The intestine is one of the largest organs. Its length is about 4 meters. This organ is part of the digestive tract. The intestine occupies most of the abdominal cavity. It originates from the pylorus of the stomach and ends at the anus. Separate the small and large intestines. The first is involved in the process of digestion of nutrients. The second is in the formation of feces and their excretion from the body. In most cases, the colon is subjected to medical manipulations. This is due to the fact that it is more prone to trauma and inflammation.
Therefore, operations on the large intestine are performed more frequently. In addition to inflammatory diseases, the risk of oncological processes and benign tumors in this organ is high. There are many ailments of the large intestine that require surgical treatment. If the lesion has a small extent, resection of the organ or removal of the formation itself is performed (for example,polyp). Colon cancer surgery involves a hemicolectomy. In such cases, half of the organ is resected. Naturally, such interventions require rehabilitation and lifestyle changes.
Symptoms of pathologies of the large intestine
Diseases of the large intestine are common in both adults and children. Many of these ailments are related to surgical pathologies. The most common and harmless disease that occurs most often is appendicitis. It refers to acute inflammatory processes of a part of the large intestine. It is difficult to detect the disease at an early stage. Appendicitis can be disguised as poisoning, exacerbation of gastritis or pyelonephritis (with an atypical location).
In addition to the pain syndrome, an indisputable indication for surgery is intestinal obstruction. It develops in various pathological conditions. Regardless of the cause, all diseases accompanied by obstruction require colon surgery. In addition to severe pain, this syndrome is accompanied by constipation and vomiting.
The main function of the large intestine is to remove decay products from the body. There are 5 anatomical parts. The first is the caecum. It is located in the right iliac region. It is from this anatomical structure that the worm-shaped process, the appendix, departs. The second part is the ascending colon, followed by the transverse and descending colon. They can be palpated in the lateral abdomen and onnavel level. The final section is the sigmoid colon, which passes into the next section of the digestive tract.
The defeat can occur in any part of the body. Regardless of this, colon surgery is performed if damaged. Oncology is more common in the descending and sigmoid region. A characteristic symptom of the tumor is fecal obstruction and intoxication of the body. Cancer of the right half of the large intestine differs in the clinic. The main symptom of the disease is anemic syndrome.
Indications for surgical treatment
Indications for colon surgery are similar in different age groups. Nevertheless, certain pathologies predominate in children. Among them - megacolon, Hirschsprung's disease and cystic fibrosis, intussusception. Also, the causes of intestinal obstruction include congenital atresia in any part of the organ and diverticulosis. Hirschsprung's disease is characterized by impaired innervation. Cystic fibrosis is a rare genetic disorder characterized by increased secretion of mucus. All of these ailments lead to disruption of the intestines. Due to the fact that the feces cannot move to the outlet, they become stagnant and obstructed.
Indications for surgery in adults are as follows:
- Appendicitis.
- Diverticulitis.
- Ulcerative colitis.
- Crohn's disease.
- Acute violation of the mesenteric circulation.
- Benign formations.
- Intestinal cancer.
All of these diseases are dangerous,as they lead to inflammation of the peritoneum (peritonitis) and obstruction. Without surgical assistance, such violations are irreversible and fatal. Therefore, each of the pathologies is an absolute indication for colon surgery.
Appendicitis is an acute inflammation of the appendix associated with hyperplasia of the lymphoid tissue. In the first hours, the disease resembles ordinary poisoning, after which the patient's condition worsens. The pain passes to the right half of the abdomen, fever and nausea increase. Only a surgeon can diagnose a pathology by special symptoms and a blood test.
Intestinal diverticula are branches of the mucous membrane in which incompletely digested food or feces (depending on location) accumulate. Due to the constant stagnation of decay products, inflammation develops, and sometimes an oncological process develops. To prevent this from happening, the diverticula are removed.
Ulcerative colitis and Crohn's disease are systemic diseases that affect the entire digestive tract. They require long-term therapeutic treatment and observation. Surgery is required when complications develop or medications fail. The volume of surgical intervention depends on the prevalence of the affected area of the intestine. Sometimes it is limited to suturing the ulcer. In severe cases, bowel resection is necessary.
Violation of the mesenteric circulation develops due to the ingress of a blood clot into large vessels. This is accompanied by necrosis of the areaintestines. This state of danger is equated to a heart attack and stroke. It requires immediate surgery to remove the colon. If the affected area is not resected in time and blood circulation is not restored, bacterial shock and sepsis occur.
Colon cancer: surgery, prognosis for life
Oncology studies not only cancer, but also benign tumors. Unfortunately, these pathologies often affect the colon. According to statistics, cancer of this organ occupies one of the first places. Only malignant processes of the mammary gland, skin, lungs and stomach are inferior to him. According to the histological structure, the most common carcinoma of the large intestine. The lower the level of differentiation of cancer cells, the more malignant the neoplasm and the more difficult it is to treat. All oncological processes are an indication for surgery. The prognosis for such pathologies depends on the prevalence of the tumor and the degree of differentiation.
The polyp of the large intestine belongs to benign formations. Operations for this pathology are required. After all, most polyps can transform into carcinoma. If a benign tumor is removed in time, the prognosis for life is favorable. If cancer is found, surgery is performed to remove the colon. In most cases, it is necessary to resort to resection of half of the organ. Such an intervention refers to radical operations. It's called a hemicolectomy. If the lesion is small, a smaller part of the intestine is removed, including the tumor itself and 40 cm of he althy tissue. This is necessary to preventrecurrence of carcinoma.
If there are no metastatic tumors in other organs, radical surgery for colon cancer helps not only save the patient's life, but also significantly prolong it. Advanced carcinoma in most cases is considered a contraindication for surgical treatment. With a large size of the oncological process and germination in neighboring organs, palliative removal of the colon tumor is performed. The operation helps to restore the process of digestion and save the patient from suffering. The prognosis for such interventions is unfavorable. Due to the presence of a remnant of malignant cells in the body, the tumor continues to grow.
Varieties of surgical treatment
There are several types of colon surgery. The choice of surgical method of treatment depends on the nature of the pathology and the extent of the lesion. In addition, doctors pay attention to the general condition of the patient and the presence of concomitant ailments. Severe pathologies of the vascular system, heart, kidneys and other organs are a contraindication for massive surgical interventions.
If the disease is not oncological, the doctor does everything possible to save the gut. This can be done in the presence of small ulcerative defects and benign tumors. In such cases, suturing the defect or polypectomy is performed. Such operations often do not require an incision in the anterior abdominal wall. They are performed endoscopically, often during an examination of the bowel. The presence of a purulent inflammatory process servesindication for surgical treatment. The most common of these operations is considered an appendectomy.
Indications for radical surgical treatment are obligate polyps, acute mesenteric circulation disorders, widespread ulcers and non-metastatic adenocarcinoma of the colon. The operation consists in removing the affected area and he althy tissues adjacent to it. Radical surgical interventions include bowel resection and hemicolectomy.
In the presence of metastases and the patient's serious condition, palliative treatment is performed. The main indication is a tumor of the colon. The operation is non-radical in nature, as it does not allow to remove the entire carcinoma. It consists in resection of most of the malignant process and closure of the intestine. Thus, it is possible to eliminate the block that caused the obstruction. The distal end of the intestine is tightly sutured, and a stoma is formed from the proximal part. An unnatural opening is brought to the anterior abdominal wall. If after a few months the patient's condition allows for a massive abdominal operation and the tumor does not progress, the colostomy is removed by bringing the stump down and suturing it to the rectum. This stage of surgical intervention is carried out only in the absence of metastases.
Colon polyp removal
A polyp is a small outgrowth on the surface of the intestinal mucosa. In oncology, 2 varieties of these benign formations are distinguished. The first is facultative precancers. Similarpolyps rarely transform into adenocarcinoma. The likelihood of malignant degeneration increases if a person is exposed to adverse factors (smoking, unhe althy diet, radiation). If the risk of developing cancer is low, an endoscopic operation is performed to remove a colon polyp, which is performed using a special camera and a coagulation loop. It is a beam of electric current. The coagulator not only quickly removes small mushroom-shaped polyps, but also stops bleeding at the site of damage.
In some cases, benign formations are impressive in size and have a wide base. This may be an adenomatous or villous polyp of the colon. Operations are performed both endoscopically and by open surgery. Large polyps are removed in a fragmentary way. With the help of a special coagulator, a diametrical loop is created. It captures the neoplasm and splits off its fragments. In the presence of multiple polyposis, it is recommended to perform bowel resection. Adenomatous and villous formations are classified as obligate precancers, since the probability of their malignancy is high. All polyps should undergo morphological examination.
Preparation for colon removal
Intestinal resection and hemicolectomy are major surgeries that require special preparation. Such surgical treatment can be carried out only in the absence of cardiovascular diseases, as well as pathologies.hematopoietic system and renal failure. In addition, the patient must understand the essence of the upcoming intervention and possible complications. The patient himself and his relatives should know that after surgery on the colon, rehabilitation and lifestyle changes, in particular nutrition, are required.
Before the surgical treatment, a number of tests are performed. In addition to standard laboratory tests, ECG and colonoscopy, consultation with a cardiologist and a therapist are required. The patient must donate blood for HIV and viral hepatitis transmitted parenterally. On the eve of surgery, a complete bowel cleansing is performed. For this purpose, cleansing enemas or taking the drug "Fortrans" are performed. It is diluted in 3-4 liters of water and begins to drink the day before the operation.
Anesthesia is selected individually for each patient. During abdominal operations, general anesthesia is required. Often combined anesthesia is used. It consists of intravenous and endotracheal anesthesia. To monitor the state of the cardiovascular and respiratory systems, the patient is connected to the apparatus. Access to a central vein is required to prevent complications. The patient's condition during the operation is monitored by an anesthesiologist and nursing staff. If necessary, antihypertensive and other drugs are administered.
Intestinal cancer surgery technique
Some foreign doctors practice laparoscopic bowel resections and hemicolectomy. This avoids a bigscar on the stomach. However, this technique is not welcome during large operations, since there is a high risk of bleeding in the abdominal cavity. In addition, small laparoscopic openings limit access to the tumor. Thus, metastatic lymph nodes can be missed.
Intestinal resection begins with an incision on the anterior abdominal wall and dissection of all layers of underlying tissues. The surgeon then mobilizes the affected area and evaluates the extent of the lesion. If the tumor is small, it is resected with the capture of he althy tissue (20-40 cm). In stage 2-3 colon cancer, hemicolectomy is most often performed. This operation differs from resection by volume. Hemicolectomy refers to the removal of the left or right side of the large intestine. After the affected area is resected, an anastomosis is formed. This is the most important part of the surgical treatment. The anastomosis should be strong and, if possible, preserve the anatomy of the organ. After its formation, the tissues are sutured in layers.
Possible complications of surgical treatment
One of the severe oncological diseases requiring surgical treatment is colon cancer. After surgery, there is a risk of complications. Even despite the professionalism of doctors, it is not always possible to carry out the planned treatment for oncology. In some cases, metastases are found that were not visible during the examination. At the same time, it is necessary to expand the scope of treatment or completely canceloperation. Possible consequences of surgery include:
- Bleeding.
- Microbial infection.
- Hernia.
The most dangerous complication is bleeding and anastomotic failure, which develops as a result of infection of the wound. Each of these consequences requires repeated surgical intervention in order to find the source of bleeding. When the wound becomes infected, it is necessary to re-form the anastomosis. Late complications include adhesions and hernia.
Condition after colon removal surgery
The first day after removal of part of the intestine, the patient should spend in the intensive care unit. After the patient recovers from anesthesia and begins to breathe on his own, he is transferred to the ward. Within 2-3 days, parenteral nutrition is carried out. After that, if there are no signs of complications and the patient's condition allows, he is allowed to drink low-fat broth and water. Doctors should monitor the patient's condition for 10-12 days. The medical staff conducts dressings and evaluates the condition of the drainage left in the wound to remove the inflammatory exudate. In the absence of complications, the patient is discharged 2 weeks after surgery if colon cancer was previously diagnosed. Survival after surgery is high, it is more than 95%. In most cases, patients die not from surgical treatment, but from complications of cancer. Therefore, it is customary to estimate the 5-year survival after surgery. While doingradical treatment and the absence of metastases, it reaches 90%. If the tumor is present in the lymph nodes, the survival rate is reduced by 1.5-2 times. In the presence of hematogenous metastases, the prognosis is poor.
Restoration of the digestive tract
If you follow the regime and all the doctor's prescriptions, the process of digestion is almost completely restored even after hemicolectomy. It should be noted that the functions of the large intestine are violated. Therefore, the diet should restore losses. Food should be fractional - 6-7 times a day. Due to disruption of the gastrointestinal tract, it is impossible to overload the intestines. Food should be easily digestible, contain vegetable protein, lean meat, butter. To make up for losses, you need to consume vitamins, minerals, enzymes and water.
