Introduction

Colectomy is a surgical procedure to remove all or part of your colon. Your colon, also called your large intestine, is a long tube-like organ at the end of your digestive system. Colectomy may be necessary to treat or prevent diseases and conditions that affect your colon.

There are various types of colectomy operations:

Total colectomy involves removing the entire colon.
Partial colectomy involves removing part of the colon and may also be called subtotal colectomy.
Hemicolectomy involves removing the right or left portion of the colon.
Proctocolectomy involves removing both the colon and rectum.
Colectomy surgery usually requires other procedures to reattach the remaining portions of your digestive system and permit waste to leave your body.
Why it's done
Colectomy is used to treat and prevent diseases and conditions that affect the colon, such as:

Bleeding that can't be controlled. Severe bleeding from the colon may require surgery to remove the affected portion of the colon.
Bowel obstruction. A blocked colon is an emergency that may require total or partial colectomy, depending on the situation.
Colon cancer. Early-stage cancers may require only a small section of the colon to be removed during colectomy. Cancers at a later stage may require more of the colon to be removed.
Crohn's disease. If medications aren't helping you, removing the affected part of your colon may offer temporary relief from signs and symptoms. Colectomy may also be an option if precancerous changes are found during a test to examine the colon (colonoscopy).
Ulcerative colitis. Dr. B C Shah may recommend total colectomy if medications aren't helping to control your signs and symptoms. Colectomy may also be an option if precancerous changes are found during a colonoscopy.
Diverticulitis. Dr. B C Shah may recommend surgery to remove the affected portion of the colon if your diverticulitis recurs or if you experience complications of diverticulitis.
Preventive surgery. If you have a very high risk of colon cancer due to the formation of multiple precancerous colon polyps, you may choose to undergo total colectomy to prevent cancer in the future. Colectomy may be an option for people with inherited genetic conditions that increase colon cancer risk, such as familial adenomatous polyposis or Lynch syndrome.
Discuss your treatment options with Dr. B C Shah. In some situations, you may have a choice between various types of colectomy operations. Dr. B C Shah can discuss the benefits and risks of each.
Risks
Colectomy carries a risk of serious complications. Your risk of complications is based on your general health, the type of colectomy you undergo and the approach your surgeon uses to perform the operation. In general, complications of colectomy can include:

Bleeding
Blood clots in the legs (deep vein thrombosis) and the lungs (pulmonary embolism)
Infection
Injury to organs near your colon, such as the bladder and small intestines
Tears in the sutures that reconnect the remaining parts of your digestive system
You'll spend time in the hospital after your colectomy to allow your digestive system to heal. Your health care team will also monitor you for signs of complications from your surgery. You may spend a few days to a week in the hospital, depending on your condition and your situation.

How you prepare
During the days leading up to your colon surgery, Dr. B C Shah may ask that you:
Stop taking certain medications. Certain medications can increase your risk of complications during surgery, so Dr. B C Shah may ask that you stop taking those medications before your surgery.
Fast before your surgery. Dr. B C Shah will give you specific instructions. You may be asked to stop eating and drinking several hours to a day before your procedure.
Drink a solution that clears your bowels. Dr. B C Shah may prescribe a laxative solution that you mix with water at home. You drink the solution over several hours, following the directions. The solution causes diarrhea to help empty your colon. Dr. B C Shah may also recommend enemas.
Take antibiotics. In some cases, Dr. B C Shah may prescribe antibiotics to suppress the bacteria found naturally in your colon and to help prevent infection.
Preparing for colectomy isn't always possible. For instance, if you need an emergency colectomy due to bowel obstruction or bowel perforation, there may not be time to prepare.

Plan for your hospital stay
You'll spend at least a few days in the hospital after your colectomy, depending on your situation. Make arrangements for someone to take care of your responsibilities at home and at work.

Think ahead to what you might like to have with you while you're recovering in the hospital. Things you might pack include:
A robe and slippers
Toiletries, such as your toothbrush and toothpaste or, if needed, your shaving supplies
Comfortable clothes to wear home
Activities to pass the time, such as a book, magazine or games
What you can expect

During your colectomy

On the day of your surgery, your health care team will take you to a preparation room. Your blood pressure and breathing will be monitored. You may receive an antibiotic medication through a vein in your arm.
You're then taken to an operating room and positioned on a table. You'll be given a general anesthesia medication to put you in a sleep-like state so that you won't be aware during your operation.
The surgical team then proceeds with your colectomy. Colon surgery may be performed in two ways:
Open colectomy. Open surgery involves making a longer incision in your abdomen to access your colon. Dr. B C Shah uses surgical tools to free your colon from the surrounding tissue and cuts out either a portion of the colon or the entire colon.
Laparoscopic colectomy. Laparoscopic colectomy, also called minimally invasive colectomy, involves several small incisions in your abdomen. Dr. B C Shah passes a tiny video camera through one incision and special surgical tools through the other incisions. He watches a video screen in the operating room as the tools are used to free the colon from the surrounding tissue. The colon is then brought out through a small incision in your abdomen. This allows Dr. B C Shah to operate on the colon outside of your body. Once repairs are made to the colon, he reinserts the colon through the incision.
The type of operation you undergo depends on your situation and your surgeon's expertise. Laparoscopic colectomy may reduce the pain and recovery time after surgery. But not everyone is a candidate for this procedure. Also, in some situations your operation may begin as a laparoscopic colectomy, but circumstances may force your surgical team to convert to an open colectomy.
Once the colon has been repaired or removed, your surgeon will reconnect your digestive system to allow your body to expel waste. Options may include:
Rejoining the remaining portions of your colon. The Dr. B C Shah may stitch the remaining portions of your colon together, creating what is called an anastomosis. Stool then leaves your body as before.
Connecting your intestine to an opening created in your abdomen. Dr. B C Shah may attach your colon (colostomy) or small intestine (ileostomy) to an opening created in your abdomen. This allows waste to leave your body through the opening (stoma). You may wear a bag on the outside of the stoma to collect stool. This can be permanent or temporary.
Connecting your small intestine to your anus. After removing both the colon and the rectum (proctocolectomy), Dr. B C Shah may use a portion of your small intestine to create a pouch that is attached to your anus (ileoanal anastomosis). This allows you to expel waste normally, though you may have several watery bowel movements each day. As part of this procedure, you may undergo a temporary ileostomy.
Dr. B C Shah will discuss your options with you before your operation.
After your colectomy
After surgery you'll be taken to a recovery room to be monitored as the anesthesia wears off. Then Dr. B C Shah will take you to your hospital room to continue your recovery.
You'll stay in the hospital until you regain bowel function. This may take a couple of days to a week. You may not be able to eat solid foods at first. You might receive liquid nutrition through a vein in your arm and then transition to drinking clear liquids. As your intestines recover, you can eventually add solid foods.
If your surgery involved a colostomy or ileostomy to attach your intestine to the outside of your abdomen, Dr. B C Shah will show you how to care for your stoma. He will explain how to change the ostomy bag that will collect waste.
Once you leave the hospital, expect a couple of weeks of recovery at home. You may feel weak at first, but eventually your strength will return. Ask Dr. B C Shah when you can expect to get back to your normal routine.

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Second Opinion Home » Disease Information » Spleen Removal (Splenectomy)
Posted in Disease Information

Spleen Removal (Splenectomy)


What is a splenectomy?

A splenectomy refers to taking out the spleen in surgery. Removing part of the spleen is called a partial splenectomy. Removing all of the spleen is called a total splenectomy.

What is a spleen?

The spleen is an organ that is located on the upper left side of the abdomen. About the size of a fist, the spleen is important because it helps fight infection in the body by filtering the blood. Another function is the storage of blood cells. The spleen keeps blood flowing to the liver.

Why would you need to have your spleen removed?

A splenectomy is recommended as a treatment for some conditions that cause hypersplenism and might be recommended as a treatment for others. Hypersplenism is not a disease itself, but is more of a syndrome, or a collection of symptoms. It means that the spleen has become overactive, enlarged, and is storing and destroying too many blood cells and platelets.

When is a splenectomy recommended?

There are two reasons that a spleen is always removed: to treat primary cancers of the spleen and to treat a disease called hereditary spherocytosis.

Hereditary spherocystosis (HS) is an inherited disease that involves the lack of ankyrin a specific protein, and the formation of abnormally-shaped red blood cells, called spherocytes. Spherocytes do not move as easily as they should and end up staying longer in the spleen. This almost always increases the size of the spleen. An enlarged spleen is called splenomegaly. The cells eventually become damaged and results in anemia and jaundice. Children with HS are given folic acid supplements on a daily basis. The spleen is removed after a child reaches the age of five.

Other conditions that are often treated with splenectomy

•Idiopathic thrombocytopenic purpura, a disease in which antibodies kill off platelets. The reason that the antibodies form is not known.
•Trauma, such as injury due to an auto accident
•Spleen with an abscess (collection of pus due to infection)
•Splenic artery rupture, possible during pregnancy
•Sickle cell disease (a blood disorder that is characterized by sickle-shaped, rather than disc-shaped, red blood cells)
•Thalassemia (inherited blood disorder resulting in inadequate hemoglobin production)
How are spleen disorders diagnosed?

•Blood tests
•Physical examination (an enlarged spleen may be felt by Dr. B C Shah)
•Imaging tests such as ultrasounds, X-rays, magnetic resonance imaging (MRI), or computerized tomography (CT) scans
•Bone marrow tissue biopsy
Removal of spleen tissue is not advisable due to the possibility of excessive bleeding.

How are spleens removed?

In most cases, splenectomies can be performed as laparoscopic surgeries if the spleen is not too enlarged. Using this technique, a tube is inserted into the abdomen and the space inflated with carbon dioxide. Dr. B C Shah will place other tubes into the abdomen through other small holes, allowing the placement of instruments. The spleen is cut free of all of connections, put inside a special bag and pulled through one of the largest holes in the abdomen.

If the spleen is too large for laparoscopic removal, the spleen will be taken out in an "open" procedure with a single larger incision. In addition to spleen size, Dr. B C Shah fmight opt for an open procedure if there is a lot of scar tissue from previous procedures, if there is an ability to see clearly enough to perform laparoscopy, or if there are bleeding problems. This decision may be made prior to or during surgery.

What are the possible complications of splenectomy?

Possible complications include the usual risks of all surgeries, including infection. There is also a risk of pneumonia or pancreatitis (inflammation of the pancreas). Immediately after the surgery, the patient is likely to be put on medications to prevent infection.

After having a splenectomy, the patient must always be extra careful about infections. Dr. B C Shah is likely to have immunized the patient before surgery. Other likely recommendations include:

•Have a pneumonia vaccine about every five years.
•Have yearly flu shots.
•A child who has had his or her spleen removed may be put on antibiotics for two to several years after the surgery, possibly until adulthood.
•Contact Dr. B C Shah immediately if you have a fever or other indications of infection.
•Avoid travel to places where you could contract malaria.

A rare surgery for a rare disease
Sushma Bagwe came with severe blood vomiting and with feeble pulse and blood pressure. An emergency upper GI scopy was performed by me as the bleeding was profuse. With all the blood in stomach it was a tricky job. I noticed that she had a tumor growing in her stomach that was heavily bleeding. This tumor did not appear like a typical stomach cancer or a peptic ulcer. In order to stop the bleeding, using the endoscope I injected medication around the tumor That stopped the bleeding. Subsequently she was shifted back to ICU and was transfused four units of blood to restore her blood. I also took mulitple biopsies to know what was the nature of the tumor but to my dismay it did not indicate much. I repeated the biopsy again but that also was not conclusive. Subsequently CT scan was performed but even that was not conclusive of the nature of the tumor. I planned out the surgery for her. Instead of opening her abdomen with a large incision, I decided to give her the benefit of Minimally invasive surgery. I performed a total Laparoscopic partial stomach removal (Partial gastrectomy) using harmonic scalpel and endostaplers. This gave her the benefit of fast recovery, minimal post operative pain and almost invisible scar. The diagnosis of the tumour was leiomyoma – benign stomach tumor. Her condition was solved. Thus minimally invasive procedure that I used on this patient (endoscopy and laparoscopy) once again saved the life of a patient and cured her from her disease with minimal pain.

You can visit my site http://drbcshah.com/blood-vomiting-almost-died/ for more information and photos.

Disciple: Master! Should capital punishment be abandoned?
Guru: Yes! Certainly!
Disciple: What is the rationale?
Guru: Firstly; in principle; our punishments should be born out of the vision of global benevolence and not vindictive impulses. Vindictive impulses and urge of vengeance; appear justifiable; but this is only because they gratify our basal nature.
Secondly; the laws should be such; that they help us to blossom; and NOT throttle our freedom, harass us and in fact promote all varieties of crimes ranging from relatively innocuous mistakes and misdeeds; to murders and rapes. Further; the laws should be should be understood by people; and ideally so simple; that compliance would be much easier “law breaking” would become rarer. Even the need of lawyers would be reduced.
Thirdly; we can curb the criminal tendencies; right from the beginning (when they are not as ghastly as they latter become); and prevent crimes to a large extent
Fourthly; the nature of punishments; in general should be emphatically corrective and reformative to such an extent; that ‘deterrence’ would ensue through correction and reformation.
Fifthly; the capital punishment usually leaves no chance for an individual; for compensation and/or chastisement; for a particular crime.
Sixthly; capital punishment (and in general; the idea of deterrence as such in punishments) seems to further; the chain reaction of crimes; and multiply the evil; and not eliminate it!
Seventhly; this does not mean that the punishment should be mild. What it means is; it should be appropriate; to both; chastise and compensate (to at least some extent)! For example; a person, who throws litter on road; should be made to clean it free of cost for a week or two.
Eighthly; we ourselves (the makers of law and those who implement it) have to rise above our own criminal tendencies; and also the craving of vengeance. For this; we have to undertake some activity that can sublimate our “rage about crimes and injustice”; into “honest concern” for universal welfare!
Such activity; useful; irrespective of race, region, nationality, occupation, religion and ideology; is NAMASMARAN (JAP, JAAP, JIKRA, SUMIRAN, SIMARAN i.e. remembering God’s name or true self). If we have this pill to cure and prevent a disease (crimes); then why should we use radical surgery; such as amputation (capital punishment)?
Disciple: But would a society in rage; accept such punishments for heinous crimes?
Guru: Till we grow beyond our subjectivity, prejudices and notice the nascent criminal tendencies within us; we may not appreciate the value of all the foregone discussion. But as we get more and more civilized, through the practice of NAMASMARAN; even more creative and constructive suggestions would emerge!
DR SHRINIWAS KASHALIKAR

NAMASMARAN is a process of promotion from a position of helpless engagement; in compulsions, activities and duties; of primitive and basic nature; to the positions of being increasingly closer to and in tune with; the omniscient, omnipotent and omnipresent superpower; our Guru! This is also called the phenomenon of self realization and is the greatest of all achievements; as there is nothing else to achieve!
But this does not appear to be true; till we are engrossed and entangled in consciousness; associated with body metabolism, endocrine system, autonomic nervous system and central nervous system; and its interactions with the internal and external environments (KARMA).
The environments (including the educational, occupational, political, cultural, economic, social, religious etc); keep stimulating and arousing us to act in one way or another! But we find that in spite of our efforts; life “leaves us behind” and continues to shape itself beyond our imagination!
In the process; our passions, desires, love, hatred, ambitions, missions and so on; appear to be defeated! The world moves ahead and we get dragged after it; helplessly; even if we are physically and financially sound!
As and when; our Guru blesses us; we realize that ‘we’ do not fully understand the nature of universe and the myriads of good or bad entities and desirable and undesirable events; inside and outside; and that; our Guru fully “knows and governs appropriately”; everything!
As a result; we begin to “see” our Guru’s eternal divine wisdom at work; in everything and in every event; and the merit of surrendering Him! Thus we stop considering the practice of NAMASMARAN (JAP, JAAP, JIKRA, SUMIRAN, and SIMARAN i.e. remembering God or true self); a defeatist, escapist, helpless expression of an aging or ailing person; but a promotion to a top position of governance and benevolence!