Colorectal Surgery

In most cases, colorectal surgery can be performed laparoscopically. The main reasons to perform colorectal surgery include:
– A diagnosis of colon (large intestine) cancer
– To remove polyps that either are too large to remove during a colonoscopy or appear to be cancerous
– To treat diverticulitis, a condition where small sacs or pouches form in the intestinal lining, usually the colon, and become inflamed or infected

In addition, small bowel (small intestine) surgery can also be performed to treat:
– Small bowel obstruction
– Tumors
– Inflammatory bowel disease (Crohn’s disease or ulcerative colitis)

There are several benefits to laparoscopic colorectal surgery:
– Less pain
– Fewer wound complications, blood transfusions and intestinal blockages
– Shorter hospital stay

Patients who have laparoscopic colorectal surgery can expect a hospital stay of three to four days. Those who have traditional open surgery may need five to seven days before their bowel function returns to normal, and they can go home.

Surgery for rectal cancer

Surgery for rectal cancer often can be performed laparoscopically. It typically involves removing the entire rectum and part or all of the sigmoid colon. The remaining colon is then brought down and attached to the anal canal. The anal sphincter muscles maintain their function; this is called sphincter preservation surgery and represents an advance for patients, who will be able to move their bowels normally. Some individuals may need to have a temporary ileostomy (bag appliance) until full healing has occurred.

Rectal resection and reconstruction

Rectal resection is surgery that removes a segment of the rectum, which is the last part of the large intestine, or colon. This surgery may be required to remove cancer, a large polyp or an area affected by inflammatory bowel disease.

Today, individuals who need to have their entire colon and rectum removed—either because of cancer or inflammatory bowel disease—can have a “new” rectum (neo-rectum) constructed from their small intestine.

Transanal rectal surgery

Some early-stage rectal cancers can be removed with minimally invasive transanal surgery, in which instruments are placed through the anus and into the rectum. No abdominal incision is made; the incision is made through the rectal wall, which is the closed.

Anal-rectal surgery

A number of disorders can occur at the junction of the anal canal and rectum, including hemorrhoids, fissures, abscesses and fistulas.

– Hemorrhoids
Internal hemorrhoids, which bleed painlessly, can be treated via rubber-band ligation, an office procedure that cuts off the blood supply and causes the hemorrhoid to fall off.
Large internal hemorrhoids or external hemorrhoids can cause pain and burning. Surgical treatment is very effective and has a low recurrence rate. However, this surgery usually requires a recovery period of up to two weeks.

– Anal Fissures
Anal fissures are tears in the rectal lining that can occur due to either hard stool or diarrhea, resulting in involuntary spasm in the sphincter. If conservative therapy fails, surgery is often the next step. During surgery, a small cut is made in the sphincter that stops the spasm and allows healing to occur. Some patients are given Botox or other medications that achieve “chemical cutting” that leads to healing.

– Perianal Abscesses
Perianal abscesses result when a crypt or gland becomes blocked, which can be very painful and cause a fever. They often require a drainage procedure, which often can be performed in the surgeon’s office or the Emergency Department. Larger or more complex abscesses may need to be drained in the operating room. Once of the goals of surgery is to avoid formation of a fistula—an abnormal tract that may develop when an anal gland is blocked.

– Anal fistulas
This is an abnormal connection, similar to a tunnel, between an anal gland and buttock tissue. Treatment typically involves “unroofing,” which opens the tunnel to allow healing. In some cases, a second procedure is required after the associated abscess has healed completely.

Rectal prolapse

In this condition, the rectum turns inside out and, over time, protrudes from the body. Because the condition will not resolve on its own, surgery is required. Laparoscopic and transanal surgery (performed through the anus) are options for most patients.

Colostomy repairs, revisions and closures

An “ostomy” is a surgically created opening of an internal organ to the outside of the body. An ileostomy is an opening of the ileum (the last part of the small intestine), and a colostomy is an opening of the colon. These bowel openings are covered a bag appliance that collects stool.

When a disease process prevents the safe reattachment of two segments of colon, a colostomy is placed. Most are reversible, meaning they can be “closed” with a surgical procedure. Colostomy closure often is performed laparoscopically.

Most people live comfortably and function well with a colostomy, but certain problems can require a surgical repair or revision. They include skin irritation around the ostomy, development of a hernia at the ostomy site (called a parastomal hernia) and protrusion or prolapse of the ostomy into the appliance bag.