What Is A Polyp?
A polyp is an abnormal growth of cells in the lining of the intestines. They can be found from the esophagus to the rectum. Most polyps are harmless or benign but they can grow and become malignant. Polyps can be classified as non-neoplastic vs neoplastic.
Non-neoplastic polyps, as the name suggest have a very low risk of malignancy. They include hyperplastic polyps, inflammatory polyps, and hamartomatous polyps.
Neoplastic polyps have a higher risk of becoming malignant. They include adenomas and serrated polyps.
What Causes Polyps?
Normal cells divide or multiply in an organized fashion. If this cycle gets interrupted or changed by any given factor abnormal growth can happen. Genetic changes, chronic inflammation, poor eating habits, and other environmental factors can promote polyp formation.
Colon polyps are very common, and the risk of developing them goes up with age. This is particularly true after age fifty. Patients with a personal or family history of polyps, obesity or smokers are also at a higher risk of forming polyps.
- Age: Patients over 50 are at higher risk for polyps
- Chronic Inflammatory Conditions: Chrons disease, ulcerative colitis or other inflammatory conditions
- Lack of Exercise
- Family History: First-degree family members with polyps are a significant risk factor for personal developments polyps
- Race: Colon polyps are more prevalent in African Americans
Symptoms Of Colon Polyps
Patients with colon polyps are usually asymptomatic. Patients with larger polyps can develop subtle symptoms like changes in stool color that could be secondary to occult bleeding.
Patients with chronic slow bleeding can be found to have iron deficiency anemia.
Changes in bowel habits can be seen in patients with large colon polyps that can be causing partial obstruction of the bowel lumen. With partial obstruction and/or chronic constipation the patients can experience intermittent crampy abdominal pain and abdominal distention.
How Are Polyps Diagnosed?
Because colon polyps usually lack symptoms screening is very important in the diagnosis. Several procedures or screening tools are readily available.
- Guiac or occult stool test: This is as basic as it gets when it comes to colon polyps or colon cancer screening. A positive test usually precipitates further testing.
- Stool DNA test: This is a new test for screening of polyps and/or colon cancer. It detects DNA changes and mutations in the stool. Cologuard was approved by the FDA in 2014.
- Digital rectal examination: For very low rectal polyps palpation of the polyps could be possible.
- Virtual colonoscopy: Is done by combining radiographic contrast and a CT scan in order to identified defects in the lining of the colon. This technique is more sensitive for larger polyps or masses.
- Colonoscopy: Invasive procedure that is considered the gold standard for the diagnosis of colon polyps. A long camera flexible scope that is advanced through the anus to examine the entire colon under direct visualization by an experienced gastroenterologist.
How Are They Treated?
The treatment of choice for colon polyps is removal. A colonoscopy is the technique of choice not only to identified polyps but also for removal. Most polyps can be removed using colonoscopic tools but larger polyps might require surgical resection. That is also true for colon polyps located in a difficult area to reach with a colonoscopy.
Below we will briefly discuss some of the techniques used for polyp removal.
Colon Polyp Removal
A colonoscope is a long flexible tube that was designed to navigate through the inside of the colon. The flexible tube has a high definition camera, a channel for suctioning and another channel to introduce other tools for therapeutic interventions.
When a colon polyp is identified, a biopsy forceps or a snare can be pass through the scope and the polyp can be snipped. The tissue is then removed and sent to the pathologist for examination under a microscope.
In the image above a snare is been used to remove a pedunculated polyp. These are the easiest polyps to remove. Flat polyps can be significantly harder to remove. Several passes with the snare might be needed to remove the polyp in several fragments.
A very skill endoscopist is usually needed to remove the most challenging polyps. The endoscopist is usually a gastroenterologist or a surgeon.
Patients that are found to have colon polyps that are not suitable for endoscopic resection are normally referred to a surgeon.
Surgery For Colon Polyps
Laparoscopic Colon Surgery
Laparoscopic colon surgery for polyps is usually done electively. Surgery is routinely done with 3-4 small incisions. Surgery time ranges between 2-4 hours, depending on the patient’s surgical history or body habitus. Significantly overweight patients will require longer operative time.
Most cases will require a segmental resection base on what part of the colon the polyp is located. By doing a formal segmental resection further surgery is routinely not needed if the pathology comes back as cancer.
In most cases, approximately 6-12 inches of the colon is removed. That will ensure that adequate clear margins before and after the polyp are obtained.
The colon is then reconnected and a colostomy bag is rarely needed.
The laparoscopic approach has many benefits for the patient. From faster recovery to regular activities to less pain. Many studies have also shown less blood loss, shorter hospital stay, and less overall complications.
Dr. Caban has ample experience in advanced laparoscopic surgery. He has performed hundreds of minimally invasive colon resections for colon polyps or colon cancer. In Ocala, no other surgeon has more experience or better skills doing this type of surgery than Dr. Caban.
Surgery For Colon Polyps
Robotic Colon Surgery
Robotic surgery is very similar to laparoscopic surgery with some minor differences. Robotic colon surgery is also done with 3-4 small incisions and the operative time also ranges between 2-4 hours. Hospital stay, post-operative pain, overall complications and return to regular activities is relatively identical to laparoscopic surgery.
The main advantage of robotic surgery is the arm articulation. Laparoscopic instruments are rigid, that limits the ability to reach tight places in difficult angles.
Post Operative Period
What Happens After Colon Surgery?
After colon surgery, the patients will be admitted to the hospital for observation. Most patients will be admitted for an average of 3-7 days. For the first 2-3 days, the patient will be without eating awaiting for the bowel to start functioning again. Once the bowel function returns the diet will be advanced slowly. Most patients will go home eating a regular diet.
At discharge from the hospital, you will be given a prescription for pain medications and other basic instructions.
You will follow up with Dr. Caban in 2-3 weeks and then at three months.
Most patients that have office type job can expect to return to work after one to two weeks after leaving the hospital. For those of you that have a labor intense job were heavy lifting more than 15-20 pounds is necessary, you should account for 4-6 weeks out of work or sooner if light duty is an option.
Other activities like playing golf, pickleball, bowling or any other sports were using the core muscles is necessary should be postponed for 4-6 weeks. Swimming should be limited until the incisions are completely healed.
What People are Saying
“Dr. Angel Caban performed my surgery almost 5 years ago on 6/2/2014. He is a kind doctor and always treated me fairly. I always felt welcome in his office. I recommended him to many over the past 5 years”.
“Me encanta no lo cambio. Exelente el doctor caban y su personal. Muy buen grupo”.
“Another successful experience”
“Dr. Caban did my colon resection and did an outstanding job all the way across the board. I highly recommend him as well”.
“Very fortunate to have him”
“I have the privilege of working with Angel M Caban in the hospital environment. I also have had him be the surgeon to one of my family members. I would like everyone to know that he is a great surgeon. We are fortunate to have him here in Ocala. He is personable, easy to talk too and has excellent bedside manners”.
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