I never set out to be as knowledgeable as I have recently become about colon surgery. But if you want to know the real lowdown on a procedure, ask someone who has gone through it.
First a few basics: The colonoscopy is the gold standard for detecting colon issues. If you wait until you have symptoms in the case of colon cancer, it is usually too late. Fecal occult blood test would not have found my polyp (it wasn’t bleeding). Sigmoidoscopy — i.e. looking up the descending (left) colon as far as the first bend, is a numbers game. It will discover a lot of abnormalities, but it wouldn’t have found mine: mine was in the transverse colon on the right (far) side. Women especially should insist on a full colonoscopy: statistically women tend to experience more issues higher up in the colon whereas men tend to have polyps and cancers closer to the rectum. Virtual colonoscopy is less annoying to prepare for, but the results aren’t as good. Don’t settle for anything less than a full colonoscopy. If you are going to test, get the best test.
Second: So-called colon cleansing products have no effect on colon cancer, and it’s highly dubious if they prevent it. They make a lot of money for those who sell them, but the colon is designed to clean itself, and will do so happily if provided with high quality nutrition. High colonics and enemas are not good for you when done regularly. Mixtures such as psyllium/bentonite will certainly pull a lot of water from your body and give you a temporary light feeling, but psyllium is an irritant to some. Likewise, chronic laxative use is bad and can set up a dependency. The best prevention is to maintain proper weight, eat little or no red meat, sugar, transfats and refined carbs and lots of fresh fruit and vegetables and exercise regularly and drink lots of water.
You are probably reading this because you or someone you love has been diagnosed with some sort of colon abnormality and you are looking at surgery. Your abnormality may already been diagnosed as cancer, or you may have been told, as I was, that a polyp that size (between pingpong ball and baseball sized) is almost sure to contain cancer. So naturally you want it out of there post haste.
Unfortunately, surgery is pretty much your only option, but be educated about the finer details and you will have dramatically better results.
Too big to do through the endoscope? The endoscope is the flexible tube with cameras and instruments that is inserted in your anus during a colonoscopy. A normal endoscopist is trained to snip small polyps, especially the common kind that grow on a stalk, with a tool called an endoscopic snare. It’s basically just an adjustable loop of fine wire that they poke out the tool head of the flexible tube containing the scope. They make it big enough to go around the polyp, then they tighten it up until it cuts off the polyp. They retrieve the polyp and biopsy it but the assumption is that the majority of small polyps are benign. It’s only the ones that get left in a long time and grow big that are more likely to contain cancer. If the endoscopist determines that the polyp is small enough, he/she just snips it automatically. If you are looking at surgery like I was, it is because your polyp is large, and/or sessile (that means it has a very broad base and is well anchored on the inside of the colon.) Mine was both.
Bowel Resection: The current standard procedure for a large polyp if the rest of the colon is otherwise healthy is what I had: a bowel resection: meaning they basically remove the segment of bowel containing the polyp and then reattach the ends of what is left. There are numerous ways to do this, depending on the skill of the surgeon, the location of the polyp and the condition of the patient.
Open abdominal surgery: Prior to the mid 90’s bowel resections were usually done as open abdominal surgery. This means they cut a large incision in your abdomen to access the colon and they work through it. Your body cavity is open for the duration of the surgery and when it’s done you have a large incision that is slow to heal because it was open for so long.
Modified laproscopic procedure: In the mid 90’s they started doing this procedure laproscopically, i.e. they insert three small tubes under your skin and muscle layer and operate through the tubes. When they have dislodged the bad bit and bagged it and sutured the ends of the colon they then create an incision to remove the bad bit. Because the incision is smaller and open only for a few minutes, it heals much faster and better, necessitating a much shorter hospital stay. This procedure is contraindicated for an obese patient or in someone who has already had multiple previous surgeries. Apparently the laproscopes don’t work very well with a lot of stuff on top of them. This is what I had done.
Experimental combo lapro/endo: This is what I wish I could have had done. I wondered why they couldn’t just roto-root, scrape out the polyp like a D&C and remove it in chunks through the anus. There are three reasons why they don’t: one, risk of perforating the colon, two, if it is cancer they need to be careful not to let any cancer cells escape to start a new colony, and three if it is cancer you would want to take the surrounding tissue anyway. It turned out my polyp, although huge, was benign, but there was no way to know that until it was all out. There is a technique now where they do this but I’m guessing they will do it only if the risk of cancer is low. My risk of cancer was considered to be very high. I of a case where the patient had a polyp too large for a standard endoscopic snare and they went in through the rectum with an endoscope with some souped up tools and basically roto-rooted the polyp, while another doctor made laproscopic incisions and watched the outside of the colon with a laproscope to make sure it didn’t get perforated. If they perforated the colon they had a plan B, which was to go ahead and do a laproscopic bowel resection. And if anything they scraped out of that patient had cancer in it, they were prepared to go back in and give him a bowel resection anyway. Lucky for that patient, they didn’t perforate him, and his polyp turned out to be benign and he walked out that day with only a couple band-aids on his abdomen. This procedure is regarded as experimental and is not widely used, but I predict it will be within the next five years. I heard that it was invented at UCLA Med center so if you live near there you might wish to investigate further.
Colon suture options: All the illustrations I found on the net show the ends of bowel reattached end-to-end so eventually it just looks like a somewhat shortened but continuous tube. A lot of times, however, they bring up the two bowel ends even, suture across the top, and then make a new hole for the fecal matter to travel through. This seems kludgey, bumpy and ugly to me but that is what they did. According to two surgeons I consulted both ways work equally well. One of them said the ugly way is less likely to rupture and the other said they were about the same. When I get to be a constipated old lady I will update and let you know if my modified colon is giving me any problems, but so far it’s working just fine.
Your exit scar: Unless you are fortunate enough to have the latest minimally invasive surgery you will either end up with a big scar, or a smaller scar and three laproscopic incisions. The small incisions heal quickly. You will want to do everything you can, including acupuncture and self massage, to soften up that scar as soon as it heals. You will also not be able to use your core abdominal muscles for a little while or lift anything. Do not push this because you do NOT want your incision to get a hernia!
Finally, find other people your surgeon has operated on and Google your surgeon! Laproscopic bowel resection is regarded as a difficult procedure and it takes a long time for a surgeon to get good at it. You will have to live with the results of his/her work for the rest of your life.