Definition and Overview
Patients who are about to undergo colorectal surgery are required to consult a surgeon prior to the procedure. This is the first step in seeking surgical treatment for various conditions that affect the colon. It usually becomes necessary when other non-surgical treatment options, such as medications, failed to yield desired results.
Colorectal surgery refers to a group of surgical procedures that are used to treat a wide variety of conditions that affect the colon, rectum and anus. The procedures are performed by colorectal surgeons, and may involve different techniques depending on the patient's condition and its severity.
Who Should Undergo and Expected Results
The consultation is for patients who are suffering from serious conditions that are listed below and who consider surgical procedure as one of their treatment options:
- Cancer (bowel, anal, or colon cancer)
- Pre-cancer (polyps or benign tumors and cysts)
- Crohn’s disease
- Anal fissure
- Inflammatory bowel disease
- Irritable bowel syndrome
- Ulcerative colitis
- Fecal incontinence
- Diverticulosis or diverticulitis
- Abscess and fistula
Colorectal surgical procedures can be performed using either traditional open surgery or modern minimally invasive surgical techniques. Some examples include:
- Surgery to remove the colon either partially or completely
- Surgery to drain an abscess
- Surgical resection
Nowadays, most colorectal procedures also involve laparoscopy and endoscopy, both of which help make the procedures safer for patients. All these different types and techniques will be explained in detail during the initial consultation with the surgeon.
At the end of the consultation, the patient should have all the information he or she needs to decide whether to undergo surgery and, if so, what kind of surgery he or she prefers. The surgeon will provide expert recommendations, but the patient will still be responsible for making the final decision, making the initial consultation with the surgeon extremely important.
How Does the Procedure Work
A colorectal surgery consultation takes place at the surgeon’s clinic or office and lasts for about an hour. It is usually upon the referral of the patient’s primary care provider or an oncologist in cases that involve bowel or colon cancer. Patients with colon and rectum conditions are first treated using non-surgical means, such as medications, sclerotherapy injections, radiofrequency treatments, chemotherapy and radiation therapy before they are referred to a colorectal surgeon. They are advised to bring along their appointment letter from the referring physician during the consultation.
The goal of the consultation is to educate the patient about the different surgical procedures that can be used to treat his condition. To achieve this, the consultation will begin with the surgeon analyzing all existing information regarding the patient’s condition. The surgeon will also assess the patient’s:
- Medical history
- Family history (especially if cancer is involved)
- Diagnosis and all diagnostic information including:
- Symptoms, both past and present
- Results of all diagnostic tests and imaging scans
- Medications used so far – The patient should provide the surgeon a list of all current medications being taken including their dosage and schedule.
- Other treatments/therapies used so far
This information will help the surgeon to:
- Assess how much can be accomplished with surgery and how the procedure will improve the patient’s condition
- Evaluate the treatment that the patient has so far received
The surgeon will then perform a physical examination, including a rectal exam. This involves inserting a gloved finger into the rectal passage to check for any lumps or inflammation. During the examination, only the patient, the surgeon, and one of the surgeon’s assistant nurses will be present in the exam room. The patient will be asked to undress from the waist down but will be provided with a modesty sheet for their privacy.
The surgeon may also need to perform a rigid sigmoidoscopy, also known as a proctoscopy, which involves inserting a thin flexible tube into the rectal passage while the patient is lying curled on his side. The tube, which has a light source and camera on one end is used for checking abnormalities and taking a biopsy sample from the rectum as well as photos of the colon.
If the surgeon still requires more information following a sigmoidoscopy, he may request for additional testing, which can be performed at a later date. These may include colonoscopy and CT scan.
Due to the nature of these examinations, patients may request to consult either a male or female doctor, depending on who they are more comfortable with.
Once the surgeon has all the necessary information, he will share his expert opinion and make recommendations. He will also explain the most appropriate procedures and techniques that may be beneficial to the patient given his condition. As the goal of the consultation is to fully educate the patient, he will be encouraged to ask any questions or raise any concern before the consultation ends.
Possible Risks and Complications
A colorectal surgery consultation is a safe, routine appointment that poses minimal risk to the patient and only if examination or testing is necessary. No procedures will be performed during the visit, except for a rectal examination and sigmoidoscopy, which is usually for diagnostic purposes only. A rectal exam takes only a few minutes and is not considered painful, although some patients may find it a bit embarrassing and uncomfortable.
A sigmoidoscopy may take a bit more time and may cause patients to feel some pressure in their bowel area and the urge to have a bowel movement. It is normal to experience some bloating or cramping after the procedure and to pass gas. There is also a small risk of bowel perforation and bleeding, especially if a biopsy sample is taken.
Burt RW, Barthel JS, Dunn KB, et al. NCCN clinical practice guidelines in oncology. Colorectal cancer screening. J Natl Compr Canc Netw. 2010 Jan;8(1):8-61.
Engstrom PF, Arnoletti JP, Benson AB 3rd, et al. NCCN Clinical Practice Guidelines in Oncology: colon cancer. J Natl Compr Canc Netw. 2009 Sep;7(8):778-831.