Laparoscopic Colectomy

The widespread application of laparoscopic approaches to common general surgical operations has changed abdominal surgery. This technology has also been applied to resections of the colon. When compared with other commonly performed laparoscopic procedures, such as cholecystectomy, laparoscopic colon resection is technically more chal-

FIGURE 96-1A. Right hemicolectomy.

FIGURE 96-1B. Left hemicolectomy.

FIGURE 96-1C. Sigmoid colectomy. Illustrations by Corinne Sandone from Cameron JL. Current surgical therapy, 7th ed. St. Louis: Mosby; 2001.

lenging because of necessary mobilization and the anastomosis that must be performed. Concerns about this approach include difficulty localizing small lesions because of the lack of the ability to palpate the colon. Preoperative colonoscopic tattooing of the lesion, as well as the ability to perform intraoperative colonoscopy, aids in finding these small lesions. Early experience with this technique also raised concerns about the oncologic adequacy of the laparoscopic approach (Wexner and Cohen, 1995). Resections with curative intent must adhere to oncologic principles. Laparoscopic colectomy must maintain adequate margins as well as a proper lymphadenectomy. Thus far, studies have shown these concerns to be unfounded. The data has shown that margins and numbers of lymph nodes harvested are comparable to open techniques (Korolija et al, 2003). The advantages of the laparoscopic approach, however, are less evident than with other laparo-scopic operations. Laparoscopic colon resection tends to take longer to perform, requires expensive operative equipment, and still requires an incision. Studies to date have shown reduction in hospital length of stay, pain, and morbidity, but no difference in mortality when compared to open colectomy. Only a small fraction of colon resections are currently performed laparoscopically.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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