How to remove part of the intestine with a 'keyhole' operation (Laparoscopic Proctosigmoidectomy)

If you or someone you know is having surgery to remove part of their colon, it's normal to feel a little nervous and curious. Especially when the terminology is a bit complicated. One such surgery is called a laparoscopic proctosigmoidectomy. While the name may sound scary, let's talk about its simple meaning. Imagine a knowledgeable friend explaining it to you.

Why is this surgery being performed? What are the reasons for this?

Simply put, this surgery involves cutting out and removing the diseased part of your colon and rectum. Specifically, the S-shaped part of your colon, the sigmoid colon , and the upper part of your rectum below it.

Doctors recommend this surgery mainly as a treatment for certain medical conditions. Let's see what those are.

What does the word 'laparoscopic' mean?

Here's what's special about this surgery. 'Laparoscopic' stands for ' keyhole surgery ', as we all know. Instead of cutting your abdomen like before, the surgeon makes a few very small incisions (about 5-10 millimeters) in your abdomen and performs the surgery through those holes.

This involves using a small, tube-like instrument called a laparoscope with a small camera attached to it. When this is inserted into the abdomen, the surgeon can see the organs inside the abdomen clearly on a monitor and perform the surgery very precisely. The advantages of this method are that it is less painful, heals quickly, and does not leave a large scar.

What are the five main steps in surgery?

This surgery usually consists of five main steps. Let's understand them one by one in simple terms.

1. Insertion of the laparoscope and instruments

First, you will be given general anesthesia , so you will not feel anything during the operation, you will be completely asleep. Then, the surgeon will make a small incision about a centimeter near your navel (belly button) and insert the laparoscopic camera through it into your abdomen. Now he can see inside your abdomen. Then, he will make about five or six more small incisions to insert the other delicate instruments needed for the operation.

2. Freeing the diseased part of the intestine

Now we need to cut out the diseased sigmoid colon and part of the rectum. But before that, we need to free that part from other tissue.

Our intestines are connected to the abdominal wall by a membrane called the mesentery . Inside this membrane are the main blood vessels (arteries) that supply blood to that part of the intestine. The surgeon carefully cuts these blood vessels, clips them shut (to stop the bleeding). Then, the diseased part of the intestine is freed from this mesentery. Finally, the affected part of the intestine is removed along with the diseased part of the intestine.

Sometimes, if the entire rectum has to be removed, it is called a Total Proctosigmoidectomy.

3. Preparing for bowel reconnection

After the diseased part is removed, the remaining two healthy parts of the intestine need to be reconnected. This means that the healthy end of the colon at the top needs to be connected to the healthy end of the remaining rectum at the bottom.

To do this, the surgeon releases a little more of the healthy part of the intestine from the mesentery, so that it can be pulled down more easily. He also releases the rest of the rectum. The two can be connected together. In the case of cancer, the rest of the rectum is washed and cleaned with a special solution to reduce the spread of cancer cells .

4. Removal of the diseased part of the intestine from the body

Because the 'keyhole' incisions are so small, the cut part of the large intestine cannot be removed through them. A special procedure is used for this. The surgeon makes one of the original incisions slightly larger and inserts a special bag into the abdomen through it. Then, the cut part of the intestine is placed inside the bag and the bag is carefully pulled out.

5. Reconnecting the two ends of the intestine (Anastomosis)

This is the final and most important step of the surgery. The process of connecting the two healthy ends of the intestine together is called an anastomosis in medical terms.

For this, the surgeon inserts a special stapling device through the anus. The device fires a ring of staples, gluing the two ends of the intestine together. The surgeon then checks for any leaks at the connection point and thoroughly washes out the abdominal cavity.

Sometimes, a 'drain', a small tube, may be placed for a few days after surgery to help drain any fluid that collects inside. Finally, all incisions are closed with stitches or special tape.

How is the recovery time after surgery?

The recovery time after the surgery is as important as the success of the surgery.

• Avoid lifting weights: You should completely stop lifting weights and doing exercises that strain your stomach (like sit-ups) for 6 weeks after surgery.
• Walking is great: Gradually increase your activity level after you get home. Walking is the best exercise you can do during this time. Walking gives you energy, improves blood circulation and prevents blood clots, and helps keep your lungs healthy.
• Food and Drink: You can eat most foods when you go home. However, you should avoid eating raw fruits and vegetables for a while. It is best to follow a “soft” diet until you see your doctor after surgery (post-surgical check-up). If you experience constipation due to this diet, call your doctor immediately for advice.
• Other exercises: If you were exercising before surgery, you can start exercising again when you feel comfortable and your doctor says, "Okay, start now."

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