What is a laparoscopic proctosigmoidectomy?
A laparoscopic proctosigmoidectomy is an operation that removes a diseased section of the rectum and sigmoid colon.
The surgery is used to treat:
- Cancers of the colon and rectum
- Some types of non-cancerous growths in the colon and rectum
- Complicated diverticulitis
The term laparoscopic refers to a type of surgery called laparoscopy. Laparoscopy enables the surgeon to complete the surgery through very small "keyhole" incisions in the abdomen. A laparoscope-a small, telescope-like instrument-is placed through a small incision near the bellybutton.
Laparoscopic proctosigmoidectomy removes the diseased section of sigmoid colon and rectum (area shaded in diagonal lines in figure 1).
What happens during the surgery?
There are five main steps to this surgery.
Laparoscopic surgery is performed through two to four small incisions in the abdomen
Step 1: Positioning the laparoscope
Once you are under anesthesia, the surgeon will make a small cut (about 1 / 2 inch) near the bellybutton. A laparoscope will be inserted into the abdomen through this incision. Images taken by the laparoscope will be projected onto video monitors placed near the operating table.
Once the laparoscope is in place, the surgeon will make two to four more small incisions in the abdomen (figure 2 at right). Surgical instruments will be placed through these incisions to complete the surgery.
Step 2: Dividing the sigmoid colon
The diseased section of sigmoid colon and rectum must be cut away from the healthy bowel. Before this section can be divided from the healthy bowel, it must be freed from its supporting structures.
The bowel is attached to the abdominal wall by a layer of tissue called the mesentery. The mesentery also contains the main blood vessels (arteries) that supply blood to the left side of the colon and rectum. These arteries will be carefully cut and closed. Your surgeon will free the sigmoid colon and part of the rectum from the mesentery and cut away the diseased tissue. This part of the mesentery will later be removed with the diseased bowel.
Step 3: Preparing to rejoin the colon
The remaining end of the descending colon must rejoined with the remaining end of the rectum. First, a part of the healthy descending colon is detached from the mesentery so that it can be stretched toward the rectum. Likewise, the rectum is freed from its mesentery so it can meet the end of the colon.
If you are having surgery for cancer, your rectum will be washed out with a solution at this time. This solution helps reduce the risk of spreading cancer cells.
Step 4: Removing the diseased bowel
The incisions in laparoscopy are very small, so the diseased section of bowel must be removed in a special way. Your surgeon will enlarge one of the incisions and place a bag into the abdominal cavity. The diseased bowel is placed into the bag. The bag is then pulled out of the enlarged incision.
The open ends of the colon are rejoined.
Step 5: Rejoining the ends of the colon
Your surgeon will rejoin the colon by using a special stapling device placed into the rectum. This end-to-end rejoining of the colon and rectum is called an anastomosis. The stapling device sends a ring of staples to connect the two ends. The anastomosis is checked for leaks and the pelvis is rinsed out.
A drain may also be placed in the abdomen to aid recovery after surgery. The drain will be removed a few days after surgery. All the keyhole incisions in the abdomen will be stitched or taped closed.
When you wake up from surgery, you will be in a post-anesthesia care unit. After you have recovered from the anesthesia, you will be taken to your hospital room.
Recovering at home
You will be encouraged to increase your activity level steadily once you are home. Walking is great exercise. Walking will help your general recovery by strengthening your muscles, keeping your blood circulating to prevent blood clots and helping your lungs remain clear. If you are fit and did regular exercise before surgery, you may resume exercising when you feel comfortable.
For six weeks after surgery, you should not lift or push anything over 30 pounds or do abdominal exercises such as sit-ups.
You will be sent home on a soft diet, which means you can eat most everything except raw fruits and vegetables. You should eat this diet until your post-surgical check-up. Talk to your doctor if you experience any difficulty with this diet.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 11/15/2006...#4514