I.

INTRODUCTION
A. General Description of Disease Condition requiring Surgical Procedure
The colon is the last part of the digestive system in most vertebrates. The large
intestine also known as the colon comes after the small intestine in the digestive tract
and measures approximately 1.5 meters in length. Although there are differences in the
large intestine between different organisms, the large intestine is mainly responsible for
storing waste, reclaiming water, maintaining the water balance, absorbing some
vitamins, such as vitamin K, and providing a location for flora-aided fermentation.
Vitamin K is essential as a coagulation factor. The colon 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.
Colectomy consists of the surgical resection of any extent of the large intestine
(colon). An operation to remove all or part of the colon. When only part of the colon is
removed, it is called a partial colectomy. In an open colectomy, one long incision is
made in the wall of the abdomen and doctors can see the colon directly. In a
laparoscopic-assisted colectomy, several small incisions are made and a thin, lighted
tube attached to a video camera is inserted through one opening to guide the surgery.
Surgical instruments are inserted through the other openings to perform the surgery.
Resection of any part of the colon entails mobilization and ligation of the corresponding
blood vessels. Lymphadenectomy is usually performed through excision of the fatty
tissue adjacent to these vessels (mesocolon), in operations for colon cancer.
There are various types of colectomy operations. Colectomy that involves
removing the entire colon is called total colectomy. Colectomy to remove part of the
colon may be called subtotal colectomy or partial colectomy. Removing the right or left
portion of the colon is called hemicolectomy. Surgery to remove both the colon and
rectum is called proctocolectomy.
Colectomy surgery usually requires other procedures to reattach the remaining
portions of your digestive system and permit waste to leave your body.
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. For instance, in
rare cases, pockets in the colon (diverticula) can cause bleeding that may
require surgery.
  Bowel obstruction. A blocked colon is an emergency that may require total
or partial colectomy, depending on the situation.
 Bowel perforation. A torn colon is also an emergency that may require
colectomy.
 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.
 Ulcerative colitis. Your doctor may recommend total colectomy if
medications aren't helping to control your signs and symptoms.
 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.

Sir William Arbuthnot-Lane was one of the early proponents of the usefulness of
total colectomies, although his overuse of the procedure called the wisdom of the
surgery into question.
B. Relevant and current statistical evidences or critical findings
Indications for colectomy includes Crohn’s disease, Ulcerative colitis and Colon
cancer. In the US, 60 to 70 million people are affected by all digestive diseases. Crohn’s
Disease affects 500,000 Americans approximately 1 in 544 or 0.18% or 500,000 people
in USA and affects 158,532 in the Philippines every year. Inflammatory Bowel Disease
like Crohn’s has the prevalence of 359,000 people with a mortality rate of 622 deaths
every year and Ulcerative Colitis has a Prevalence of 619,000 people and has a
prevalence of 311 deaths every year in the US.

It is estimated that about a million people in the United States suffer from IBD,
and that half of those - 500,000 in case you’re not a mental math whiz - have Crohn’s.
The other half are people who have Ulcerative Colitis, the second type of IBD. In parts of
Europe, around 0.3 to 0.5% of people are thought to have Crohn’s. People who smoke
are believed to be more likely to get Crohn’s, and there is no noted preference between
the number of males or females who contract the disease. Crohn’s is slightly less
common in people of African American heritage and slightly more common in people of
Jewish descent.
About 1 in 5 people who have Crohn’s have a close family relative with some
other form of IBD or IBS. Onset of the disease occurs most commonly in people in their
20’s.
Crohn's disease is an important cause of morbidity in Australia and affects
approximately 50 people per 100 000 of the population. The incidence is set to increase
even further in future years. The disease is most common in adolescents and young
adults with up to 60% of patients being diagnosed before 25 years of age. However,
Crohn's disease can occur at any age. Females are affected slightly more than males.
Colon cancer claims a third rank in the list of most common cancers diagnosed in
the United States (skin cancer excluded). American cancer society estimate that this
year a total of 106,370 people will be diagnosed with new colon cancer and an estimated
56,730 patients will die from colon cancer. It is estimated that more women (55,970) will
have new diagnosis of colon cancer compare to men (50,400). However the total deaths
from colon cancer is expected to be about equal in men (28,320) and women (28410).
Together with rectal cancer, colon cancer claims about 10 percent of all cancer deaths.
The death rates from colon cancer have been decreasing for the last several
years. Many people are getting routine screening colonoscopy and this may be
preventing many cases of colon cancer and finding many other in an earlier stage where
cure is more possible.

C. Recent trends, refinements, and/or innovations in treatment

Ulcerative Colitis Treatment Reduces Need for Surgery by Almost Half,

Study Suggests (Oct. 1, 2009)

A study has found that ulcerative colitis patients had a 41% reduction in colectomy after
a year when treated with infliximab.

Ulcerative colitis, an inflammatory bowel disease (IBD) that causes chronic

inflammation of the colon, is characterized by abdominal pain and diarrhea. Like Crohn's
disease, another common IBD, ulcerative colitis can be debilitating and often lead to
colectomy or surgical removal of the colon.

The purpose of the study was to see if the use of infliximab for ulcerative colitis
would reduce the need for surgery. They found that treatment with infliximab reduced the
need for colectomy by 41% compared to patients treated with placebo."

728 patients received placebo or infliximab (5 or 10 mg/kg) for 46 weeks and

were monitored for hospitalization or surgical outcomes. 87% (630 of 728) had complete
follow-up for the endpoint of whether or not they had colectomy, while the remaining
13% (98 of 728) of patients had follow-up for less then a year, with a median follow-up of
6.2 months in these patients. The research showed that treatment with infliximab at 0, 2
and 6 and then every 8 weeks reduced the incidence of colectomy through 54 weeks by
41% in outpatients with moderately-to-severe active ulcerative colitis. Compared with
placebo, fewer ulcerative colitis-related hospitalizations and surgeries/procedures
occurred with infliximab therapy.

One of the most feared outcomes for ulcerative colitis patients is surgical removal
of the colon. The research hopes to provide other treatment solutions for patients
beyond surgery

Previous research has shown that infliximab therapy induced clinical remission
and bowel healing for colitis patients. This new research provides more information and
options for patients struggling with this difficult disease.

Infliximab is an artificial antibody that works by blocking tumour necrosis factor

alpha (TNF alpha). TNF alpha is a chemical messenger and a key part of the immune
reaction. Infliximab blocks the action of TNF alpha by preventing it from binding to its
receptor in the cell.

Ulcerative colitis usually affects only the inner lining of the large intestine (colon)
and rectum. It usually occurs in a continuous stretch of the colon, unlike Crohn's
disease, which occurs in patches anywhere in the digestive tract and often spreads into
the deeper layers of affected tissues.

D.Implications for Nurses as a productive member of society

 We, student nurses, believe that we should not limit ourselves only in
curative aspects in providing health care. Aside from hospital work, we also
have the responsibility to encourage and educate the public on the
importance of having a healthy lifestyle, which includes proper exercise and
nutrition, in maintaining good health and to prevent themselves from
acquiring diseases. One of our duties as nurses is to provide interventions for
health promotion and disease prevention. This is possible through proper
health teaching. The early effort of educating and informing the public would
be of great importance and significance in lowering the incidence of diseases.
As nurses, having a good grasp on the concepts about Colectomy may
enable us to provide informations to our patients who are about to undergo
such operation. It will give them the idea on what to expect on his/her
operation which is important to allay his/her anxiety. Furthermore, it will also
help us to provide the “best patient care possible” for our patients having the
same disease condition and/or to undergo such surgical procedure.
From the statistics that we have gathered, it somehow gave us ideas
on who are the clients at risk and what are they at risk of. With this, current
and early interventions can be done for public health maintenance and
prevention of crisis that may occur from situations and disorders.
Competence among nurses is very important. This may be achieved
through continuous learning by being up to date to the latest trends, since
being knowledgeable and competent could enable the nurse to be
productive. Being up to date with the aforementioned latest approach in
colectomy will not only help the patients but as well as the health care
providers. First, the patients are provided with the informations that they
need in deciding which treatment will be suitable for them. This means that
the information given will lessen their fear in undergoing the surgery. It is
also a way of telling the patient that new innovations regarding surgeries and
medications are being conducted for better treatment outcomes.