Removal of polyps in the intestine is a surgical operation consisting in the removal of these benign neoplasms, attached to the walls of the intestines and growing deep into the intestinal lumen.
Having a habit to grow in any part of the large or small intestine, polyps differing in their size and structure can be discrete and multiple in nature.
Polyps of a discrete nature are distinguished by a single arrangement of several benign neoplasms located far from each other.
In the presence of hundreds of such tumors, they speak of the multiple nature of polyps. If their number significantly exceeds this figure, the patient is diagnosed with a diffuse polyposis. It is in this case that the risk of their malignancy is greatest.
Indications and contraindications for the operation of
Indications for removal of polyps in the intestine are:
- the presence of bleeding and copious mucus secretion from the anal canal;
- a feeling of severe discomfort;
- permanent pain in the lower abdomen;
- disruption of active intestinal motility;
- development of intestinal obstruction;
- ulceration of the intestinal mucosa.
Rapid removal of polyps in the intestine is strongly contraindicated in the presence of a patient:
- diabetes;
- epilepsy;
- malignant neoplasms;
- of infectious diseases;
- pacemaker;
- is an acute inflammatory process in the intestinal region that is subject to surgery, as this increases the probability of perforation of the intestinal wall affected by polyps.
Preparation of
Since most intestinal polyps can be removed during colonoscopy and sigmoidoscopy procedures, the preparation algorithm for an operation is reduced to an identical set of bowel cleansing measures performed before these diagnostic tests.
In clinical practice, the following options for preparing for the procedure of a colonoscopy are most often used:
- For 48 hours before the procedure, the patient is required to follow a strict slag-free diet. In the second half of the day preceding the operation, the patient must take castor oil. One cleansing enema at home is performed in the evening and three( at half-hour intervals) - in the morning hours before colonoscopy. Since the procedure is usually prescribed in the first half of the day, eating is contraindicated. A few hours before surgery, the patient can drink a cup of light tea or a glass of juice.
- The second variant of training, which is extremely popular nowadays in clinics around the world, is based on the method of bowel cleansing with the help of the drug fortrance. To prepare the medicine, one packet of powder is dissolved in 1000 ml of water. The prepared solution is taken in a glass every twenty minutes in the evening hours on the eve of the scheduled operation. For patients who are relieved of the need to observe a slag-free diet and perform cleansing enemas, this method of preparation is more attractive. A major disadvantage of this variant of bowel cleansing is that not every patient is able to drink such a quantity of medicinal product in such a short time. In some patients, taking Fortrans can provoke attacks of nausea and vomiting, a feeling of discomfort and heaviness in the abdominal cavity. Usually, this symptomatology is typical for patients suffering from concomitant diseases.
A large number of complaints lead the doctors to search for new schemes for taking Fortrans. The most popular versions are:
- It is proposed, dividing the entire prepared solution into two equal parts, taking one half of it in the morning, and the second - in the afternoon of the day preceding the operation. On the day of surgery, the patient should drink another liter of drug solution.
- According to the second variant, the patient takes two liters of diluted drug in the afternoon of the day preceding the procedure for removal of polyps. Another liter of medicine is taken on the morning of the operation day. According to reviews, it is this variant of bowel cleansing that is most easily tolerated by patients;In addition, with it, there are significantly fewer side effects than with all the techniques described above.
In these cases, osmotic laxative forlax is used to purify the intestine, which is used to relieve constipation in adult patients. A great advantage of this drug is that one portion of it dissolves in a glass of water.
Since the effect of forlax results after 24 or 48 hours after admission, patients are prescribed taking two packets of this drug for one day. They are received during breakfast in the morning hours for 72 hours before the scheduled operation.
In some cases, the scheme is applied when the patient is given the reception of two forlax bags in the morning and the same amount - in the evening. Due to these actions, it is possible to relieve the proximal parts of the intestine. For the purification of other parts of it perform an easy enema.
Sometimes, instead of enemas, they practice half the dose of the drug on the eve of the operation. No complications after purification of the intestine with forlaks in medical practice are not recorded.
Another advantage of using forlaks is the absence of sugar in its composition, which makes it possible for diabetics and patients with contraindications to taking galactose.
Methods for removal of polyps in the intestine
Conservative treatment of polyps because of its low effectiveness is used only if there are serious contraindications to performing a surgical intervention or for temporary relief of symptoms.
In the surgical procedure, each detected polyp is removed, followed by a histological examination to identify the cancer cells.
According to experts, a timely surgery to remove polyps is the leading measure of prevention to prevent colorectal cancer.
In modern medical practice the most demanded operations:
- endoscopic polypectomy with electrocoagulation of the removed tumor;
- transanal excision of the polyp;
- removal of benign neoplasms by the method of colotomy.
Very often polyps in the intestine are removed during the diagnostic procedure of a colonoscopy. In this case, the diagnostic procedure is easily transformed into a treatment procedure.
Sometimes, even the malignant polyps, having a leg and deprived of a mesh of venous and lymphatic vessels, are removed in this way, but only if the degeneration touched only the head of the neoplasm.
Endoscopic polypectomy
This type of surgery is applied to benign lesions localized in the middle parts of the intestine. Relating to the number of minimally invasive intraluminal surgeries, endoscopic removal of intestinal polyps is most often performed using local anesthesia.
Video about endoscopic removal of intestinal polyps:
During the operation, several stages can be clearly seen:
- the endoscope is first introduced into the intestine of the patient to the location of the polyp;
- a lead plate( passive electrode) is banded to the waist of the patient;
- fixing the endoscope at the level of the polyp being removed, a special endoplate is introduced into its biopsy channel, performing the function of the second electrode and dumping it on the basis of a benign neoplasm;
- loop is gradually tightened and fed to it high frequency current;
- as a result of a two-second action of the current charring of the place surrounded by a red-hot loop, leading to reliable sealing of the ends of cutoff vessels;
- then the specialist monitors the process of hemostasis;
- if necessary, take measures for additional electrocoagulation of the base of the removed polyp;
- clipped polyp is removed from the patient's body.
Large neoplasms are removed by the lump method, since too deep a burn of the intestinal wall is fraught with its perforation and explosion of intestinal gases. To remove large polyps instead of endoplites biopsy forceps are used.
The plucking of the parts from the head of the neoplasm is carried out in several steps. The tactic of gradual removal is also used for the multiple nature of polyps with a heap of neoplasms.
When endoscopic removal of large( over two centimeters) neoplasms, villous or multiple polyps one year later, the procedure of control endoscopy is performed. If the recurrence of polyposis is absent - to monitor the state of the colon with the help of a colonoscopy is recommended every three years.
Laparoscopy
Laparoscopic operations are applied to benign neoplasms of large( over two centimeters) in size.
Unlike classic operations that require large incisions, they are performed through small punctures of the abdominal wall using special laparoscopic surgical instruments.
Operations of this type require the use of general anesthesia and a sufficiently long rehabilitation period.
Laparotomy
If polyps can not be removed by the method of endoscopic polypectomy, it is not possible( usually for polyps with a wide base) to perform a laparotomy( with opening of the abdominal cavity) operation for their excision through a cut in the wall of the affected bowel.
To remove such polyps and hairy lesions on thick legs, also apply a colotomy - an operation that requires access through the abdominal wall. Through the incision in the lower ileal region or in the lower-median incision, the sigmoid colon affected by the polyposis is removed.
I feel by locating the location of the polyp, placing soft beetles on both ends of the extracted intestine and, after performing a longitudinal incision of the intestinal wall, excise the tumor together with a part of the adjacent mucosal tissues( after excision they are stitched).For suturing the intestinal wall, a seam is used in two rows, and for the abdominal wall, a stub layer.
Bowel resection
Bowel resection is an operation to remove polyps, which involves the need to cut the abdominal wall and remove a part of the bowel that is affected by multiple neoplasms. This method is used in relation to the accumulation of polyps localized in a specific area of the intestine.
If this cluster is concentrated in the upper segment of the rectum, anterior resection is performed. During surgery, this part of the rectum is removed from the lower segment of the sigmoid colon located above it. At the final stage of the operation, the ends of both intestines are sewn together.
If the accumulation of neoplasms is concentrated in the very center of the rectum, perform a low anterior resection.
The localization of polyps in the lower segment of the rectum is an indication for the transanal excision performed through the anal canal. A full recovery of the patient who undergoes an intestinal resection operation requires at least four weeks.
Complications of
Operation of polypectomy can lead to a number of complications, the most frequent of which are:
- Bleeding. The probability of bleeding is maintained for ten days after the removal of polyps. Bleeding from the anus, which developed the day after the polypectomy, indicates insufficient effectiveness of coagulation of the base of the removed polyp. The bleeding that occurred a few days after the operation is most often due to the rejection of the thrombus formed at the ends of the cut blood vessels. The intensity of both early and late bleeding can be either insignificant or significant enough to endanger the patient's life. In this case, urgent surgical intervention, carried out with the help of endoscopic instruments and consisting of cauterization( coagulation) of bleeding blood vessels is necessary. If the hemorrhage was not stopped with the help of coagulation, specialists resorted to laparotomy - an operation requiring an opening of the abdominal cavity.
- Damage( perforation) of intestinal walls. This complication can occur during and after surgery. The formation of a hole in the wall of the intestine is a consequence of a deep burn resulting from the cauterization of a distant polyp. Through this hole the contents of the intestine can enter the abdominal cavity, giving a push to the process of infection. To eliminate this complication, a laparotomy( incision of the abdominal wall) is performed, followed by suturing the opening and applying a colostomy( it is necessary in order to temporarily exclude the injured part of the gut from the passage of stool).After the final healing of the eliminated defect( usually in 8-16 weeks), the colostomy is eliminated.
- Cases of recurrence of benign neoplasms. After surgery to excise polyps, 15% of patients still have a risk of reappearance within the next two years.
Recovery in the postoperative period
The most important composite moment of the postoperative period for a patient who underwent an operation to remove polyps in the intestine is careful adherence to a sparing diet that promotes recovery of motor-evacuation functions of the intestine.
The therapeutic diet of the operated patient consists of three stages:
- The first stage occurs immediately after the operation and lasts three days after it. During the first 24 hours after surgery, the patient is completely banned from eating and drinking. At the end of this period, he is allowed to quench his thirst with a small amount( not more than 50 ml) of water, a little later - to drink a little vegetable broth and compote. After twelve hours the patient is offered a little rice broth, meat broth or jelly. All restrictions are aimed at minimizing the motor activity of the intestine and reducing its excretory functions, since digestive enzymes and bile secreted by digestion of food can have a negative effect on the condition of the joints and injured tissues.
- After 72 hours after the operation of , mucous soups, thin porridges( from rice, millet and oatmeal), soufflé from lean meat are introduced into the patient's diet carefully following his condition. If after eating a particular dish in the patient there is a pain or increased gas formation, it is removed from the diet. The goal of this stage of the therapeutic diet is to normalize the stool and gradually increase the load on the intestines.
- Two weeks after the operation, the third stage of the sparing diet of begins( lasting at least four months).The use of products rich in coarse plant fibers is detrimental to the patient undergoing surgery. Its diet should consist of broths, vegetable and cereal soups, mashed cereals, dietary pates and soufflé.
From the patient's diet are completely excluded:
- all kinds of spices, spices, sauces and salt;
- is sour, salty, peppery and spicy food;
- mushrooms( in any form);
- fatty fish and meat;
- raw fruits and vegetables;
- canned foods;
- is too hot or cold food;
- freshly baked bread. Instead of fresh bread, which causes the processes of fermentation in the intestine, the patient is recommended to use breadcrumbs. For the same reason, he should abandon the use of legumes, asparagus and nuts.
To take food( at least six times a day), the patient who is recovering should be treated at the same time in very small portions: the intestinal motor functions will improve from this, and the load will not be too great.
Reviews
Marina:
Polyp in the intestines was removed during the colonoscopy. It was not painful or scary at all. After a couple of hours I was already sitting in the office - at my usual workplace. I did not even have to comply with the diet.
Victoria:
An endoscopic surgery to remove polyps in the intestine a year ago was done by my 75-year-old mother-in-law. The operation was successful: her mother-in-law felt well and immediately after surgery, and after discharge from the hospital( she was kept in the hospital for ten days).The first time I had to hold her on a medical ration to normalize the stool and not injure the intestines. Now the old woman does not even remember about the operation and enjoys life.
Price
The cost of surgery to remove polyps in the intestines largely depends on the region in which the medical institution is located. Approximate prices are shown in the following table.
Removal of polyps:
- in the sigmoid colon( through the anal canal or through the incision of the intestinal wall) - from 7,000 rubles;
- in the rectum - from 6,000 rubles;
- in the colon - from 10,000 rubles.
Sometimes, in the presence of a quota, such operations in district clinics are performed completely free of charge: information about this can be obtained by visiting a specialist of the appropriate profile.