bowel cancer test | Bowel resection

Bowel resection




Bowel resection is surgery that removes part of the small intestine, large intestine or both. The large intestine includes the colon, rectum and anus. Depending on which part of the intestine is removed, intestinal resection may also have the following names:

resection of the small intestine
resection of the colon (or large intestine)
colectomy
segmental bowel resection
Diagram of the small intestine and the large intestine

Why is there a bowel resection
Bowel resection is performed for the following reasons:

treat cancer of the small intestine, colon, rectum or anus
treat or relieve symptoms of cancer that has spread to the intestine
clear bowel obstruction (bowel obstruction)
remove as much of a cancer as possible (tumor reduction)
remove a precancerous condition before it becomes cancer (prophylactic surgery)
remove areas of the colon that are damaged by inflammatory bowel disease (IBD) or diverticulitis
repair a tear or hole in the intestine (intestinal perforation)
Types of bowel resection
Different types of bowel resection are used to remove different parts of the bowel. Each type of intestinal resection is named according to the part that is removed.

Segmental resection of the small intestine
Segmental resection of the small intestine removes part of the small intestine. The surgeon also sometimes removes part of the mesentery (fold of tissue that supports the small intestine) and the lymph nodes in the area.
Segmental resection of the small intestine is used to remove tumors in the lower part of the duodenum (first segment of the small intestine). It is also used to remove a tumor located in the jejunum (central part of the small intestine) or the ileum (last segment of the small intestine) if the cancer is located only in these structures or if it is has spread beyond the small intestine.

Right hemicolectomy
A right hemicolectomy is used to remove:

part of the ileum (last part of the small intestine);
the cecum (first part of the large intestine);
the ascending colon (first part of the colon);
the right angle of the colon (curvature of the colon near the liver);
the first part of the transverse colon (central part of the colon);
Appendix.
Right hemicolectomy removes tumors on the right side of the colon, including the cecum and ascending colon. An enlarged right hemicolectomy can also be used, which can also remove the entire transverse colon, to remove tumors located in the right angle of the colon or the transverse colon.

Diagram of the right hemicolectomy

Transverse colectomy
Transverse colectomy removes the transverse colon.

This surgery can be used to remove a tumor located in the center of the transverse colon when the cancer has not spread to any other part of the colon. Some doctors prefer to perform an enlarged right hemicolectomy rather than a transverse colectomy.

Diagram of transverse colectomy

Left hemicolectomy
Left hemicolectomy is used to remove:

part of the transverse colon;
the left angle of the colon (curvature of the colon near the spleen);
the descending colon;
part of the sigmoid colon.
Left hemicolectomy is used to remove tumors located in the left side of the colon, which includes the left angle of the colon.

Diagram of left hemicolectomy

Sigmoid colectomy
Sigmoid colectomy removes the sigmoid colon. It is used to remove tumors located in the sigmoid colon.

Diagram of sigmoid colectomy

Low anterior resection
During the lower anterior resection, the sigmoid colon and part of the rectum are removed.

Low anterior resection is used to remove a tumor located in the central or superior part of the rectum.

Diagram of low anterior resection

Proctocolectomy with colo-anal anastomosis
During proctocolectomy (also called proctectomy), the entire rectum and part of the sigmoid colon are removed. The colo-anal anastomosis is an operation in which the surgeon fixes the remaining colon to the anus.
This surgery removes a tumor located in the lower part of the rectum. It is not performed very often, because many surgeons prefer to use low anterior resection or abdominoperineal resection to remove rectal tumors.

Diagram of proctocolectomy with colo-anal anastomosis

Abdominoperineal resection
An abdominoperineal resection is performed to remove the rectum, anus, anal sphincter and muscles around the anus. The surgeon makes an incision (cut) in the abdomen and one in the perineum (region between the anus and the vulva in women, or between the anus and the scrotum in men). It is also necessary to make a permanent colostomy since the anal sphincter is removed.

Abdominoperineal resection is used to remove a tumor near the anus or that has spread to the muscles around the anus.

Diagram of abdominoperineal resection

Partial or total colectomy
A colectomy is a surgery in which the colon is removed, in part or in whole. If you remove almost the entire colon, it is a partial colectomy. If the entire colon is removed, including the cecum and appendix, the procedure is called total colectomy.

Partial or total colectomy is performed if the cancer is located on both the right and left side of the colon. These interventions could also be offered to people with familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (HNPCC) as a preventative measure for colorectal cancer (prophylactic colectomy). People with inflammatory bowel disease (IBD) may have partial or complete colectomy to remove the damaged or diseased portion of the colon.

Depending on the type of colectomy performed, the surgeon may also have to perform a colostomy or ileostomy.

Diagram of total colectomy

Whipple's operation
Whipple's operation (pancreatoduodenectomy) is a surgery in which part of the pancreas is removed along with the duodenum (first segment of the small intestine). The lower part of the stomach, the gallbladder and part of the common bile duct are also removed.

Whipple's operation may be used to treat cancer of the pancreas, bile duct, gall bladder and small bowel.

Learn more about Whipple's operation.

Preparation for bowel resection
Before surgery, your health care team usually conducts tests to check your general health and ensure that you can have an intervention. For example, blood tests, a chest x-ray and an electrocardiogram (ECG) are done to check the health of certain organs. It may also be that you have blood tests to see if you are malnourished. In case of malnutrition, the health care team could delay your bowel resection until your nutrition is better. Learn more about these tests and interventions and the nutrition of people with cancer.

Your doctor or health care team will tell you if you need to follow a special diet before surgery. Your health care team will also tell you when to stop drinking and eating before surgery.
Depending on the type of intestinal resection, you may need to clean your bowels before surgery. This usually involves administering a preparation that cleanses the gut, made from a laxative type and taken 1 or 2 days before surgery. You could also be given cleansing enemas at the hospital to make sure the intestine is as empty as possible.

If you have a colostomy or ileostomy, your surgeon usually makes a mark on the abdomen where the stoma will be placed to ensure that it is in a convenient location that will not cause a stoma. discomfort. Your surgeon or health care team may also discuss the type of collection bag (ostomy appliance) that you will need to use after surgery. You may be given antibiotics just before the procedure to prevent infection.

Surgical approaches
The surgeon may use an invasive or laparoscopic technique. With the invasive technique, the surgeon makes a large cut (incision) in the abdomen to reach the intestine. With the laparoscopic technique, the surgeon makes small cuts in the abdomen and then inserts an endoscope (a thin instrument similar to a tube with a light and a lens) and instruments to perform the surgery.

Laparoscopic technique tends to result in shorter hospital stay, faster convalescence, less incision pain, and fewer complications than invasive technique. Some people, however, can not undergo laparoscopic bowel resection because of the location and stage of the cancer, or other factors. In addition, surgeons must have special training as well as specialized skills and equipment to use the laparoscopic technique. This technique may not be available in all centers, and it is not the standard way to perform bowel resection.

How is bowel resection performed?
Resection of the intestine takes place in the hospital under general anesthesia.

During resection of the intestine, some parts of the intestine must be moved. This means that the surgeon cuts the membranes that hold the intestine in place so that it can move and stretch.

The surgeon then removes the diseased or damaged part of the intestine. It also removes a margin of healthy tissue on either side of the diseased or damaged part of the intestine.

anastomosis
Once the bowel portion is removed, the surgeon connects the remaining 2 ends of the bowel with stitches or staples. This procedure is called anastomosis.

When the large intestine is removed in its entirety and the anastomosis is made between the small intestine and the anus, it is an ileoanal anastomosis. When the procedure is performed between the colon and the anus, it is called colo-anal anastomosis.

During these two procedures, it is possible for the surgeon to form a pouch with the ileum or colon before connecting it to the anus. This is called a J-shaped colonic reservoir, because it has the shape of the letter J. A J-shaped colonic reservoir creates a location where the stool is stored before being evacuated when the rectum has been removed. removed, which helps to reduce the number of stools removed and to manage incontinence (inability to control stool evacuation).
In some cases, the surgeon does not connect the ends of the intestine together. Instead, it attaches one or both ends of the intestine to an opening in the abdomen. This procedure is called colostomy or ileostomy (depending on the part of the intestine used).

Ganglionic cleaning
If bowel resection is required to remove cancer, the surgeon will also remove at least 12 adjacent lymph nodes. Surgery that removes lymph nodes is called ganglion dissection.

Total mesorectal excision (MTE) is a type of lymph node dissection that removes the mesorectum, the fatty tissue that surrounds the rectum and contains the lymph nodes and major blood vessels. MTE is usually performed during intestinal resection to remove cancer from the rectum. This surgery allows the surgeon to remove the lymph nodes as well as tissue margins that surround the tumor (surgical margins).

Learn more about ganglion dissection.

Colostomy or ileostomy
Depending on which part of the intestine is sick and the state of health of the rest of the bowel, the surgeon may have to do a colostomy or ileostomy after resection of the bowel.

Colostomy is a surgical procedure that creates an opening in the colon to the outside of the body through the abdominal wall. The ileostomy is an operation in which an opening is made in the ileum to the outside of the body through the abdominal wall.

The colostomy or ileostomy can be temporary or permanent. The doctor may perform a colostomy or temporary ileostomy to allow the bowel to rest and heal after surgery. A colostomy or permanent ileostomy is performed when the lower rectum and anal sphincter are removed during bowel resection.

Learn more about colostomy and ileostomy.

Side effects
Regardless of the surgery, it is possible that side effects occur, but each person feels them differently. Some people experience a lot of side effects, while others experience few or none at all.

The side effects of bowel resection are usually temporary. The effects you may feel depend mainly on the type of bowel resection performed and your overall health. These effects can be:

pain
tired
bleeding
blood clots
diarrhea
constipation
bowel obstruction (bowel obstruction)
bowel become "paralyzed" or inactive (paralytic ileus)
damage to nearby organs, such as the small intestine, bladder, ureter or spleen
leak at the site where both ends of the intestine were connected (anastomotic leak)
infection
sexual dysfunction (erectile dysfunction or retrograde ejaculation in men, and pain during sex in women)
inability to control the evacuation of urine (urinary incontinence)
frequent urination
urgent need to urinate
Learn about the side effects of surgery and how to treat symptoms and side effects.
After the surgery
After resection of the intestine, you will have to stay in the hospital for several days. You will be given medication so that you feel good. These drugs are usually given by a needle inserted into a vein (intravenous, or IV).

You will first be offered clear fluids for 1 or 2 days after surgery. Solid foods and full meals will be reintegrated little by little.

If bowel resection has been done to remove cancer, you may need to receive other treatments. You may be referred to a doctor specialized in the treatment of cancer (oncologist).

If you have had a colostomy or ileostomy, a specially trained health care professional, called a stomotherapist, will teach you how to live with a stoma and take care of it. Before your return home, the health care team or the stomotherapist will provide you with information on the following topics:

change of bandages or bandages
how to take a shower and a bath
how and when to take his medication
what to drink and eat
physical activity
what to do in case of problems
frequency of follow-up visits with the surgeon
If the colostomy or ileostomy is temporary, your health care team will tell you how long you will need it. Temporary stomas usually remain in place for a few months. When the rest of the large intestine is healed, you will undergo another surgery that will connect the 2 ends of the ileum or colon. This procedure is called anastomosis. The surgeon will also close the opening on your abdomen. After this second surgery, you can evacuate your stool through the anus normally. Learn more about how to live with a stoma.