Gastrointestinal Procedures: Colon Surgery
Guest: Dr. Kerry Hammond - Surgery
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I am Dr. Linda Austin. I am talking today with Dr. Kerry Hammond who is Assistant Professor of Surgery and a specialist in surgery of the GI tract at the Digestive Disease Center at the Medical University of South Carolina. Dr. Hammond, let’s talk in this podcast, if we could, about surgery for the colon. First of all, what is the colon?
Dr. Kerry Hammond: The colon is another name for the large intestine. The GI tract begins with the mouth and as you ingest food, it goes down through the esophagus and stomach, into the small intestine and ultimately into the colon, or the large intestine, and ends with the rectum.
Dr. Linda Austin: So, in other words, it is sort of the last part of the intestine, where the last part of digestion occurs?
Dr. Kerry Hammond: Yes.
Dr. Linda Austin: What are some the reasons why a patient might have to have a portion of their colon resected, or taken out surgically?
Dr. Kerry Hammond: There are many different reasons why a patient might be referred for a colon resection, or removal of part of their colon. One of these that is common is if a colon cancer is found. Other reasons might be in patients that have problems such as Crohn’s disease or ulcerative colitis, or if there are some problems related to chronic diverticulitis.
Dr. Linda Austin: So, those are the most common sorts of things? Let’s focus on what a patient might expect if they had to have this procedure. Let’s imagine I am going to come in for colon surgery. What would be the instructions I would get for preparing for this?
Dr. Kerry Hammond: Well, first we would talk a bit about other risk factors for surgery. Patients that have had a history of coronary artery disease or heart attacks or high blood pressure and a lot of medical problems, we need to make sure that you are overall fit for surgery. Once we have established that, the second major decision is how to do the colon resection because we have made good advancements in laparoscopic techniques for colon resection and this is becoming more common. Certain patients are better candidates for that technique than others. It is a combination of what previous surgeries that one has had in making that decision.
Dr. Linda Austin: So, that would be what patients would think of as minimally invasive?
Dr. Kerry Hammond: Minimally invasive laparoscopic surgery. The technique is similar to any of the other laparoscopic techniques. We use a camera, which is a very small scope that goes inside, and we are able to see inside without making a large incision. We still do have to make incisions that are big enough to remove the colon through. So, the incision is a little bit bigger than it would be if you were just having your gallbladder or appendix removed, but it still is minimally invasive. The advantage of laparoscopic surgery is that patients are able to return, often, to their normal activities sooner and usually leave the hospital about a day sooner.
Dr. Linda Austin: So, in that case, then, how large is the incision typically for minimally invasive or laparoscopic?
Dr. Kerry Hammond: Well, for laparoscopic surgery, our goal is to have an incision that is just large enough to remove the bowel through. That could range from 6 to 10 cm.
Dr. Linda Austin: Which is about 2.5 - 3 inches?
Dr. Kerry Hammond: Yes. At times, we may employ what we refer to as a hand-assisted technique, in which case we make the incision just large enough to place a hand inside and help with our dissection. This also is a smaller incision, usually 8 - 10 cm in length.
D. Linda Austin: So, in the case, then, of a laparoscopic procedure, how long does the patient have to stay in the hospital afterwards?
Dr. Kerry Hammond: It certainly depends on the extent of the colon resection. When we do a colon resection, we will remove a small piece of the colon or, sometimes, the entire colon. That generally guides how long the stay in the hospital is. I usually tell patients to expect at least three to five days, if everything goes perfectly.
Dr. Linda Austin: Is that the same if you do an open procedure, that is, the non-laparoscopic procedure?
Dr. Kerry Hammond: Most studies have shown that patients that have laparoscopic surgery are usually discharged an average of one day sooner than the standard for open surgery. Certainly, every patient is different, and some patients take longer to recover from surgery than others.
Dr. Linda Austin: What are some of the things you tell patients to expect after they wake up from surgery?
Dr. Kerry Hammond: Most patients will have what we call a PCA, or a patient controlled analgesia pump. Sometimes, the anesthesiologist may actually place an epidural prior to surgery, which can be left in after surgery to control pain. Patients typically do not eat on the day of surgery, except for small amounts of liquids and ice chips. Once we have some thought that the bowel function is returning, which means that the intestines are starting to pass gas through, then we will start the patient back to eating. It usually takes a few days until we advance to a regular diet.
Dr. Linda Austin: So, there are a few days, I would imagine, of some discomfort that is controlled with medication?
Dr. Kerry Hammond: But also during that time, we do want our patients to be up and walking around so that we can prevent complications such as blood clots forming that are more likely to happen when one is in bed for a long time. We focus on things like breathing exercises to try to prevent complications such as pneumonia.
Dr. Linda Austin: Sometimes, when you take out a portion of the colon, you end up performing a colostomy. Can you describe what that is?
Dr. Kerry Hammond: A colostomy is, instead of the waste products from your intestines exiting through your rectum and anus, we divide the bowel above that and bring out the end through the abdominal wall and skin and suture that there so that the patient will have their bowel movements on their side. The waste is controlled using pouches or appliances, as we refer to them, and we have nurses that are specialized in helping patients learn how to take care of this and how to take care of their pouch.
Colostomy is necessary sometimes unexpectedly such as if we are doing a surgery and find that the bowel is not healthy enough to sew back together. Sometimes a colostomy may be the only possible way to completely remove a cancer of the colon. That is sometimes a reason that one would have to have a colostomy.
Dr. Linda Austin: Generally that is a temporary procedure, though?
Dr. Kerry Hammond: It is generally something that can be reversed. But, in certain cases, such as in patients with a very low rectal cancer, there is a possibility of having to have a permanent colostomy.
Dr. Linda Austin: So, that becomes something the patient needs to be educated about then so that they can have quality of life.
Dr. Kerry Hammond: That usually is evident before we go to surgery and we focus on education before the time of surgery.
Dr. Linda Austin: Now, in situations where you reverse that colostomy, that is, you go back in and sew things back up, what is a typical length of that interim period that the patient has the colostomy, or is there a typical length?
Dr. Kerry Hammond: It is variable. It would usually be at least six weeks to allow the inflammation from the initial surgery to subside and to give optimal conditions to do a second surgery. Sometimes we want an ostomy to be in place for longer, but it varies from patient to patient.
Dr. Linda Austin: But, this is clearly a discussion you have before surgery?
Dr. Kerry Hammond: Yes.
Dr. Linda Austin: Dr. Hammond, thanks so much for talking with us today.
Dr. Kerry Hammond: Thank you.
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