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Laparoscopic Colorectal Surgery

Overview

Surgery to the colon and bowel (colorectal surgery) can be conducted using two approaches – conventional 'open' surgery and laparoscopic 'keyhole / minimally invasive' surgery.

Unlike conventional surgery, where a large incision is made to allow the surgeon to directly visualise and operate on the organs and tissue, laparoscopic surgery involves a number of much smaller incisions being made in the skin (called 'ports') through which specialised instruments are inserted into the body cavity. The surgeon is then able to see the tissue and organs being operated on via a small video camera, with real time images appearing on a large monitor.

Pros and cons of laparoscopic surgery

In very general terms the main advantages of laparoscopic surgery are related to the reduction of stress to the body compared to open surgery.

Smaller incisions and less disturbance to internal tissue mean that patients undergoing laparoscopic surgery enjoy the following benefits compared to conventional surgery:

  • Lower post-operative pain.
  • Quicker recovery (including return to normal bowel function in the case of colorectal surgery).
  • Less scarring from surgical incisions.
  • Lower complication rate after surgery.

These benefits are demonstrated by extensive research.

Surgical Risks

All types of surgery are subject to the following risks, which are rare, but can occur:

  • Allergic reaction to medication / anaesthetic.
  • Bleeding.
  • Difficulty breathing.
  • Infection.

Specific to this type of surgery the following risks are also rare, but can occur:

Anastomosis failure

This is where the sections of the colon that have been reconnected do not heal properly or develop an infection at the connection point. More surgery or the fitting of a colostomy may be required.

Bowel / bladder issues

These may be caused by an obstruction or blockage in the colon, or damage may have occurred to ureters (tubes that connect the kidneys and the bladder) during surgery

Organ injury

Injury or perforation may occur to nearby organs, such as the bladder, kidneys and spleen.

Sexual function (in males)

After this type of surgery in rare cases sexual function may be inhibited ie an inability to ejaculate or have an erection.

Laparoscopic Surgical Risks

The following risks are specific to laparoscopic surgery:

Trocar placement risks

A 'trocar' is a device placed into the abdomen through which other laparoscopic instruments are passed. Some injuries that may be related to trocar placement include:

  • Large bowel / blood vessel perforation.
  • Abdominal wall haematoma.
  • Umbilical wound infection.

Electrode burns

Electrosurgery is the application of a high-frequency (radio frequency) current as a type of laparoscopic surgical technique. Electrode burn injuries are a risk of this technique.

Gas insufflation risks

This can cause pain in the shoulder area or pain when breathing where the gas forms a 'pocket' in the abdominal cavity (the pain generally subsides as the gas is absorbed by the body).