When cancer or precancerous polyps in the colon require major surgery, the procedure has typically involved a long incision, a lengthy hospital stay, and an extended and uncomfortable recovery.
Dr. Jason Radecke, a Sebastian surgeon who shares a practice with partner Dr. Patrick Domkowski, says bariatric or weight loss surgery is perhaps the better known aspect of the practice, but laparoscopic or minimally invasive surgery accounts for about 50% of it.
It is this advanced laparoscopic technique that can make undergoing abdominal surgery, including colon surgery, far less daunting.
Radecke and his partner are among a handful of area surgeons trained in the minimally invasive techniques, which make a significant positive impact for patients requiring colon surgery. This approach to colon cancer, he says, “is just huge; it has changed everything, a complete paradigm shift.”
The procedure involves the introduction of a tiny camera and delicate instruments through small incisions, while the abdominal cavity is expanded with carbon dioxide to allow the surgeon sufficient visibility and room to maneuver; he then watches the procedure on a monitor screen as he works.
“Two of the greatest decreases in cancer in this century are in colon and cervical cancer, because of (the introduction of) colonoscopies and Pap smears,” Radecke says. “That’s why they are SO important. With these screening tools, (cancer) can be found far in advance.”
Because the likelihood of colon polyps increases “exponentially after the age of 50” for both men and women, everyone should get a colonoscopy at age 50, earlier if there is a family history of colon cancer, Radecke urges.
If the test reveals no problems, it need not be repeated for another 10 years. When a polyp is detected during a colonoscopy, it might be removed then and there, with the tools used during the procedure; however, if it cannot be completely removed or if cancer is found, major surgery will be required.
The traditional procedure, still often used, involves a vertical incision “stem to stern,” extending about 10 inches down from just below the breastbone. In order to access the segment of colon to be removed, the colon and the intestines must displaced and large devices placed into the abdominal cavity to hold the abdominal wall out of the way. This can be a very traumatic experience.
“Your bowels have always been safe and warm inside the abdomen – always at a constant 98.6 degree,” Radecke explained. “They’ve never been manhandled, never seen the light of day. Imagine if you had never seen the sun and no one had ever touched you, and all of a sudden you’re sitting out, in this bright light in a room that is 60 degrees, and big hands are grabbing and cutting and stretching you. It’s a big deal. You’re in shock. After that you don’t wake up for a couple of days.”
After this invasive procedure, patients aren’t able to eat for several days, because the bowels aren’t working properly yet. The national average hospital stay is five to seven days, the recovery is lengthy and uncomfortable; and there is a very long, unattractive scar.
By contrast, with the minimally invasive procedure, the patient can usually eat the night of the surgery; the hospital stay is 24 to 72 hours, (which saves the patient and the insurance company tons of money); the recovery time is significantly shorter with far less pain; and, because a tiny 1/2 inch incision is sufficient to remove “a foot or two of colon,” scars are hardly visible.
It is still major surgery, but with far less recovery time.
A recent laparoscopic patient of Radecke’s in her 60’s had half the colon removed and left the hospital with almost no pain, jokingly asking Radecke, “are you sure you cut me?” Another patient was able to leave the hospital in only 18 hours. “She had half the colon removed and walked out feeling good – and could hardly see the stitches. “Now that makes me happy,” Radecke says, adding that the minimally invasive surgery, at 1½ to 2½ hours, may take longer, “but only a little.”
The colon or large bowel is the part of the body’s digestive system that curls around the small intestine, up the right side, across the abdomen and down the left side, processing and moving waste material from the small intestine to the rectum.
Following the removal of a segment of the colon, a patient may experience soft stools, because the remaining length of colon will be able to remove less water than before. “The body will acclimate” within a few weeks,” Radecke said.
While the colon will never be a popular topic of conversation, with the exciting new technology, colon surgery doesn’t have to be as scary as it used to be.
