Colon diseases: diagnosis and minimally invasive surgery
Benign and malignant conditions of the colon may require medical, endoscopic or surgical treatment. When indicated, many operations can be performed laparoscopically or robotically, including in some selected emergency conditions.
The colon can be affected by very different conditions. Some require only follow-up or medical therapy, while others may make planned or emergency surgery necessary.
The choice of treatment depends on
- diagnosis
- site of the disease
- extent
- the patient's general condition
- presence of complications
Which colon diseases may require surgical assessment?
The main conditions that may require specialist assessment include:
- diverticulosis and diverticulitis;
- colon cancer;
- polyps or lesions that cannot be completely removed endoscopically;
- strictures;
- bowel obstruction;
- perforation;
- inflammatory bowel disease in selected cases;
- volvulus and other acute conditions.
Not all of these conditions necessarily require surgery.
Diverticulosis and diverticulitis
Diverticula are outpouchings of the colonic wall, most often located in the sigmoid colon.
When may surgery be indicated?
Surgery may be considered in the presence of:
- recurrent or persistent episodes associated with significant symptoms;
- colonic stricture;
- fistulas, i.e. abnormal connections between the colon and neighbouring organs;
- complex abscesses;
- perforation;
- peritonitis;
- other complications of diverticular disease.
The indication does not depend only on the number of episodes, but on severity, complications and the impact of the disease on quality of life.
Colon cancer
Colon cancer requires a multidisciplinary diagnostic and treatment pathway.
When surgery is indicated, the aim is to remove the affected bowel segment together with its blood vessels and lymph nodes, in accordance with oncological principles.
Minimally invasive surgery for colon cancer
In many patients the operation can be performed laparoscopically or robotically.
The choice depends on:
- 01site of the tumour;
- 02extent of the disease;
- 03the patient's anatomy;
- 04general clinical condition;
- 05any complications.
The priority always remains the safety of the operation and adherence to oncological principles.
Polyps and lesions not amenable to endoscopic treatment
Most polyps can be treated during colonoscopy.
In some cases, however, size, anatomical or histological features may make surgical treatment necessary.
The decision depends on:
- size;
- site;
- morphology;
- suspected invasion;
- histological examination;
- whether complete endoscopic resection is possible.
Colonic stricture and obstruction
A stricture is a narrowing of the bowel lumen that can hinder transit.
The causes may be benign or malignant.
When the obstruction becomes significant, the following may occur:
- abdominal pain;
- distension;
- nausea and vomiting;
- reduced or absent bowel movements;
- inability to pass wind.
Bowel obstruction
Colonic obstruction can be a surgical emergency.
Treatment depends on
- cause
- site
- bowel distension
- viability of the colon
- the patient's general condition
Which symptoms may require further investigation?
Symptoms that may make further investigation necessary include:
- persistent change in bowel habit;
- new-onset constipation or diarrhoea;
- abdominal pain;
- bloating and distension;
- blood in the stool;
- anaemia;
- unintentional weight loss;
- nausea or vomiting;
- recurrent episodes of diverticulitis.
These symptoms do not necessarily mean that surgery is needed, but they may warrant a specialist assessment to plan the diagnostic and treatment pathway.
Diagnosis
The diagnostic pathway is tailored to the clinical picture.
Colonoscopy
Allows direct visualisation of the colon, biopsies and the removal of many types of polyps.
Contrast-enhanced abdominal CT
Particularly useful for assessing inflammatory complications, obstruction and perforation, and for staging malignant disease.
Blood tests
May reveal anaemia, inflammation, infection or other abnormalities.
Histological examination
Defines the nature of lesions that have been biopsied or removed.
Colon surgery
When surgery is indicated, it may be necessary to remove the affected bowel segment.
The main procedures include:
- 01
right hemicolectomy;
- 02
left hemicolectomy;
- 03
sigmoidectomy;
- 04
segmental resection;
- 05
subtotal colectomy;
- 06
total colectomy;
- 07
anterior resection of the rectum.
After resection, whenever possible, the two bowel ends are rejoined by means of an anastomosis.
Laparoscopic and robotic colon surgery
Minimally invasive surgery may offer:
- less trauma to the abdominal wall;
- smaller incisions;
- early mobilisation;
- generally faster postoperative recovery;
- less impact on the surgical wound.
Minimally invasive surgery is always performed with the aim of achieving the correct oncological result.
Emergency colon surgery
Some colon diseases can present with acute complications and require urgent treatment.
Colonic perforation
It can cause peritonitis and sepsis and requires prompt assessment.
Bowel obstruction
It may be caused by tumours, benign strictures, volvulus or other conditions.
Complicated diverticulitis
Abscesses, perforation and peritonitis are some of the possible complications.
Colonic volvulus
Twisting of the bowel can cause obstruction and compromise its blood supply.
In an emergency the priority is to gain rapid control of the disease and ensure patient safety.
Can laparoscopic surgery be performed in an emergency?
Yes, in selected patients.
The laparoscopic approach can also be used in emergency surgery when the clinical and anatomical situation allows.
It may be considered when:
- the patient is clinically stable;
- bowel distension does not prevent safe access;
- abdominal contamination is compatible with a minimally invasive approach;
- the condition can be treated effectively with this approach.
When these conditions are not met, open surgery may be necessary.
Recovery after surgery
The postoperative course depends on the type of resection and the clinical condition.
Whenever possible, enhanced perioperative recovery protocols are adopted, promoting:
early mobilisation;
gradual reintroduction of food;
multimodal pain control;
reduced immobilisation;
gradual return to normal activities.
Length of hospital stay varies from patient to patient.
When should you seek a surgical assessment?
A specialist assessment may be appropriate when:
- a colon disease has been diagnosed and surgery has been proposed;
- there are recurrent or complicated episodes of diverticulitis;
- a lesion that cannot be removed endoscopically has been identified;
- a tumour has been diagnosed;
- a stricture is present;
- you wish to assess the possibility of a laparoscopic or robotic approach.
When to seek urgent medical attention
Urgent assessment is required in the presence of:
- severe, worsening abdominal pain;
- marked abdominal distension;
- persistent vomiting;
- inability to open the bowels or pass wind;
- high fever with abdominal pain;
- significant bleeding;
- rapid deterioration in general condition.
The decision to operate is made after reviewing the diagnosis, tests, colonoscopy, any histology and the patient's general condition.
When indicated, the operation can be planned with a laparoscopic or robotic approach.
Frequently asked questions
No. Many conditions are treated with medical therapy, endoscopy or observation.
No. Many episodes are treated without surgery. Surgery is considered when complications are present or in selected situations.
In many patients, yes, when the approach allows the operation to be performed safely and in accordance with oncological principles.
Yes, some operations can be performed with robotic surgery.
There is no single best technique. The choice depends on the condition, the anatomy and the type of operation.
In selected patients, yes, when the clinical and anatomical conditions allow a safe minimally invasive approach.
In some selected cases, yes, provided it does not delay the necessary treatment.