The large intestine (colon) is the section of the digestive tract between the small intestines and the rectum, which is located in an inverted U shape in the abdomen. This is the final stage of digestion, the reabsorption of water and the exchange of ions, and is where the formed faeces are formed and passed out through the rectum, the final outlet of the large intestine.
Due to inflammatory, benign or malignant tumours of the colon, partial or, in rare cases, complete removal of the colon may be necessary. Left hemicolectomy involves the removal of the last stage of the ileum, the left colon flexure, the descending colon and the sigmoid colon, with no long-term lifestyle changes.
During laparoscopic surgery, 3-4 incisions of 5-10 mm are made, where the camera is inserted and the additional instruments needed for the operation are inserted. The continuity between the two ends of the bowel is restored by a smaller incision of about 10-12 cm in front of the abdominal cavity.
Benign tumours may continue to grow without surgery, and some may develop into malignant tumours. In advanced cases, malignant lesions can lead to intestinal obstruction, haemorrhage, peritonitis through perforation of the intestinal wall, metastasis to distant organs, and complications can be fatal.
The operation is performed under general anaesthesia. Through a small incision made above the navel, the abdominal cavity is inflated with carbon dioxide gas through a special device. The laparoscope is a thin tube with a camera at the end, which is used to navigate inside the abdomen, to view the abdomen, and to follow the operation through a large screen. 3-4 small incisions are made, through which the instruments are inserted and the last section of the transverse colon, the left colon flexure, the descending colon and the sigmoid colon are lifted from the posterior abdominal wall, together with the potentially affected lymph nodes and lymphatic ducts. The arteries and veins supplying the intestine are cut off, and the intestine is lifted to the level of the abdominal wall through a small incision and removed. If a suspicious metastatic mass is found in the liver or elsewhere, a sample is taken.
Sometimes the lesion cannot be safely removed using laparoscopic techniques, in which case we will switch to open abdominal surgery. In rare cases, the bowel segments may not be safely matched based on the findings, so the retained colon is temporarily passed through an opening in the abdominal wall to the abdominal wall to form a stoma (a guest opening). After the operation, the stool is emptied into a stoma bag that can be fixed to the abdominal wall. If possible, the healed bowel segments can be fused at a later date during another operation.
The advantages of laparoscopic surgery over open surgery:
Benign tumours in the early stages (polyps in the colon) can sometimes be removed by colonoscopy, while larger polyps can only be removed surgically. There is no alternative therapy for malignant lesions of the colon. In some cases, so-called neoadjuvant treatment (radiotherapy, chemotherapy) may be needed to reduce the size of the tumour tissue to help the surgery succeed.
Haemorrhage, vascular haemorrhage, separation of intestinal sutures, infection of abdominal wound, fistula formation, skin around the scar may become numb (usually resolves within 2-3 months), deep vein thrombosis.
You will most likely arrive the day before your operation. However, we will carry out the necessary tests 1-2 weeks before the planned day of surgery, which may include laboratory tests, ECG, X-ray and anaesthesia if necessary.
Colonoscopies may require complete emptying of the colon and rectum, and your surgeon may ask you to follow a fluid diet for a few days before the operation, and you may also need to take a stool softener or enema before the operation. Your surgeon will give you detailed advice on this.
You are usually discharged from our institution 3-5 days after the operation.
During the operation, you will sleep and feel no pain. Upon waking, you can expect to experience some discomfort, and we will do our best to minimise this, or if it has developed, to alleviate it. The incision may be painful after the operation, and the wound will be anaesthetised as a final step in the operation.
After a partial removal of the colon, it is normal to feel weaker and more tired for up to weeks, but you should be back to normal activity within 1-2 weeks. It is important that you follow the diet recommended by your doctor at home and gradually increase your exercise. If you have had stoma training during surgery, a stoma therapy nurse can help you learn how to manage your stoma after surgery.
When can I start exercising?
You will feel more tired in the few weeks after surgery, it is recommended that you gradually resume daily activity. For the first 6 weeks, avoid heavy physical work, lifting weights and intense sports activities.
When can I go back to work?
Return to work depends on the type of work and the extent of the surgery. If you have had laparoscopic surgery, you can expect to return to work within 1-2 weeks.
