Colorectal surgery

Colorectal surgery involves numerous surgical procedures for repairing the damage to the colon, rectum, and anus caused due to diseases such as cancer, diverticulitis, and inflammatory bowel disease. Sometimes, it also involves surgery to the pelvic floor to repair Hernias and Rectocele.

There are several conditions that might necessitate bowel surgery. Some of them are:

  • Injury, obstruction, and ischemia or compromised blood supply.

  • Hemorrhoids

  • Anal fissures or tears that occur in the lining of the anus

  • Rectal prolapse

  • Bowel incontinence.

Sometimes, scar tissue can develop inside the rectum, resulting in blockages that interfere with the normal removal of feces. Diseases such as diverticulitis and ulcerative colitis can create perforations in the rectum. Surgical removal of the damaged regions can restore the normal bowel function.

As per the current estimates, Colorectal cancer severely affects 140,000 people annually and causes approximately 60,000 deaths. Polypectomy or the removal of polyps in the colon has gone a long way in fighting against this type of cancer. Surgery is considered as the most effective treatment for colorectal cancer. The chances of the recurrence of disease due to surgical failure are significantly low, from 4% to 8%, if the surgery is carefully performed.

Tests and diagnosis:

The doctor may recommend several tests for diagnosing the disease including Colonoscopy, Flexible Sigmoidoscopy, and a lower GI (gastrointestinal) series. This will help him to precisely determine the condition of the intestinal tract and in locating the masses and perforations on the walls of the bowel.

A lower GI series: It refers to a series of X-rays of the colon and rectum. This test helps to identify the presence of ulcers, cysts, polyps, diverticuli and cancer. In this procedure, the patient is administered a barium enema. The barium covers the intestinal tract and makes any signs or symptoms visible on the X rays.

Flexible Sigmoidoscopy: In this procedure, a flexible tube attached with a small camera is inserted into the rectum of the patient so that the physician can closely examine the lining of the rectum and the sigmoid colon. The sigmoidoscope also helps to remove polyps or samples of tissue for biopsy.

Colonoscopy: A colonoscopy is a procedure which is similar to Flexible Sigmoidoscopy. However, in this procedure, the flexible tube is used to view the whole intestinal tract.

Magnetic Resonance Imaging (MRI) is used both before and during surgery. It enables the physicians to identify the accurate margins for resections of the colon, so that they can remove the entire damaged tissue. MRI scan also helps to identify patients who could notably benefit from adjuvant therapy such as Chemotherapy or Radiation.

Sometimes, blood and urine studies, along with different x rays and an electrocardiograph (EKG), may also be performed.

The patient will be placed on a controlled diet for several days before the surgery in order to cleanse the bowel, A liquid diet may be recommended for at least a day prior to the surgery. A series of enemas and/or oral preparations would be administered to empty the bowel. Oral anti-infectives may also be prescribed to reduce the bacteria in the intestine and to prevent postoperative infection.

Types of surgery

There are numerous procedures that a colorectal surgeon might use for treating intestinal disorders. In certain cases, colorectal surgery is performed by creating large incisions in the abdomen, opening up the intestinal cavity, and repairing the damaged portion. This could involve resection or cutting the diseased portion and Anastomosis or connecting the cut ends of the intestine. While some procedures tighten sphincter muscles or repair the fissures, others help in removing hemorrhoids. Strictureplasty is an advanced procedure that widens the intestine and is used mainly in patients suffering from extensive Crohn’s disease.

Colorectal surgery often involves creating an Ostomy, an opening from the interior of the body to the exterior, generally to remove feces or urine. Colostomy refers to a surgical procedure in which a part of the large intestine is brought through the wall of the abdomen, thus creating an opening or ‘stoma’ which helps in removing the feces out of the body to a pouch. An ileostomy is a procedure which involves removing the whole colon, rectum, and anus.

For all types of Ostomies, a pouch will be usually positioned around the stoma on the abdomen of the patient during surgery. During the stay in the hospital, the patient and his caregivers will be provided detailed information regarding the care and maintenance of the stoma and the ostomy pouch.

Most of the colostomies and ileostomies which are performed are permanent. Temporary colostomies are often done to divert stool from the damaged parts of the large intestine, thus facilitating the process of healing.

Laparoscopic surgery is being widely used for the treatment of diseases of the intestinal tract, including initial cancers.

The patient is generally out of bed in eight to 24 hours following the surgery and would be discharged in two to four days.

Risks

The general health of the patient before the surgery is often indicative of the potential for risk especially if he/she has a prior history of cardiac disorders and stressed immune systems. After the surgery, sometimes, patients can feel or they might have feelings of low self-esteem caused by a change in their lifestyle and appearance.