A laparoscopic sigmoidectomy is a surgical procedure involving the removal of the sigmoid colon, the final S-shaped segment of the large intestine before the rectum. The term “laparoscopic” refers to the minimally invasive technique, often called keyhole surgery. This approach uses small incisions instead of a single, large cut, which is associated with a quicker recovery and less pain compared to traditional open surgery. The procedure is commonly used to treat various diseases affecting the lower digestive tract.
Medical Conditions Treated
The most frequent reason for performing a laparoscopic sigmoidectomy is complicated or recurrent diverticulitis. Diverticulitis occurs when small pouches, called diverticula, that form in the lining of the colon become inflamed or infected, leading to symptoms like severe pain, fever, and nausea. Surgery is often indicated for patients who experience multiple severe flare-ups or for those with complicated cases involving abscesses, fistulas, or bowel obstruction.
The procedure is also a standard treatment option for localized sigmoid colon cancer. For malignant conditions, the surgeon removes the tumor-bearing segment of the colon along with nearby lymph nodes to ensure a complete oncologic resection. This laparoscopic approach has been shown to have similar long-term survival outcomes to open surgery for colorectal cancer.
Other indications include the removal of large, non-cancerous growths or polyps that cannot be safely or completely taken out during a standard colonoscopy. The surgery may also be necessary to treat sigmoid volvulus, a condition where the sigmoid colon twists upon itself, causing an intestinal obstruction. In specific cases of inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis, a sigmoidectomy might be performed if the disease is confined to that segment of the colon and other medical treatments have failed.
Steps of the Minimally Invasive Procedure
The laparoscopic sigmoidectomy is performed while the patient is under general anesthesia, beginning with the creation of several small incisions, typically four to five, that are about half an inch long. One of these small cuts, often near the belly button, is used to insert a laparoscope, which is a thin instrument with a light and a miniature camera. The camera transmits a magnified image to a monitor, allowing the surgical team to view the abdominal cavity.
To create a working space for the instruments, carbon dioxide gas is introduced into the abdomen, a process called insufflation. Specialized surgical tools are then inserted through the other small incisions, known as port sites. The surgeon first mobilizes the sigmoid colon by carefully cutting the tissue and blood vessels that hold it in place, often using a medial-to-lateral approach.
The blood supply to the diseased segment is divided, and the section of the sigmoid colon to be removed is then cut free using endoscopic stapling devices. This diseased segment is placed into a small protective bag and is then extracted through one of the port incisions, which may be slightly enlarged for this purpose. After the removal, the two healthy ends of the remaining colon and rectum are reattached to restore continuity of the digestive tract, a process called anastomosis.
This reattachment is often secured using a circular stapling device that is inserted through the rectum. In certain situations, such as when the patient is malnourished, the operation is performed urgently, or the anastomosis is considered high-risk, the surgeon may elect to create a temporary ostomy (stoma). This involves bringing a portion of the bowel through an opening in the abdominal wall to divert stool away from the newly created connection. The ostomy is typically reversed in a second, smaller surgery a few months later.
Hospital Stay and Initial Recovery
Following a laparoscopic sigmoidectomy, the hospital stay is short, with most patients being discharged within three to five days. Because the incisions are small, patients typically experience less severe post-operative pain. Pain is managed with medication, often delivered through an intravenous drip or epidural initially, which allows the patient to move more comfortably.
A central component of the recovery process is early mobilization, which means getting out of bed and walking as soon as possible, usually within the first day after surgery. This activity is important for reducing the risk of complications like blood clots and pneumonia, and it also encourages the bowel to begin working again. The return of bowel function, signaled by passing gas, generally occurs sooner with the laparoscopic technique, often within one to three days.
Dietary progression also starts quickly, moving from clear liquids to a regular diet as the digestive system wakes up and can tolerate food. Patients are typically able to return to light, non-strenuous activities, such as driving and office work, within two to three weeks of the procedure. However, all patients are advised to avoid heavy lifting and strenuous exercise, generally anything over ten pounds, for approximately four to six weeks to allow the surgical sites to heal completely.