The most common conditions requiring surgery of the colon include diverticular disease and tumors. Many surgeons continue to perform traditional open surgeries to treat these illnesses. With minimally invasive robotic surgery and enhanced recovery pathways, patients have less postoperative pain, quicker recovery, and shorter hospital stays.
Diseases of the Colon
Diverticulosis describes a condition where small outpouchings develop on the wall of the colon. These occur most commonly in the sigmoid colon (just before the rectum) but can develop anywhere in the colon. Diverticula are very common, and the likelihood of having diverticulosis increases substantially as we age. However, not everyone with diverticulosis becomes symptomatic. Problems occur if a person with diverticulosis develops bleeding from the diverticulum, inflammation, or obstruction.
Diverticulitis describes the condition when the small outpouchings become inflamed. The extent of inflammation can vary widely. In mild cases, a small amount of pain may resolve on its own or with a course of antibiotics. In the most severe cases, the diverticulum can perforate and spill intestinal contents into the abdomen, requiring emergent surgery. Between these two extremes, there is a spectrum of disease that can develop. In some cases, inpatient hospitalization for IV antibiotics may be sufficient treatment. In other cases, a radiologic drainage procedure may be required or surgical resection. Chronic diverticulitis may cause an obstruction of the colon, or may even create a connection with the bladder, called a fistula. In both instances, surgery is required.
Diverticular bleeding almost always stops on its own, without intervention. Most bleeding that does not stop can be successfully treated endoscopically. In few instances, surgery may be required to remove the part of the colon containing the bleeding diverticulum.
Polyps are benign growths originating from the inner lining of the colon. In many cases, polyps can be safely and completely removed during colonoscopy. In other instances, a polyp may not be able to be removed during colonoscopy, and surgical resection is indicated. Some polyps may transform into colon cancer over time. Surgery for removal of the portion of the colon containing cancer and its surrounding lymph nodes is paramount to treatment and staging. Some colon cancers are identified at an early stage on screening colonoscopy. Others may be found in patients with anemia, or they may develop an obstruction at the site of the tumor. In more advanced cases, a patient may present with perforation from the tumor itself.
In many cases, surgery to remove a portion of the colon can be safely performed with robotic surgery or laparoscopy (minimally invasive surgery), allowing for less pain, quicker recovery, and shorter hospital stay. When a segment of the colon is removed, the remaining ends are reconnected, called an “anastomosis.” In some emergency cases, contaminated conditions inhibit proper healing of this reconnection, and a temporary ostomy may be required. An ostomy is commonly known as a “bag” on the skin. In this situation, rather than reconnecting the ends of the remaining colon, and risking poor healing and leakage, an end of the colon is brought up to the level of the skin to allow stool to empty into a bag. After the patient heals from their emergent condition and they are medically optimized, they can be brought back to surgery at a later date to safely reconnect the intestine. This procedure can often be completed with robotic surgery as well.
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Dr. Anthony Pozzessere performs robot-assisted surgery whenever it is necessary, and the patient is a good candidate for it. Dr. Pozzessere has performed a great many colorectal surgeries in his career, and is considered to be one of the foremost practitioners of this kind of surgery in the medical field.