The intestine is the portion of the alimentary canal extending from the stomach to the anus. The intestine is a long, tubular organ consisting of two parts:

• Colon or large intestine
  
• Small intestine

The large intestine is about 3.5 meters long. The large intestine is divided into 6 parts: caecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. The inner surface of large intestine is covered with mucous and is convoluted. The large intestine is responsible for absorption of water and excretion of solid waste material

The small intestine is about 6 meters long. It is divided into 3 sections: duodenum, jejunum, and ileum. This part is where the most extensive part of digestion occurs. Most food products are absorbed in the small intestine.

The introduction of laparoscopic removal of the gall bladder (Laparoscopic Cholecystectomy) in the late 1980s revolutionized the surgical management of many abdominal operations. It offered less discomfort to the patient and faster recovery. But it was only the delay in the development of proper instruments that prevented Colon and Rectal Surgeons from performing laparoscopic intestinal surgery until 1991.

Today, laparoscopic surgery is an increasingly popular option for people with intestinal conditions, who may need sections of the bowel repaired or removed. Laparoscopy is a minimally invasive procedure in which the surgeons operate through very tiny holes (approximately 1/2-inch wide) instead of large incisions (8- to 12-inch wide). While recovery from open surgery for intestinal disease, takes an average of six weeks, people who have undergone laparoscopic surgery tend to feel back to normal in just three weeks.

Laparoscopic surgery is used to treat:

• Inflammatory bowel disease (IBD), most often classified as ulcerative colitis or Crohn's disease. Crohn's disease is a chronic inflammatory disease of the intestine while Ulcerative colitis is a chronic inflammation of the colon.
  
• Colon polyps, which are fleshy growths that occur on the inside lining of the large intestine
  
• Diverticulitis, a condition in which small, pea-size pouches form in the walls of the intestines and they become infected and inflamed
  
• Colorectal cancer
  
• Bowel incontinence
  
• Rectal prolapse, a condition in which rectum prolapses and protrudes from anus.

Open surgery and laparoscopic surgery

Traditionally, abdominal surgery has been performed in an open manner and what that means is the patient has a reasonably large incision, which varies in size between four and 10 inches long. It's usually in the midline of the abdomen, so it runs from the pubis at the lower midline of the abdomen up to the navel. The length depends on the extent of surgery and the extent of bowel that one has to free up or take out. When the surgery's performed laparoscopically, three or four access ports are put, which are little plastic tubes that go into the abdomen that are positioned through incisions less than half-an-inch long. Then through these access ports we put in a camera, which is less than a half-inch in diameter, which is used to see what's going on inside the abdominal cavity. Through the other access ports we put in very fine little surgical instruments, about 5 millimeters in diameter. We use those instruments to free up the bowel and then we make an incision of four to six centimeters in size (around two inches) to remove the bowel.

Proctosigmoidectomy- Surgical removal of a diseased section of the rectum and sigmoid colon. This is used to treat cancers and non-cancerous growths and complications of diverticulitis.

Right colectomy or Ileocolectomy- Surgical removal of a section of the colon that is adjacent to the small intestine. This is used to remove cancers, non-cancerous growths or polyps, and inflammation from Crohn's disease.

Total abdominal colectomy- this is the surgical removal of the large intestine. It is done to treat ulcerative colitis, Crohn's disease , and familial polyposis.

Faecal diversion- This is surgical creation of an ileostomy (opening between the surface of the skin and the small intestine) or colostomy (opening between the surface of the skin and the colon). It is done to treat complex rectal and anal problems, including poor bowel control.

Abdominoperineal resection- Surgical removal of the anus, rectum and sigmoid colon. This is used to remove cancer in the lower rectum or in the anus, close to the sphincter (control) muscles.

Rectopexy- A procedure in which stitches are used to secure the rectum in its proper position. It is done to correct rectal prolapse.

Total proctocolectomy- This is the most extensive bowel operation performed and involves the removal of both the rectum and the colon. However, often a permanent ileostomy, in which the ileum is attached to the stoma, is needed particularly if the anus must be removed, is weak, or has been damaged.

Before the surgery

Once the diagnosis of the disease is established, the patient has to consult the surgeon for the treatment. The surgeon will take a detailed case history and a general physical examination will be performed. He will suggest the course of the treatment. All patients are generally asked to go for a blood check. Depending on the age and general health, they may also have an ECG, a chest X-ray, lung function tests done.

The rectum and colon must be completely empty before surgery. The patient will be advised to take a laxative medicine, an evening before the surgery.Usually, the patient must drink a large volume of a special cleansing solution. Antibiotics by mouth are commonly prescribed.

During the surgery

Most minimally invasive intestinal procedures start the same way. Carbon Dioxide gas is used to distend the abdominal (peritoneal) cavity. The surgeon gains access to the abdomen using a trocar. A trocar is a narrow tube-like instrument. A laparoscope (a tiny telescope connected to a video camera) is inserted through the trocar, giving the surgeon a magnified view of the patient's internal organs on a television monitor. Up to 4 additional trocars are inserted for special instrumentation.

Sometimes the surgeon may decide to convert the laparoscopic operation to an open one. The decision to perform the open procedure is a judgment decision made by the surgeon either before or during the actual operation and is strictly based on patient safety.

After the surgery

Although many people feel better in just a few days, remember that the body needs time to heal. Patients are encouraged to be out of bed the day after surgery and walk. This helps to diminish the soreness in muscles. Minimally invasive procedures offer faster recovery. So the patients are able to get back to their normal activities in one to two weeks time. But patients are advised to come regularly for follow ups.

• Less postoperative pain
  
• Faster return to solid diet
  
• Better cosmetic results
  
• Quicker return of bowel function
  
• Shorter hospital stay
  
• Quicker return to normal activity