Loyola surgeon performs complicated laparoscopic procedure

Janet Bunch of Chicago had just experienced another "excruciating" bout of diverticulitis, an inflammation of the pockets in the lining of the colon.

"It was the second time in 19 months and the pain was worse than you could imagine," said Bunch, 64, a resident of Chicago.

Mild cases of diverticulitis can be treated with changes in diet, rest and antibiotics. However, Bunch's condition was more serious and the chances of recurrences were high. Her doctors at Loyola University Health System said her best option would be surgery to remove the inflamed section of colon.

Upon learning that her surgeon was going to perform her procedure laparoscopically, involving a camera and small incisions, she went online to learn as much as she could about the technology. What she learned calmed her, but on the day of her surgery she was still fearful of complications, especially one that would require the use of a colostomy bag after the procedure.

"Of course you're always scared when you go into surgery," she said. "I just remember when I woke up, I was feeling my stomach, feeling for a bag to see if something went wrong and they had to give me that bag. I whispered, 'What did they do?' And they said, 'Oh, honey, you had laparoscopic.' I was like, 'Oh, thank you, Jesus.'"

Unlike traditional colon surgery, which requires a long incision in the abdomen, the laparoscopic technique allows surgeons to perform the same procedure through small incisions, about the width of a dime, resulting in less pain and reduced loss of blood. A tiny camera is inserted through a small incision in order to give surgeons a three-dimensional view of the inside of the abdomen.

"This is the future of colon surgery," said Dr. P. Marco Fisichella, the surgeon who performed Bunch's procedure. "More and more patients needing colon surgery are going to be treated this way."

"We use the other incisions to insert instruments so that we can hold and manipulate the tissue in the abdomen," said Fisichella, who is also an assistant professor, division of general surgery, Loyola University Chicago Stritch School of Medicine, Maywood. "The diseased portion of the colon is then identified and removed."

Traditional surgery to remove a portion of the colon generally requires a five- to eight-day stay in the hospital after the procedure. Recovery can take between six to 12 weeks. The hospital stay after a laparoscopic procedure is usually three to four days. Also, although most laparoscopic procedures take about the same amount of time as traditional surgery, recovery is closer to two to three weeks since patients don't have to care for a large incision. There is also less pain and the risk of infection is lower.

"I was up and about right away. I found it mind blowing that they were able to do that," said Bunch, who was discharged home two days after her procedure, which resulted in the removal of one foot of her colon. "I was given some painkillers in a big bottle. I think I took two. I didn't need them. I can earnestly say that the entire experience was a piece of cake."

Because the colon regains its normal function faster with the laparoscopic procedure, patients are able to more quickly return to eating a normal diet. There is also a smaller risk of injury to adjacent organs, such as the small intestine, ureter or bladder, and scarring from the procedure is minimal.

"The smaller scar is one of the benefits our patients like the best," Fisichella said. "The incisions are made below the bikini line so in the end the patient doesn't see much by way of scars from their surgery."

At Loyola, surgeons also use the laparoscopic technique for procedures to treat other diseases of the colon, including Crohn's disease, ulcerative colitis, colorectal caner and colonic polyps.

"My friends couldn't get over how easy the operation seemed to be," she said. "It was not a bad experience at all. I'm just very grateful to the surgeons, the nurses, all of them. They couldn't have been more superb."