Due to the smaller incision sizes, recovery time is shorter for laparoscopic colectomy than for the open procedure and postoperative pain is decreased. However, laparoscopic colectomy also has disadvantages compared to an open procedure, and complications can still occur.
Converting a Laparoscopic Surgery to an Open Procedure
Not all surgery can be done laparoscopically, and in some cases, a laparoscopic procedure may need to be converted to an open procedure. If cancer is found, for example, a larger incision provides better visualization of the entire abdominal cavity so that no cancer is missed. Other reasons for conversion to an open procedure include bleeding, scar tissue or adhesions from previous surgery and an inability to visualize necessary structures, surgeon Martin Weiser M.D. of Memorial Sloan-Kettering Cancer Center states.
Development of an Ileus After Colectomy
Prolonged ileus, paralysis of the bowel, can occur after both open and laparoscopic surgery to remove part of the bowel. Ileus normally occurs in the first 24 to 48 hours of the postoperative period possibly due to handling of the bowel during surgery, anesthetic agents, narcotic pain medication and electrolyte imbalance, lead author Brian Behm M.D. reports in the 2003 Clinical Gastroenterology and Hepatology.
Prolonged ileus leads to pain, longer hospital stay and immobilization, poor wound healing, increased nausea and vomiting and an increase in pneumonia and other pulmonary complications. Laparoscopic surgery reduces the incidence of ileus by 27 to 40% over open surgery, Dr. Behm reports, but ileus still occurs in 2.8% of cases, lead author Anthony Senagore of the Medical University of Ohio reported in the March 2006 issue of The American Journal of Surgery.
Anastomatic Leaks in Laparoscopic Colectomy Surgery
Often, two healthy sections of bowel are attached together after removal of an unhealthy section, a procedure called an anastomosis. If the two ends don’t heal together well, a leak can develop at the site. A second procedure may be necessary to stop the leakage, which can cause peritonitis, infection in the abdominal cavity. Around 2% of patients experience an anastomatic leak after surgery, surgeon Mark Fusco, M.D. reports on his website, MarkFuscoMD.com.
Injury to Nearby Structures During Laparoscopic Colectomy
Injury to nearby structures, such as the ureter, spleen and other parts of the intestine occur in around 2% of laparoscopic colectomy, according to Dr. Fusco.
Sources
CancerLink: Laparoscopic Surgery for Colorectal Cancer: Is It Ready for Prime Time?; Accessed September 15, 2010
Clinical Gastroenterology: Postoperative Ileus: Etiologies and Interventions; Accessed September 15, 2010
The American Journal of Surgery: A Critical Analysis of Laparoscopic Colectomy at a Single Institution; Accessed September 15, 2010
MarkFuscoMD.com: Laparoscopic Colectomy; Accessed September 15, 2010
Sharon Perkins - Sharon is an RN with over 20 years experience in maternal child health, oncology, and ophthalmology. She was the RN coordinator for an ...
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