Keyhole bowel surgery (laparoscopic colectomy)

What is keyhole bowel surgery?

Keyhole bowel surgery, or laparoscopic colectomy, removes part of the large bowel through three to five small cuts using a camera and fine instruments, with a slightly larger cut to take the bowel out. The healthy ends are usually joined. It is an alternative to open surgery through one long cut when suitable.

A colectomy is an operation to remove all or part of the colon. In the keyhole approach, the surgeon makes three to five small cuts in the abdomen, fills the abdomen with a harmless gas to create space, and works while watching a camera image. A slightly larger cut may be needed to take the bowel out. The diseased section is removed, usually with nearby lymph nodes when the reason is cancer, and the healthy ends are stitched or stapled together. This join is called an anastomosis. Keyhole surgery is not suitable for everyone, and an operation may begin as keyhole and be completed as open surgery.

Why is keyhole bowel surgery done?

Keyhole bowel surgery is used for bowel cancer, polyps too large to remove through a colonoscope, diverticular disease with repeated attacks or complications, and Crohn's disease or ulcerative colitis not controlled by medicines. It is also used for volvulus, inherited polyp conditions and some cases of severe bleeding from the colon.

• Bowel cancer in the colon or rectum
• Polyps too large or complex to remove through a colonoscope
• Diverticular disease with repeated attacks or complications
• Crohn's disease or ulcerative colitis not controlled by medicines
• Twisting of the bowel (volvulus) or a blockage
• Inherited conditions with many polyps, such as familial adenomatous polyposis
• Severe bleeding from the large bowel

When should I seek help after bowel surgery?

After bowel surgery, contact the team or seek urgent care for fever, worsening abdominal pain or swelling, vomiting, no wind or stool passing, a red or leaking wound, heavy bleeding, or a stoma that stops working for more than 12 hours. Leg pain, chest pain or breathlessness need emergency care.

The warning signs below need prompt attention.

• Fever, or increasing abdominal pain or swelling after discharge
• Redness, swelling or discharge from a wound
• Vomiting, or being unable to pass wind or stool
• Bleeding from the back passage beyond a small amount
• A stoma that is not active for more than 12 hours, or very high output with signs of dehydration
• Leg swelling or pain, chest pain or breathlessness

How is the operation planned?

Before keyhole bowel surgery, a colonoscopy and biopsies confirm the diagnosis, and scans such as CT show the extent of disease. Blood tests and fitness checks prepare you for anaesthesia, and a stoma nurse joins the discussion when a stoma may be needed. You receive instructions on medicines, diet and bowel preparation.

• Colonoscopy with biopsies to confirm the diagnosis and mark the area if needed
• CT scan of the chest, abdomen and pelvis when cancer is the reason for surgery
• Blood tests, heart tracing and a check of your fitness for anaesthesia
• Advice on stopping smoking, medicines, diet and bowel preparation before the operation
• A discussion with you and a specialist stoma nurse when a stoma may be needed

What operations can be done by keyhole surgery?

The operation depends on where the disease is. A right hemicolectomy removes the right colon and a left hemicolectomy the left colon. An anterior resection removes the lower sigmoid colon and all or part of the rectum, sometimes with a temporary stoma. Total colectomy treats disease throughout the colon.

• Right hemicolectomy: removal of the ascending colon and right part of the transverse colon, joining the small bowel to the remaining colon
• Left hemicolectomy: removal of the descending colon and part of the transverse colon
• Sigmoid colectomy or high anterior resection: removal of the sigmoid colon
• Anterior resection: removal of the lower sigmoid colon and all or part of the rectum, sometimes with a temporary stoma to protect the join
• Total colectomy or proctocolectomy for disease affecting the whole colon
• An enhanced recovery programme to help you eat, walk and go home sooner

What are the risks and complications?

Keyhole bowel surgery is major surgery. Risks include leakage from the join, which can be serious, bleeding, infection, damage to nearby organs such as the ureter, later blockage from scar tissue, hernia at a wound, blood clots and changes in bowel habit. Sometimes conversion to open surgery is needed.

• Leakage from the join (anastomotic leak), which can be serious
• Bleeding inside the abdomen
• Wound infection, chest or urine infection
• Damage to nearby organs, including the ureter or bladder
• Scar tissue causing a later bowel blockage, or a hernia at a wound
• Blood clots in the legs or lungs
• Conversion to open surgery during the operation when needed
• Changes in bowel habit, especially after anterior resection