Our Summary

This study looked at the risks associated with two types of colectomy surgery (removal part of the colon) in older, frail patients. The two types of surgery were open colectomy (where a large cut is made in the abdomen) and laparoscopic colectomy (where several small cuts are made and a camera is used to guide the surgery). The researchers used a large database of surgeries performed between 2005 and 2014 to compare results.

They found that the death rate within 30 days of surgery was significantly higher in the open colectomy group for patients of all levels of frailty. The rates of other health complications (including problems with the wound, blood, lungs, kidneys, and heart or blood vessels) were also generally higher in the group that had open surgery.

In conclusion, the study suggests that laparoscopic colectomy is a safer option than open colectomy for frail elderly patients.

FAQs

  1. What are the two types of colectomy surgery discussed in this study?
  2. How did the researchers conclude that laparoscopic colectomy is a safer option for frail elderly patients?
  3. What were the observed complications and death rates in open colectomy compared to laparoscopic colectomy?

Doctor’s Tip

A doctor might tell a patient undergoing colectomy surgery to consider opting for laparoscopic surgery over open surgery, especially if they are older and frail. Laparoscopic surgery has been shown to have lower rates of complications and mortality in this population. It is important to discuss the risks and benefits of each type of surgery with your doctor to make an informed decision about your treatment plan.

Suitable For

Patients who are typically recommended for colectomy surgery include those with the following conditions:

  1. Colon cancer: Colectomy may be recommended as a treatment for early-stage colon cancer or as a preventive measure for those at high risk of developing colon cancer.

  2. Inflammatory bowel disease: Patients with conditions such as ulcerative colitis or Crohn’s disease may require colectomy if medications and other treatments are not effective in managing their symptoms.

  3. Diverticulitis: Severe cases of diverticulitis, where the colon becomes inflamed and infected, may require colectomy to remove the affected portion of the colon.

  4. Bowel obstruction: Colectomy may be necessary in cases of bowel obstruction, where a blockage in the colon prevents the passage of stool.

  5. Chronic constipation: In some cases, severe chronic constipation that does not respond to other treatments may warrant colectomy to remove part of the colon.

  6. Familial adenomatous polyposis (FAP): Patients with FAP, a genetic condition characterized by the development of numerous polyps in the colon, may undergo colectomy to prevent the development of colon cancer.

  7. Trauma or injury: In cases of severe trauma or injury to the colon, colectomy may be necessary to repair the damage and prevent complications.

It is important for patients to discuss the risks and benefits of colectomy with their healthcare provider to determine if this surgery is the best treatment option for their specific condition.

Timeline

Before colectomy:

  • Patient will undergo a series of tests and consultations with their healthcare team to determine the need for surgery and assess their overall health and fitness for surgery.
  • Pre-operative preparations such as bowel preparation, fasting, and medication adjustments may be necessary.
  • Patient may experience anxiety and uncertainty about the upcoming surgery.

After colectomy:

  • Patient will be closely monitored in the recovery room immediately following surgery.
  • Patient may experience pain, discomfort, and fatigue in the days following surgery.
  • Patient will gradually resume eating and drinking, and may require assistance with mobility and self-care tasks.
  • Patient will be discharged from the hospital once they are stable and able to manage their recovery at home.
  • Patient will continue to recover at home, gradually increasing activity levels and following post-operative care instructions provided by their healthcare team.
  • Patient will have follow-up appointments to monitor recovery progress and address any concerns or complications that may arise.

What to Ask Your Doctor

Some questions a patient should ask their doctor about colectomy include:

  1. What are the potential risks and complications associated with open colectomy and laparoscopic colectomy?
  2. How do the risks and benefits of each type of surgery compare for older, frail patients?
  3. What factors should be considered when determining the best type of surgery for me?
  4. What is the expected recovery time and post-operative care for each type of surgery?
  5. How will my age and level of frailty impact the success of the surgery and my overall outcome?
  6. Are there any alternative treatments or procedures that could be considered instead of colectomy?
  7. How many of these surgeries have you performed, and what is your success rate with each type?
  8. What is the long-term outlook for patients who undergo colectomy, particularly in terms of quality of life and bowel function?
  9. Are there any specific lifestyle changes or precautions I should take before or after the surgery?
  10. Are there any additional resources or support services available to help me prepare for and recover from colectomy surgery?

Reference

Authors: Kothari P, Congiusta DV, Merchant AM. Journal: Updates Surg. 2019 Mar;71(1):89-96. doi: 10.1007/s13304-018-0531-7. Epub 2018 Apr 16. PMID: 29663301