• Rectal bleeding
• Dark stools called melena, caused by blood in the stools
• Anaemia, which is a low blood cell count, from blood or iron loss
• Changes in bowel habits, such as the frequency of bowel movements
• Smaller stools
• Mucus discharge from the rectum
• Vague abdominal distress, gas pain

• The operation requires only four small openings in the abdomen.
• Minimal post-operative pain.
• Faster recovery than open surgery patients
• Patients go home within one day and resume normal activities soon.

Candidates with the following conditions are not suitable for laparoscopic surgery

• Pregnancy or previous surgery in the upper abdomen 
• Other pre-existing medical conditions considered relevant by the physician

Complications though rare may include

• accidental damage to structures inside the tummy such as blood vessels and bowel requiring an open operation
• risk from anesthetics
• leak from the joined bowel ends requiring an emergency operation
• death in extremely rare cases

• Digital rectal examination (DRE)
  The physician inserts a lubricated, gloved finger into the patient’s rectum to feel for tumours.
• Fecal occult blood test
  Used to detect microscopic blood in the stool, which may indicate early colorectal cancer
• Laboratory tests such as urinalysis, blood tests
• Imaging Tests
  1. Flexible sigmoidoscopy
     The examination of the inside of the intestine with an endoscope, a long, flexible instrument that shines light allowing the doctor to view the inside of the intestine through a tiny video camera.
  2. Total colonoscopy
     An examination of the inside of the colon using a thin, lighted tube, called a colonoscope, inserted into the rectum.  
  3. Chest x-ray used to detect cancer that has spread to the lungs
  4. Double-contrast barium enema
     An x-ray test of the bowel after giving the patient an enema of a white chalky substance that outlines the colon and the rectum.

• The doctor discusses and advises on options of anaesthesia, surgery, type of facilities, risks, outcome and cost with the patient.
• The patient must inform the doctor of medications being taken and any medical conditions.
• The doctor performs a thorough physical examination.
• The patient is asked to sign a consent form after the procedure is explained thoroughly.
• Drugs such as aspirin, blood thinners, anti-inflammatory medications and Vitamin E must be stopped temporarily for several days to a week prior to surgery.
• The patient is instructed to stop smoking and arrange assistance at home
• The patient must arrange for transportation and assistance to leave for home after the surgery.
• Blood tests, medical evaluation, chest x-ray and an EKG are done prior to the procedure
• Depending on the blood cell count, the patient may be instructed to donate 2 pints of blood 2 weeks prior to the procedure or blood is reserved at the blood bank, in case of a necessity for blood transfusion during or after the procedure
• Food and fluids are prohibited after midnight before the procedure.
• If nausea or vomiting is present, a suction tube to empty the stomach and a urinary drainage catheter are used to decrease the risk of accidental puncture of the stomach or bladder with insertion of the trocar (a sharp-pointed instrument).
• Enemas are given to clean out the bowel.
• The patient is asked to shower the night before or morning of the operation
• The area around the surgical site may be shaved.
• On the day of surgery an intravenous (IV) tube is inserted into a vein in the arm to deliver medicines and fluids and the patient is taken to the operating room.
• The skin over the surgical site will be cleansed with an antiseptic solution.

• The anaesthesia is injected into the IV and after the patient sleeps the abdomen is cleaned with antibacterial soap
• Three or four small incisions are made in the belly button and abdomen.
• The laparoscope attached to a camera is inserted through an incision, which sends images to a video monitor.
• Carbon dioxide gas is inflated into the abdominal cavity to provide room to work.
• Through the other incisions, laparoscopic instruments to hold and dissect the tissue are inserted.
• The diseased part of the colon is identified and carefully dissected and removed through a larger incision that is made towards the end of the surgery after which the incisions are sutured.

• The blood pressure, pulse, respiration and temperature are monitored
• A certain amount of postoperative pain occurs which can be relieved by pain medications prescribed by the physician
• A unique post-operative pain may be experienced in the right shoulder related to pressure from carbon dioxide used through the laparoscopic tubes which may be relieved either by lying on the left side with right knee and thigh drawn up to the chest or walking
• The throat might be sore from the breathing tube that was present during surgery which subsides after a day or two
• Nausea and vomiting are seen due to which food and drink are given slowly for the first few days after surgery.
• The patient may begin to drink liquids the morning after surgery.
• The patient is allowed to resume a solid diet once he has passed gas from the rectal area or have had a bowel movement
• The patient is encouraged to get out of bed, starting the first day after surgery to lessen the chance for complications such as pneumonia or the formation of blood clots in the leg veins.
• The length of hospital stay will depend on the type of procedure and recovery period ranging from 2-6 days

• The patients can remove the dressings and shower the day after the operation.
• The patient can resume normal activities within a week's time, including driving, walking up stairs, light lifting and working.
• The patient must avoid heavy lifting for about 10 days.
• Walking is advised to the patients
• The patient must come for a follow up visit 2 weeks following the operation
• The patient must notify the doctor immediately in case of
• fever, chills
• constipation
• bleeding
• increasing abdominal swelling
• worsening abdominal pain that is not relieved by medications
• distension
• persistent nausea or vomiting
• persistent cough or shortness of breath
• drainage from the incision or redness surrounding any of the incisions that is worsening or getting bigger
• inability to eat or drink

Colon: The last three or four feet of your intestine (except for the last eight inches, which is called the rectum). Crohn's disease: An inflammatory bowel disease that involves all layers of the intestinal wall. Crohn's disease might affect any portion of gastrointestinal tract, including the anus, rectum, colon, and small intestine.
Laparoscopy: Surgery that utilizes a telescope-like instrument (a laparoscope) passed through a small incision at the umbilicus (bellybutton). The laparoscope enables the surgical team to visualize the abdominal organs. Also called minimal access surgery.
Stoma: An artificial opening of the intestine to outside of the abdominal wall.
Trocar: Sharp, pointed instrument used to make a puncture incision in the abdominal wall