Laparoscopic surgery for colon (large bowel) cancer has many, many advantages over conventional open surgery.
Less pain, smaller scars, faster recovery and from the surgeon’s point of view, sometimes much clearer views enabling more complete clearance of the cancer.
There are however some challenging situations where laparoscopic surgery is a lot more difficult than conventional open surgery.
Very large tumours is one and another is bowel obstruction.
In the case of bowel obstruction, all the bowel upstream of the obstruction gets very distended because the faeces is unable to pass the tumour causing blockage. The bowel becomes like those long sausage shaped balloons we see at the circus. There is very little space to work in and all the views are crowded out by the distended loops of bowel. It then becomes difficult to clearly identify critical structures during dissection. That makes the operation not only more difficult but also more dangerous. Moreover, it is also not possible to clean the bowel before surgery. That means the operation has to be done with the bowel loaded with faeces, greatly increasing the likelihood of infectious complications like wound infection, anastamotic leak etc.
However, there is a way to overcome the difficulties.
This is the story of Mr K. He was told 3 months earlier that he had a tumour of the sigmoid colon. Tests had shown the tumour was malignant (cancer). He had intended to come see me earlier but decided to try traditional medicine first.
This is something I see too often.
It always ends the same way.
The traditional medicine doesn’t work, the patient comes late and complications set in. The cancer spreads or the bowel becomes obstructed.
And that is precisely what happened to Mr K.
When I did a colonoscopy on Mr K, the scope could not get past the cancer. The bowel lumen, usually about 4cm in diameter had narrowed to about 5mm.
Thankfully his CT scan had shown no spread of the cancer elsewhere.
Something clearly needed to be done. The cancer needed to be removed. It was not that big – 5cm in size, but his bowel was obstructed. That would normally mean an open operation.
There was however another way.
I repeated the colonoscopy and this time, I inserted a device called a stent across the tumour. A stent is a springy cylinder made of special wire woven into a tube. It comes loaded on a narrow 2mm catheter. It is placed across the narrowed portion and when released, it expands into a springy tube that gently pushes aside the tumour and opens up the narrowed portion. It is the same principle as the stents cardiologists use to open up blocked arteries in the heart (of course those are much smaller).
The plan worked perfectly and the stent relieved his obstruction.
We were then able to get his bowel properly cleaned and emptied before surgery and he went on to have his cancer removed successfully 3 days later – laparoscopically of course!
He made a splendid recovery and went home well.
All small wounds, no colostomy needed!