Until ten years ago abdominal surgery of colon-rectal illnesses required a broad surgical incision and a long period of post-operative hospitalisation.
Currently laparoscopic surgery (also called mini-invasive) may be used to cure the greater part of colon and rectal illnesses, obtaining the same results as traditional surgery but with the considerable advantage of less post-operatory pain, rapid healing of the surgical wound (with optimum aesthetic results) and a rapid return to daily activity.
However laparoscopic surgery is practised today by a limited number of highly specialised surgical teams and for this reason it is called Advanced Laparoscopic Surgery. The centres that use such a technique are moreover endowed with state-of-the-art technology including precision surgical instruments and equipment for computer analysis of the operating pictures.
The General Surgery Unitof Aosta Regional Hospital is one of the Italian centres where advanced laparoscopic surgery has been used since the early years of the 1990s.
Diverticulitis, complicated Crohn's illness (which is concerned with both the colon and the intestine), chronic constipation, the intestinal valve, and constipation, are treated surgically in our laparoscopic centre. Moreover we are able to use the mini-invasive technique to repair rectal prolapse and also bladder-vagina, to remove the non-cancerised polyps of the colon, to treat endometriosis and to follow removal of the patological spleen, ovary cysts and those of the womb, and liver tumours.
An especially complex surgery is represented by resection of the rectum for tumour, with preservation of the genital and urinary innervation and of the sphinateral anal. In fact removal of a malign tumour of the rectum, for reasons of the particular anatomic position of the last tract of the intestine, emphasises the integrity of this important physiological function, especially when one needs to ensure a surgical operation with a radical and curative purpose.
In our Centre laparoscopy is used for rectal removal with the nervous and sphinateral technique with results that are comparable to the best internationally published case examples and with a percentage of definitive colostomies of about 10%. Out of 100 patients operated on for tumours of the lower rectum, with high level of definitive anal removal, to ensure a radical intervention, only 10 patients have experienced such definitive operations.
The particular telecamera utilised to see the internal abdominal cavity enlarges the internal pictures six times bigger than their natural size and allows the operation to be done with accuracy, also reducing risk of infection and other complicated post-operatory complications.
By means of small incisions of the abdominal wall (which usually vary from da 0.5 to 1.5 centimetrres) devices (called Trocar) are positioned inside which particular laparoscopic instruments are positioned (pliers, scissors, ultrasonic scalpels, bipolar coagulator, irrigators for breathing and washing with sterile physiological solutions, mechanical devices and intestinal stitch cutters etc.).
When it is necessary to remove the intestinal tract or a diseased part of an organ (as happens in the removal of tumours or cysts of the colon affected by diverticulitis or by constipation) one must make an incision of about 7- 8 centimetres in the most appropriate place for the extraction of the operated part which will be sent to Pathological Anatomy for histological examination.
All patients can be cured by the laparoscopic or mini-invasive technique, except for those with a high operatory risk, seriously multi-traumatised people, and those with intestinal occlusions.
In a small pecentage of cases (about 3-4%), owing to anesthesiological problems or linked to illness and/or other associated pathologies, it is not possible to complete the procedure by means of laparoscopy and therefore one follows and finishes with the traditional method (that is an abdomen incision about 25- 30 cm long is made).
Even the common and fastidious anal-rectal illnesses (hemorrhoids, fistulas and piles) are treated at our Centre with the most sophisticated equipment: ultrasonic and/or radiofrequency scalpels.
