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Sigmoid Colectomy in India

What Is Sigmoid-Colectomy Surgery?

Sigmoid-colectomy surgery involves removing the left side of the colon and reattaching the ends if at all possible.  After administering general anesthesia, the surgeon makes an incision approximately fifteen inches long in the middle part of the lower abdomen in order to free the colon loop and the upper rectum from the patient’s stomach.  Thereafter, the surgeon removes the diseased part of the colon and in most cases, the ends are rejoined.  In cases where reattachment is impossible or unsafe, the waste is rechanneled through an opening in the abdomen called a colostomy, thus, requiring the patient to wear a bag to collect the waste material.

Even if the ends are joined following the first sigmoid-colectomy surgery, a colostomy is usually necessary for short-term use to keep the waste from the bowel while the reattachment is healing. Prior to having sigmoid-colectomy surgery it is necessary to stop smoking, lose weight, and make certain any blood pressure, heart, and lung conditions are under control. Most patients will be able to get out of bed the day after sigmoid-colectomy surgery and return to normal activities within three months. It is normal to experience pain and tenderness at the incision site for up to six months.

The operation in India

You will have a general anaesthetic, and will be asleep for the whole operation.

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A cut is made in the skin in the middle lower part of the abdomen about 40cm (15 inches) long. The left side of the colon loop and the upper rectum are freed from the inside of the tummy. The diseased part is cut out and usually the ends are joined together. Sometimes it is safer if the ends are not joined together. Then the bowel waste is channelled through the bowel which opens in the front of your tummy (a colostomy), and you need to wear a bag. This looks like a big nipple of pink bowel stuck to the tummy skin. Usually the ends are joined up at a later date.

Sometimes the ends are joined up at the first operation, but a short-term colostomy is made as well. This keeps the bowel waste away from the join while it is healing up.

You should plan to leave hospital two weeks after the operation. Very rarely, if the problem area is in the lower part of the rectum, at operation, the back passage may need to be removed as well. You would be warned about this before the operation.

Possible Complications

As with any operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.

Complications are unusual but are rapidly recognised and dealt with by the surgical staff. If you think that all is not well, let the doctors or the nurses know. Chest infections may arise, particularly in smokers or obese patients. Getting out of bed as quickly as possible, being as mobile as possible and co-operating with the physiotherapists to clear the air passages is important in preventing infection. Do not smoke.

Occasionally the bowel is slow to start working again. This requires patience. Your food and water intake will continue through your vein tubing until you pass wind or open your bowels. Sometimes there is some discharge from the drain by the wound. Wound infection is sometimes seen. This happens relatively more frequently in any bowel operation compared to other 'clean' operations such as taking out your gallbladder and the reason is that the bowel has many bugs that can cause an infection. The infection settles down with antibiotics in a week of two.
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Very rarely, during the operation, another part of your bowel, your bladder or a blood vessel can be damaged and this may require another operation to deal with the problem.

One potential major complication is a leak from the area where the two parts of your bowel were put back together. The chance of a leak is up to 15% and is more frequent in patients whose wounds take longer to heal such as elderly people, diabetics and patients suffering from cancer. If a leak happens you will stop eating and drinking for several days until the bowel heals completely. In the meantime you will be given all the food and water you need via a catheter in one of your veins. This often corrects the problem but sometimes another operation is needed to control the leak.

Aches and twinges may be felt in the wound for up to six months. Occasionally there are numb patches in the skin around the wound which get better after two to three months. If you have a colostomy, you will be given help and advice from the stoma nurses

Chemotherapy in India

After the surgeon removes the section of the colon, a pathologist evaluates the cancer under a microscope. If the pathologist sees evidence that cancer has spread to the lymph nodes, or if the cancer is a type that grows quickly, the oncologist will usually recommend further treatment with chemotherapy.

Follow-up Care

After a colectomy, bowel movements might be more frequent. Bowel movements usually become more normal after one year. Your doctor can recommend a bowel care plan to help normalize bowel movements.

The most common time a cancer recurs is within the first two years following diagnosis and treatment. Follow-up care with the surgeon, gastroenterologist and oncologist is important. Periodic checkups may include a physical exam, blood tests, colonoscopy, CT scan or PET scan.

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