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SURGICAL SPECIALISTS, P.C.

COLON AND SMALL BOWEL OBSTRUCTION SURGERY

COLON SURGERY

Surgery may not always be the cure for colon disease, but it is generally the best way to stop the disease from spreading and help alleviate pain and discomfort. Over 600,000 surgical procedures are performed each year in the United States to treat colon disease.

Our surgeons provide surgical care for the following colon disorders:

  • Diverticulitis
  • Ulcerative colitis
  • Polyps
  • Tumors
  • Inflammatory Bowel Diseases including Crohn's Disease and Ulcerative Colitis
  • Minimally invasive intestinal Surgery
  • Hemorrhoids
  • Inherited Colorectal Cancers
  • Gastrointestinal Surgery
  • Anal Fistulas and Fissures
  • Surgical Oncology
  • Pilonidal Cysts
  • Perirectal Abscess

WHAT IS THE COLON?
The colon is also known as the large intestine or large bowel.
It is located in the lower part of the digestive tract. It is a muscular tube about five feet long that travels around the borders of the abdominal cavity. This long tubular organ consists of the colon (large intestine)and the rectum, which is the last part of the colon.

Once food is swallowed it starts to become digested in the stomach. Following that, it empties into the small intestine, where the nutritional part of the food is absorbed. The remaining waste then travels through the colon into the rectum. The colon and rectum absorb water, form stool, and hold the waste until you are ready to expel it.

Muscles run across and around the colon. They will contact and relax rhythmically in order to propel the stool along. Water is absorbed along the way as the stool goes from a liquid to a solid. The route it travels is up the ascending (right) colon, across the transverse colon, and down the descending (left) colon to the curved and looped sigmoid colon. Stool is stored there until such time that it is conveniently passed outside. It will exit through the anus. Located at the base of the rectum, which is the last six inches of the colon.

COLON PROBLEMS
  • TUMORS: A tumor is an abnormal growth of normal cells in the lining of the colon that are usually malignant. If the cancerous tumor is not removed, new tumors can grow in other parts of the body because the cancerous cells may spread through the blood stream. The cure rate is considerably higher if the cancer is detected through routine screening exams before actual symptoms appear. Cancers can grow for years before symptoms are evident.
  • POLYPS: Growths on the inside of the colon wall are known as polyps. They will vary in size and shape from that of a pea to that of a mushroom. In many cases, polyps cause no symptoms. In some patients polyps can cause bleeding, cramps, or constipation. Some polyps can become cancerous.
  • DIVERTICULA: Diverticula are one or more pockets pushed out of the colon due to increased pressure in the colon from trapped gas or ongoing constipation. These pockets generally develop in weak areas next to the colon's blood vessels. When this happens, patients can develop diverticulitis, which can have symptoms of abdominal pain and cramping. It can be treated in many cases with medication. However, more severe cases may require surgery. Stool can sometimes get caught in one of these pockets and cause inflammation and infection.

SYMPTOMS OF COLON PROBLEMS
The following symptoms can be caused by tumors, polyps and diverticula. Patients should look for theses as possible indications that a colon disorder may exist:

  • Bleeding: Bleeding from the colon often comes from the surface of a tumor that has broken open. It can also happen if a diverticlua erodes a nearby blood vessel. Blood can vary in color from bright red, maroon or black, depending on the location from which it originates. Patients should never assume that rectal bleeding or blood in the stool is from hemorrhoids, and should be evaluated even with a history of hemorrhoids.
  • Obstruction: Obstructions can be caused by tumors, twisting (volvulus) and chronic diverticulitis. They may partially or totally block the passage of stool through the colon and create constipation or diarrhea, gas pains, rectal bleeding and abdominal bloating.
  • Perforation: A diverticulum that is inflamed or under pressure can burst. Normal bacteria that is always present in the colon, can then possibly leak through the perforation into the abdominal cavity causing infection or other complications. Common signs of this include sudden pain, fever, nausea, and vomiting. Hospitalization and surgery will almost always be necessary.

In some cases, surgery is essential to determine if a growth is cancerous. Colon surgery is recommended to remove tumors, large or hard to reach polyps or diverticula that are causing symptoms of colon disorder. If a tumor or abnormal growth is removed, lymph nodes in the mesentery will be tested along with the tumor or growth to determine if cancer is present and if it has spread. Other organs including the liver will also be examined to determine if there is a presence of cancer.

THE PROCEDURE (COLON RESECTION)
Colon surgery is performed to remove the affected section of the colon. The portion of the colon above the area that is resected is then reattached to the portion of the colon just below the resected area. This "re-attachment" is called an anastomosis and it is accomplished with the use of a suture and stapling device. This procedure can last on average for 2 – 4 hours, and possibly more depending on the amount of the colon that has to be removed, the amount of previous scarring and the technique used.

Only when it is absolutely necessary will a colostomy or ileostomy (upper small intestine opening) be constructed during colon surgery.
This will allow the colon to recover or heal before it is rejoined a few months later. Rarely will the colostomy be permanent. However, if it will be permanent, this will be discussed extensively with the patient prior to surgery. With a colostomy, body wastes are eliminated directly through an opening of the colon in the abdomen, where the stool is collected into a special appliance. If you have the need for this, you will be trained in the use and care of it prior to leaving the hospital. There are many resourcesavailable, including specially trained ostomy nurses that can work with the patients to manage ostomy care.

LAPAROSCOPIC COLON RESECTION
Most laparoscopic colon resections are performed through 5 – 6 small incisions that are about a quarter inch in length. A canula, a narrow tube-like instrument is used to enter the abdomen. A laparoscope, a tiny telescope connected to a video camera, is inserted through the canula, This presents your surgeon with a magnified view your internal organs on a high definition television monitor. Several other canulas are inserted through the incisions to allow your surgeon to work inside the abdomen and remove part of the colon.

ADVANTAGES OF LAPAROSCOPIC COLON RESECTION

  • Less postoperative pain
  • Shorter hospital stay
  • Faster recovery time
  • May experience a faster return to a solid food diet
  • Colon function normalizes faster
  • Faster return to normal activity
  • Better cosmetic results (smaller scar)

OPEN COLON SURGERY
The traditional"open" procedure is highly invasive and patients often require a longer recovery period. Generally, open colonic surgeries require long incisions. This can result in a hospital stay of 5 – 8 days and may require a 6 week recovery period. The factors that may cause the surgery to be performed with the open method include:

  • Dense scar tissue caused by prior abdominal surgery
  • The inability to see the organs
  • Bleeding problems that may arise during the surgery
  • Large tumors

POSSIBLE COMPLICATIONS
There are risks of complications with this procedure as there is with any surgery. These include:

  • Bleeding
  • Infection
  • A leak where the two sections of the colon were reconnected
  • Injury to adjacent organs (small intestine, ureter, bladder)
  • Blood clots to the lungs

COLON CANCER
Colon cancer is one of the most common forms of cancer, and when it is caught in the early stages, it is one of the most treatable forms of cancer.

Colon cancer occurs when cancerous growths, or polyps, form in or around the colon. All polyps are not cancerous. Symptoms will vary depending on the location of where the cancer develops. They can include blood in the stool, weight loss and abdominal pain. There are circumstances where patients will present no symptoms. Treatment for colon cancer will depend on various factors including the part of the colon that is affected and the stage of the disease.

Treatment plans can include the following:

  • Surgery
  • Radiation
  • Chemotherapy
  • Newer targeted therapies, such as monoclonal antibodies
SMALL BOWEL OBSTRUCTION SURGERY

A bowel obstruction will occur when the small bowel (small intestine) or large bowel (large intestine) is partially or completely blocked. This blockage will prevent food, fluids and gas from moving through the intestines in a normal process and could cause severe pain that comes and goes.

Obstructions can be a result of:

  • A mechanical cause where something is in the way.
  • Ileus which is a condition where the bowel is not functioning properly, but there are no structural problems.

When the symptoms for small bowel obstruction appear it is an indication of a blockage in the intestines and an abnormality in the digestive process. Most of the time bowel obstruction will be a medical emergency and require surgery. One out of every four acute surgical admissions in the United States is caused by small bowel obstruction.

If it is left untreated, a small bowel obstruction can lead to peritonitis, perforation, and intestinal abscesses. This is fatal in 100% of the cases when untreated. When severe cases of small bowel obstruction are taken care within a 36 hour period, then there is a 92% chance that the patient will live. After 36 hours the percentage can decrease to 75%.

Most bowel obstruction cases cannot be prevented if there is no mechanical cause for the obstruction. In those cases where there is an underlying cause of a related condition, treating that cause may help prevent complications that can lead to small bowel obstruction. In order to prevent problems, it is important that the patient seek medical help as soon as obstruction symptoms occur.

SYMPTOMS
Symptoms can vary depending on the level of obstruction.
They include:

  • Abdominal pain – mid-abdominal intermittent cramps with spasms lasting a few minutes. The pain will sometimes center on the navel or between the navel and rib cage. When the pain is constant and severe it is indicative that the situation has a more advanced stage and become a medical emergency. It may also be a symptom of bowel strangulation.
  • Abdominal distention
  • Nausea and vomiting
  • Fecal vomiting
  • Abdominal bloating often accompanied with abdominal tenderness
  • Abdominal pain and cramping

LAPAROSCOPIC COLON RESECTION
Most laparoscopic colon resections are performed through 5 – 6 small incisions that are about a quarter inch in length. A canula, a narrow tube-like instrument is used to enter the abdomen. A laparoscope, a tiny telescope connected to a video camera, is inserted through the canula, This presents your surgeon with a magnified view your internal organs on a high definition television monitor. Several other canulas are inserted through the incisions to allow your surgeon to work inside the abdomen and remove part of the colon.

ADVANTAGES OF LAPAROSCOPIC COLON RESECTION

  • Less postoperative pain
  • Shorter hospital stay
  • Faster recovery time
  • May experience a faster return to a solid food diet
  • Colon function normalizes faster
  • Faster return to normal activity
  • Better cosmetic results (smaller scar)

OPEN COLON SURGERY
The traditional"open" procedure is highly invasive and patients often require a longer recovery period. Generally, open colonic surgeries require long incisions. This can result in a hospital stay of 5 – 8 days and may require a 6 week recovery period. The factors that may cause the surgery to be performed with the open method include:

  • Dense scar tissue caused by prior abdominal surgery
  • The inability to see the organs
  • Bleeding problems that may arise during the surgery
  • Large tumors

POSSIBLE COMPLICATIONS
There are risks of complications with this procedure as there is with any surgery. These include:

  • Bleeding
  • Infection
  • A leak where the two sections of the colon were reconnected
  • Injury to adjacent organs (small intestine, ureter, bladder)
  • Blood clots to the lungs

COLON CANCER
Colon cancer is one of the most common forms of cancer, and when it is caught in the early stages, it is one of the most treatable forms of cancer.

Colon cancer occurs when cancerous growths, or polyps, form in or around the colon. All polyps are not cancerous. Symptoms will vary depending on thelocation of where the cancer develops. They can include blood in the stool, weight loss and abdominal pain. There are circumstances where patients will present no symptoms.

Treatment for colon cancer will depend on various factors including the part of the colon that is affected and the stage of the disease.

Treatment plans can include the following:

  • Surgery
  • Radiation
  • Chemotherapy
  • Newer targeted therapies, such as monoclonal antibodies
SMALL BOWEL OBSTRUCTION SURGERY

A bowel obstruction will occur when the small bowel (small intestine) or large bowel (large intestine) is partially or completely blocked. This blockage will prevent food, fluids and gas from moving through the intestines in a normal process and could cause severe pain that comes and goes.

Obstructions can be a result of:

  • A mechanical cause where something is in the way.
  • Ileus which is a condition where the bowel is not functioning properly, but there are no structural problems.

When the symptoms for small bowel obstruction appear it is an indication of a blockage in the intestines and an abnormality in the digestive process. Most of the time bowel obstruction will be a medical emergency and require surgery. One out of every four acute surgical admissions in the United States is caused by small bowel obstruction.

If it is left untreateda , small bowel obstruction can lead to peritonitis, perforation, and intestinal abscesses. This is fatal in 100% of the cases when untreated. When severe cases of small bowel obstruction are taken care within a 36 hour period, then there is a 92% chance that the patient will live. After 36 hours the percentage can decrease to 75%.

Most bowel obstruction cases cannot be prevented if there is no mechanical cause for the obstruction. In those cases where there is an underlying cause of a related condition, treating that cause may help prevent complications that can lead to small bowel obstruction. In order to prevent problems, it is important that the patient seek medical help as soon as obstruction symptoms occur.

This picture shows the
Esophus, Stomach, Small
Bowel and Colon in order.
The Small Bowel is the
long thin tube in the
middle of the picture
Small Bowel

SYMPTOMS
Symptoms can vary depending on the level of obstruction. They include:

  • Abdominal pain – mid-abdominal intermittent cramps with spasms lasting a few minutes. The pain will sometimes center on the navel or between the navel and rib cage. When the pain is constant and severe it is indicative that the situation has a more advanced stage and become a medical emergency. It may also be a symptom of bowel strangulation.
  • Abdominal distention
  • Nausea and vomiting
  • Fecal vomiting
  • Abdominal bloating often accompanied with abdominal tenderness
  • Abdominal pain and cramping

SURGERY
Surgery is performed to relieve a bowel obstruction. If a blockage exists for an extended period of time, it can restrict the blood flow to part of the bowel, causing the bowel to die.

LAPAROSCOPIC SMALL BOWEL RESECTION
Most laparoscopic colon resections are performed through 3 – 5 small incisions that are about a quarter inch each.
A canula, a narrow tube-like instrument is used to enter the abdomen. A laparoscope, a tiny telescope connected to a videocamera, is inserted through the canula. This presents your surgeon with a magnified view of the patient's internal organs on a high definition television monitor. Several other canulas are inserted through the incisions to allow your surgeon to work inside the abdomen and remove part of the small bowel.

The part of the small bowel that is diseased is located and removed. Clamps are used on both ends of the diseased part to close it off. The healthy ends of the small bowel are then reconnected, sewn or stapled together. This procedure can take up to one to four hours.

In the event that there is not enough healthy small bowel to reconnect, then an opening (stoma) is made through the skin of the belly. The small bowel is then attached to the outer wall of the belly. Stool will pass through the stoma into a drainage bag outside of the belly. This is called an ileostomy and may be either temporary or permanent.

ADVANTAGES OF LAPAROSCOPIC SMALL BOWEL RESECTION

  • Less postoperative pain
  • Shorter hospital stay
  • Faster recovery time
  • May experience a faster return to a solid food diet
  • Bowel function normalizes faster
  • Faster return to normal activity
  • Better cosmetic results (smaller scar)

OPEN SMALL BOWEL RESECTION
The traditional"open" procedure is highly invasive and patients often encounter a longer recovery. Generally this surgery will require a cut of about 6 inches long in the mid-belly that results in a hospital stay of 5 – 8 days and may require a 6 week recovery period. Once the incision is made the same procedure to remove the obstruction laparoscopically is followed from this point on. The factors that may cause the surgery to be performed with the open method include:

  • Dense scar tissue caused by prior abdominal surgery
  • The inability to see the organs
  • Bleeding problems that may arise during the surgery
  • Large tumors

SURGERY RISKS
In addition to the risks that exist for any surgery, specific risks for this surgery include:

  • Incisional hernia (bulging tissue through the incision)
  • Bowel leakage
  • Bleeding inside the belly
  • Bowel obstruction after surgery
  • Damage to organs near the operative area
  • Short bowel syndrome (problems absorbing nutrients and vitamins because a large amount of the small intestine may have to be removed)
  • Episodes of diarrhea
  • Infection of the incision
  • Wound opening
  • Scar tissue
  • Belly scar tissue that could cause a potential future blockage
  • Anastomic leak (a leak through the opening of the edges of the intestines - small bowel) that are sewn together
  • Colostomy or ileostomy
  • Temporary paralysis of the bowel

WHY THE SMALL BOWEL RESECTION IS PERFORMED
Small bowel resections are suggested for the following:

  • Intestinal blockage caused by scar tissue
  • Intestinal blockage that is congenital (a result of deformities from birth)
  • Cancer
  • Carcinoid tumor (a slow growing cancer that spreads throughout the body)
  • Small intestine injuries
  • Meckel's diverticulum (a pouch on the wall of the lower part of the small bowel that is present at birth)
  • Precancerous polyps
  • Noncancerous tumors

PREVENTION
Diet modification and lifestyle change may possible reduce some forms of bowel obstruction. These include:

  • A balanced diet low in fat and high in vegetable and fruit, no smoking and colorectal cancer screening once a year after age 50.
  • Avoid heavy lifting to prevent hernias. Heavy lifting could increase the pressure inside the abdomen and possibly force a section of the intestine to protrude through a vulnerable area in the abdominal wall. You should visit the doctor if an abdominal lump develops under the skin of the abdomen, especially near the groin or a surgical scar.
  • Those with diverticular disease should follow a high-fiber diet and avoid foods that have seeds and popcorn that may become lodged in the diverticula.

PREPARING FOR COLON AND SMALL BOWEL SURGERY

  • Depending on the patient's age and medical condition, blood work, medical evaluation, chest x-ray and an EKG may be required.
  • Aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and vitamin E will have to be stopped temporarily for several days to a week before surgery.
  • The colon has to be cleansed the night prior to surgery. A preparation is used that that includes a high powered laxative and antibiotics which thoroughly clean out the colon and reduce the risk of infection.
  • The only thing that can be consumed after midnight is clear liquids so that the colon is kept free of stool.
  • It's highly recommended that smokers stop smoking at least five days prior to surgery because a smoker's cough can put a strain on the incision.
  • Diet medication and St. John's Wort should not be used for two weeks prior to surgery.

AFTER COLON AND SMALL BOWEL SURGERY

You will be sent to a recovery room after the surgery and transferred to a regular hospital room when your vital signs are stable. Your family will be permitted to visit with you when you are in the room. Pain medication will be made available.

You may find a thin plastic tube in your nose that will go down into your stomach to remove any air or fluid that could make you sick or uncomfortable. As soon as your bowels start working, usually 4 – 5 days after surgery, the tube will be removed. Once the tube is removed you will start on a liquid diet and eventually advanced to regular food when you are capable of tolerating it.

You will be assisted out of bed the morning after surgery and activities will gradually be introduced. It is important to do so in order to prevent complications like blood clots and pneumonia. Your abdomen might be slightly bruised and swollen. You may also have metal clips or staples on the surface depending on the type of procedure you had.

You will have to a make a follow up appointment to check your progress and address any issues you may have.

AT HOME AFTER COLON AND SMALL BOWEL SURGERY

  • Walking and climbing stairs is encouraged. You will need to rest frequently because you will generally feel tired.
  • You will be able to eat as you did prior to the operation, but many liquids and fiber will have to be included in your diet to avoid constipation.
  • Pain medication will be prescribed to take as directed.
  • You will be unable to lift anything weighing more than twenty pounds.
  • Showering is permitted as instructed with or without the dressings.
  • Sexual activity can be resumed once you are comfortable.
  • Driving and returning to work will depend on the recovery process and will be discussed at the follow-up appointment.

WHEN TO CALL THE DOCTOR AFTER COLON AND SMALL BOWEL SURGERY

  • When you have a fever of 101 degrees or higher
  • Rectal bleeding
  • Increased abdominal swelling
  • Development of cramps or bloating without having a bowel movement for 2 -3 days
  • The incision becomes red, swollen or drains
  • Persistent cough or shortness of breath
  • Pain that is not relieved by medication
  • Chills
  • Persistent vomiting or nausea
  • Unable to eat or drink liquids

LOCATIONS


148 EAST AVENUE, SUITE 3A
NORWALK, CT 06851
203-899-0744

2 TRAP FALLS ROAD, SUITE 100
SHELTON, CT 06484
203-256-9707

778 LONG RIDGE ROAD, SUITE 101
STAMFORD, CT 06902
203-348-0589

52 WASHINGTON AVENUE, SUITE 3
NORTH HAVEN, CT 06473
203-285-2861

831 BOSTON POST ROAD, SUITE 202
MILFORD, CT 06460
203-647-0140

Dr. Craig Floch

the founder and senior partner of Fairfield County Bariatrics & Surgical Specialists, P.C. His commitment has enabled us to become one of the most prominent, dedicated, personal and highly respected practices serving Connecticut, New England and New York.

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Dr. Neil Floch

the Director of Minimally Invasive Surgery at Norwalk Hospital as well as the Bariatric Director of the Hospital. He is the first fellowship trained advanced Laparoscopic Surgeon in Fairfield County.

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Dr. Peter Ingraldi

is a partner of Fairfield County Bariatrics & Surgical Specialists, P.C. He joined our practice in 2007. Dr. Ingraldi specializes in general surgery and surgical critical care and is Board Certififed in both fields.

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Abe Fridman

joined our practice September 1, 2012. Dr. Fridman specializes in general and bariatric surgery.

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Dr. Marko Lujic

is the newest member of Fairfield County Bariatrics & Surgical Specialists, P.C., having joined our practice in October 2017. Dr. Lujic will lead our initiative in Milford and will provide comprehensive general surgical services, including breast surgery, thyroid surgery and melanoma in addition to managing traditional general surgery consultations.

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