Laparoscopic Right Colectomy in a Patient With Heart Condition

By Dr Praveen Kammar

Surgery: Colorectal Surgeries

Brief History:

Mr. Shyam(name changed), 53 year old gentleman, with no hypertension, diabetes, and asthma was diagnosed with cancer of the ascending colon.

(Fig 01)The cancer had not spread anywhere else. He was admitted in a tertiary cancer center for surgery. During that admission he had episodes of palpitations (fast heart beat) and in one such episode he had to be given electric shock (electric cardio version) to get the heart rhythm back to normal.

On investigations he was found to have disturbance in the heart rhythm (atrial fibrillation). The surgery on him was considered very high risk in view of his heart condition.

He was advised a pacemaker and possibly radiofrequency ablation to control his heart rhythm. He was referred to us from the cancer center for this high risk surgery.

Patient Concern

Being the sole earning member of a young nuclear family patient was concerned about the risk to his life the surgical procedure is going to pose.

Treatment Offered

We referred the patient to an experienced cardiology team where he underwent detailed evaluation and found to have no underlying cause for his rhythm disturbances. The rhythm disturbances could not be evoked even with exercise or medicines. He was given a green signal to undergo surgery with a remote possibility of heart rhythm changes during the surgery.

We took him up for surgery with an experienced anesthetist, intensivist and a defrillator machine standby to revert rhythm changes if any occurred.

Results

Patient underwent successful resection of the right colon cancer laparoscopically. (Fig 2, 3, 4) He did not have any heart related problems during or after surgery. Because of laparoscopic surgery he did not have significant pain after surgery and his bowel function returned quickly. He was discharged on 5th day.

Fig 04. Surgical incisions for laparoscopic surgery. Notice the midline incision which is only 7cm.

CORE MESSAGE:

With the help of thorough evaluation by expert cardiologists we could understand the risk of surgery in this patient. Presence of experienced anesthetist and ICU specialist inside theater during surgery was essential. With adequate evaluation we could offer laparoscopic surgery to this patient which helped him with early recovery.

Tags : # Colorectal cancer