Sigmoidectomy: A Comprehensive Guide To Laparoscopic Sigmoidectomy
Sigmoidectomy, more precisely laparoscopic sigmoidectomy, is a surgical operation used to treat a range of sigmoid colon disorders. The purpose of this page is to give a thorough guide to laparoscopic sigmoidectomy, including a description of the anatomy, indications, surgical method, probable problems, and postoperative care.
The sigmoid colon is the S-shaped lower abdominal portion of the large intestine. It begins at the end of the descending colon and ends at the rectosigmoid junction. The sigmoid colon is approximately 40 cm long and is responsible for the storage and propulsion of fecal matter toward the rectum.
Indications For Sigmoidectomy
Sigmoidectomy is indicated for several conditions, including:
Diverticular Disease: Diverticula are small pouches that can develop in the sigmoid colon. In diverticular disease, these pouches become inflamed or infected, leading to symptoms such as abdominal pain, fever, and changes in bowel habits. Recurrent episodes of diverticulitis or complications like abscesses or fistulas may require surgical intervention.
Colorectal Cancer: Sigmoidectomy may be performed as part of the treatment for colorectal cancer localized in the sigmoid colon. It involves removing the tumor along with the adjacent lymph nodes to achieve oncological clearance.
Volvulus: Sigmoid volvulus is a condition where the sigmoid colon twists upon itself, causing mechanical obstruction. Emergency sigmoidectomy is necessary to alleviate the obstruction and prevent ischemia or perforation.
Inflammatory Bowel Disease (IBD): In some cases of severe ulcerative colitis or Crohn’s disease localized in the sigmoid colon, a sigmoidectomy may be recommended to alleviate symptoms and manage complications.
Laparoscopic Sigmoidectomy: Surgical Technique
Laparoscopic sigmoidectomy, which is also called “minimally invasive surgery,” has numerous advantages over conventional open surgery such as less pain after the operation, shorter hospital stays, and faster healing. The surgery is done while the patient is under general anesthesia, and the surgeon makes a few small cuts in the abdominal wall.
Here is a step-by-step overview of the surgical technique:
Port Placement: Carbon dioxide gas is introduced into the abdominal cavity to create a workspace. Trocars (hollow tubes) are then inserted through the small incisions to provide access for the laparoscope and surgical instruments.
Mobilization Of The Colon: The surgeon carefully dissects and mobilizes the sigmoid colon and mesentery from its attachments to the surrounding structures. This step allows for better visualization and accessibility during subsequent steps.
Vascular Control: The sigmoid artery and its branches are identified, ligated, and divided to ensure an adequate blood supply to the remaining colon.
Transection And Anastomosis: The sigmoid colon is divided using staplers or a combination of staplers and sutures. Sutures or staples are then used to connect the proximal and distal extremities of the colon (anastomosis). This reestablishes the continuity of the intestinal tract.
Specimen Retrieval: The resected sigmoid colon is extracted through one of the small incisions or through a separate incision, depending on the size of the specimen.
Closure And Recovery: After taking out the tools and the laparoscope, the small cuts are closed with absorbable stitches or surgical glue. The patient is then transferred to the recovery area.
Potential Complications And Postoperative Care
Like any surgical procedure, laparoscopic sigmoidectomy carries potential risks and complications, including bleeding, infection, injury to adjacent structures, anastomotic leaks, and blood clots. However, the overall complication rate is lower compared to open surgery.
Postoperatively, patients are closely monitored for signs of complications and are provided with pain management, intravenous fluids, and antibiotics. They are encouraged to ambulate early to prevent postoperative complications such as pneumonia and deep vein thrombosis. Beginning with clear liquids and proceeding to a regular diet as tolerated, the diet is progressively advanced.
Appointments are scheduled to monitor the patient’s recovery and ensure their progress. Long-term outcomes following sigmoidectomy are generally favorable, with most patients experiencing a significant improvement in their quality of life.
Laparoscopic sigmoidectomy is a minimally invasive surgical procedure that offers numerous advantages for patients requiring surgical intervention for conditions affecting the sigmoid colon. With careful patient selection and appropriate surgical technique, sigmoidectomy can effectively treat diverticular disease, colorectal cancer, volvulus, and severe cases of inflammatory bowel disease. It is crucial for patients to consult with their healthcare providers to determine the most suitable treatment approach based on their specific conditions.