma causing difficulty for waste to pass
- Skin irritation when changing the bag
- Bacterial infection
And last, but not least, it’s important that you keep your follow-up appointments so your doctor can monitor your healing progress and know when it’s time to “bag the bag.”
A second opinion may help.
Surgery is an important decision and you may want to get more than one opinion. A second opinion can be helpful if you’re unclear about the benefits and risks of a particular procedure and what to expect after surgery.
1
Cleveland Clinic. "Digestive Tract: Rectal and Colon Diseases and Conditions" my.clevelandclinic.org website. Revised July 5, 2019. https://my.clevelandclinic.org/health/articles/4090-digestive-tract-rectal-and-colon-diseases-and-conditions Accessed Marh 20,2022.
2
Veldkamp R, Kuhry E, Hop WC, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6(7):477-484
3
Juo YY, Hyder O, Haider AH, Camp M, Lidor A, Ahuja N. Is minimally invasive colon resection better than traditional approaches?: First comprehensive national examination with propensity score matching. JAMA Surg. 2014;149(2):177-184.
4
Orcutt ST, Marshall CL, Robinson CN, et al. Minimally invasive surgery in colon cancer patients leads to improved short-term outcomes and excellent oncologic results. Am J Surg. 2011;202(5):528-531
5
Steele SR, Brown TA, Rush RM, Martin MJ. Laparoscopic vs. open colectomy for colon cancer: results from a large nationwide population-based analysis. J Gastrointest Surg. 2008;12(3):583-591.
6
Odermatt M, Miskovic D, Siddiqi N, Khan J, Parvaiz A. Short- and long-term outcomes after laparoscopic versus open emergency resection for colon cancer: an observational propensity score-matched study. World J Surg. 2013;37(10):2458-2467.
7
Prakash K, Varma D, Rajan M, et al. Laparoscopic colonic resection for rectosigmoid colonic tumors: a retrospective analysis and comparison with open resection. Indian J Surg. 2010;72(4):318-322.
8
Chen K, Zhang Z, Zuo Y, Ren S. Comparison of the clinical outcomes of laparoscopic-assisted versus open surgery for colorectal cancer. Oncol Lett. 2014;7(4):1213-1218.
9
Hardy KM, Kwong J, Pitzul KB, et al. A cost comparison of laparoscopic and open colon surgery in a publicly funded academic institution. Surg Endosc. 2014;28(4):1213-1222.
10
Thompson BS, Coory MD, Gordon LG, Lumley JW. Cost savings for elective laparoscopic resection compared with open resection for colorectal cancer in a region of high uptake. Surg Endosc. 2014;28(5):1515-1521.
11
Marshall CL, Chen GJ, Robinson CN, et al. Establishment of a minimally invasive surgery program leads to decreased inpatient cost of care in veterans with colon cancer. Am J Surg. 2010;200(5):632-635.
12
da Luz Moreira A, Kiran RP, Kirat HT, et al. Laparoscopic versus open colectomy for patients with American Society of Anesthesiology (ASA) classifications 3 and 4: the minimally invasive approach is associated with significantly quicker recovery and reduced costs. Surg Endosc. 2010;24(6):1280-1286.
13
Day AR, Smith RV, Jourdan IC, Rockall TA. Survival following laparoscopic and open colorectal surgery. Surg Endosc. 2013;27(7):2415-2421.
14
Kapritsou M, Korkolis DP, Konstantinou EA. Open or laparoscopic surgery for colorectal cancer: a retrospective comparative study. Gastroenterol Nurs. 2013;36(1):37-41.
15
Agarwal S, Gincherman M, Birnbaum E, Fleshman JW, Mutch M. Comparison of long-term follow up of laparoscopic versus open colectomy for transverse colon cancer. Proc (Bayl Univ Med Cent). 2015;28(3):296-299.
16
Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Webmaster. Laparoscopic colon resection surgery patient information from SAGES. SAGES. https://fascrs.org/patients/diseases-and-conditions/a-z/minimally-invasive-surgery-expanded-version. Updated March 1, 2015. Accessed Jan. 10, 2017.
17
Fitch K, Engel T, Bochner A. Cost differences between open and minimally invasive surgery. Manag Care. 2015;24(9):40-48.
18
Peters W. Minimally invasive surgery expanded version. American Society of Colon and Rectal Surgeons. https://fascrs.org/patients/diseases-and-conditions/a-z/minimally-invasive-surgery-expanded-version. Accessed Jan. 17, 2017.
19
Bilimoria KY, Bentrem DJ, Merkow RP, et al. Laparoscopic-assisted vs. open colectomy for cancer: comparison of short-term outcomes from 121 hospitals. J Gastrointest Surg. 2008;12(11):2001-2009.
20
Kiran RP, Kirat HT, Ozturk E, Geisler DP, Remzi FH. Does the learning curve during laparoscopic colectomy adversely affect costs? Surg Endosc. 2010;24(11):2718-2722.
21
Wilson MZ, Hollenbeak CS, Stewart DB. Laparoscopic colectomy is associated with a lower incidence of postoperative complications than open colectomy: a propensity score-matched cohort analysis. Colorectal Dis. 2014;16(5):382-389.
22
Braga M, Frasson M, Zuliani W, Vignali A, Pecorelli N, Di Carlo V. Randomized clinical trial of laparoscopic versus open left colonic resection. Br J Surg. 2010;97(8):1180-1186.
23
Li Z, Li D, Jie Z, Zhang G, Liu Y. Comparative study on therapeutic efficacy between hand-assisted laparoscopic surgery and conventional laparotomy for acute obstructive right-sided colon cancer. J Laparoendosc Adv Surg Tech A. 2015;25(7):548-554.
24
Tiwari MM, Reynoso JF, High R, Tsang AW, Oleynikov D. Safety, efficacy, and cost effectiveness of common laparoscopic procedures. Surg Endosc. 2011;25(4):1127–1135.
25
Johns Hopkins Medicine. “After Surgery: Discomforts and Complications.” John Hopkins Medicine, https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/after-surgery-discomforts-and-complications Accessed April 1, 2022.
26
Surgical Procedures: Colectomy | OncoLink. www.oncolink.org. https://www.oncolink.org/cancers/gastrointestinal/colon-cancer/treatments/colectomy. Accessed April 5, 2022.
27
American Cancer Society. “What is a Colostomy?” Revised October 2, 2019. https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/surgery/ostomies/colostomy/what-is-colostomy.html Accessed March 9, 2022.
28
Colorectal Cancer Alliance. “There are many treatment options: Ostomy.” https://www.ccalliance.org/colorectal-cancer-information/treatments/ostomy Accessed April 1, 2022.
29
National Institute of Diabetes and Digestive and Kidney Diseases. “Complications of Ostomy Surgery of the Bowel.” https://www.niddk.nih.gov/health-information/digestive-diseases/ostomy-surgery-bowel/complications?utm_source=email&utm_medium=sharing+button&utm_content=%2Fhealth-information%2Fdigestive-diseases%2Fostomy-surgery-bowel%2Fcomplications Accessed April 1, 2022.