Colorectal Surgery

Colectomy

A colectomy, or, colon resection, removes all or part of the large intestine.

Segmental Colectomies: Generally, a vertical incision is made in the middle of the abdomen, overlying the portion of the bowel with disease. The segment of bowel containing the disease is removed. If the excision is for cancer, an effort is made to remove a wider segment to include lymph nodes. The ends of the bowel are joined together (anastomosis) to be water-tight and permit healing.

Polypectomy: A surgeon may remove a cancerous polyp or polyps from the colon or rectum using a colonoscope. The colonoscope is inserted into the rectum and a wire loop is passed through the instrument to remove the polyp.
Total Colectomy and Total Proctocolectomy: A few diseases, such as familial polyposis, require removal of the entire colon with anastomosis of the end of the small bowel to the rectum. Familial polyposis or ulcerative colitis often require removal of the colon and rectum. A new pouch (neorectum) is created with the small bowel folded and stapled back on itself; this pouch is joined down to the anus.

Colostomy

A colostomy is a surgical procedure during which your surgeon creates a hole in your abdominal wall and pulls one end of the colon through the opening. Surgeons perform colostomy procedures to treat a number of colon and rectal conditions.

This procedure fundamentally alters how your body excretes waste and fecal matter. While you will need some time to get used to living with a colostomy, you will find that you can live a full life, complete with all the activities you enjoyed previously. The area where the new opening sits is called a stoma. This is where waste matter will exit your body. After your procedure, you will need a colostomy bag, which collects the waste from your body. The bag lies outside of your body. Before you are discharged, a trained ostomy nurse will teach you how to care for your stoma and manage the bag.

The colostomy is either temporary or permanent:

Temporary colostomies are performed for specific conditions that allow for the reattachment of the colon at later point in time. This allows the affected area to heal because the stool is not passing through the area. Once the affected area has healed, you undergo a colostomy reversal procedure.

Permanent colostomies are used in cases of chronic disease, such as Crohn’s disease and diverticular disease. Your surgeon may also remove the infected area of the colon or rectum.

Endoscopic Surgery

Endoscopic surgery is performed using a scope, a flexible tube with a camera and light at the tip. This allows your surgeon to see inside your colon and perform procedures without making major incisions, allowing for easier recovery time and less pain and discomfort. Snaring is the most common surgical procedure that can be performed through any of the endoscopes. A snare is a wire formed like a lasso that is looped over a tumor and tightened; then the wire is electrified to prevent bleeding as it cuts through.

Endoscopic procedures are most often used for diagnosis.

Hemorrhoidectomy

Your doctor may first recommend nonsurgical treatments for hemorrhoids, including lifestyle changes and medications. If you tried home treatments and did not feel sufficient relief, you may be a candidate for surgery. Surgery for hemorrhoids is called a hemorrhoidectomy. During a hemorrhoidectomy, your doctor will place you under local anesthesia and make incisions around your anus to remove the hemorrhoids. A hemorrhoidectomy is generally an outpatient procedure, meaning you can go home the same day. You may feel some tenderness around the incisions. Hemorrhoidectomy often provides the best long-term results for hemorrhoids.

Procedure for prolapse and hemorrhoids (PPH), also known as stapled hemorrhoidectomy is a minimally invasive procedure to treat hemorrhoids and prolapse. During PPH, your doctor will use a circular stapling device to reposition the hemorrhoidal tissue back to its original position in the anus and trim the tissue that is causing pain. PPH reduces the blood flow to the hemorrhoids, causing them to shrink. PPH is a highly effective procedure, but surgeons must undergo special training to perform it effectively.

In addition to PPH, your surgeon may use rubber band ligation, where a rubber band is placed around the hemorrhoid to cut off its blood supply and destroy the tissue.

Rectopexy

Resection

A resection is a surgical procedure to remove all or part of a diseased organ or tissue.

Abdominoperineal (Rectal) Resection: This surgery is performed to treat anal and distal rectal cancer. The anus, rectum and part of the sigmoid colon are removed to include the attending vessels and lymph nodes. The end of the colon is then brought through an opening made in the abdominal wall (this is called a colostomy).

Small Bowel Resection: This surgery is performed to remove Crohn’s disease, cancer, ulcers, benign tumors, and polyps. This surgery removes a portion of the small intestine. The surgeon will remove the diseased parts of the small intestine and sew the healthy parts back together. If necessary, an opening to the outside of the body called an ostomy is created.
Low Anterior Resection: In this operation, part of the rectum is removed, but it is rejoined (anastomosed). Entailed in this operation is dissection deep into the pelvis. Anastomoses at this deep level are at increased risk to leak, so often, an ostomy is created above to stop the pressure of bowel movements. Another risk in the deep pelvic dissection is injury to nerves that serve the bladder and sex organs, which may cause later dysfunction.

Laparoscopic Colon Resection: Several techniques in laparoscopic colon resection are being used to treat colorectal cancer. The laparoscope is a lighted tubular instrument used to examine abdominal organs when passed through a small abdominal incision. Laparoscopic colon resection uses this minimal-access approach for removing cancerous tissue and lymph nodes.
Local Full-Thickness Resection of the Rectum: Very early stage rectal cancer can be treated by cutting through all layers of the rectum to remove the cancer and some surrounding normal tissue.