Definition and Overview

Colorectal surgery is a term that refers to various surgical procedures performed on the colon, anus, and rectum. Medical professionals performing such procedures are known as proctologists or colorectal surgeons. These surgeons treat various disorders such as anal fissures (abnormal tears or cracks in the patient’s anus), birth defects in the anus or colon, swelling and inflammation of veins in the rectum (also known as haemorrhoids), anorectal fistulas (passageways that connect different parts of the anorectal area to the surface of the skin), faecal incontinence, colon and rectal cancers, anal or rectal prolapse, diverticular disease, diverticulitis, imperforate anus and other birth defects, Crohn’s disease and other severe colic disorders, and anal cancer.

There are various techniques used in performing colorectal surgery. These include colectomy, which is the surgical resectioning of the colon or the large intestine. This procedure can also involve the removal of the entire large intestine and the rectum. Strictureplasty is another colorectal surgical procedure, which removes scar tissues that have grown on the patient’s intestinal walls, usually as a result of bowel inflammation (in severe colic disorders such as Crohn’s disease). Other surgical procedures include lateral internal sphincterotomy, transanal endoscopic microsurgery (TEM), bowel diversion surgery, rubber band ligation, abdominoperineal resection, haemorrhoidectomy, anoplasty, polypectomy, and colostomy.

Modern surgical techniques for colorectal issues include laparoscopic surgery, which is minimally invasive and requires less downtime for the patient. Robotic surgery is also fast becoming an ideal option for many patients; it is more precise and can access previously difficult to reach areas, such as in the case of rectal cancers.

Colorectal surgery can also involve various diagnostic procedures such as colonoscopy, sigmoidoscopy, defecating proctography, and proctoscopy.

Who Should Undergo and Expected Results

Patients suffering from the following serious colorectal disorders and issues may undergo colorectal surgery.

  • Anal fistula
  • Haemorrhoids
  • Anal cancer
  • Colon cancer
  • Rectal cancer
  • Presacral tumours
  • Pelvic floor dysfunction (for female patients)
  • Constipation
  • Bowel obstruction
  • Faecal incontinence
  • Ulcerative colitis
  • Crohn’s disease
  • Inflammatory Bowel Disease
  • Diverticulitis
  • Microscopic Colitis

The expected result of colorectal surgical procedures is the treatment of the disease or a more effective management of the condition. Proper colorectal functions should also be restored following the success of such procedures.

How Is the Procedure Performed?

Colorectal surgical procedures vary widely in terms of technique, equipment, approach, and objective.

Laparoscopic surgery for colorectal diseases and conditions is one of the more modern approaches to surgical treatment. Before this surgical approach, most colorectal procedures are performed by making long incisions in the abdomen, which meant that the patient will feel a lot of pain and will need a longer period to recover. Laparoscopy was formerly used in treating gallbladder disease and gynaecological conditions, but was seen by many innovators as an ideal way to perform various colorectal surgeries.

Unlike traditional colorectal surgery, laparoscopic surgery only requires a significantly smaller incision in the abdomen to perform the same procedure with the same results. Some types of laparoscopic surgery can also allow the surgeon to insert a hand directly in the abdominal cavity while being assisted by a laparoscope for precision. Laparoscopy also involves the use of carbon dioxide to lift the abdominal wall so the surgeon can access the site of the tumour or abnormal growth or tissue.

Possible Complications and Risks

Depending on the type of colorectal surgery performed, the patient can experience different types of complications after the procedure. Traditional open colorectal surgery can result in excessive bleeding and a negative reaction to the anaesthesia or sedative, and infection. Deep infections, or peritonitis, can occur inside the abdominal cavity, which will require additional surgery and long-term antibiotics. Some colorectal surgical procedures also result in unsightly scars on the skin, which can then require additional aesthetic surgical procedures.

Other complications of colorectal surgery include damage to the spleen, perforating the intestines or the stomach, damaging the bladder and its connecting tubes (which can result in impaired bladder function), injuring the ovaries, uterus, and other parts of the female reproductive system, hernias, and the breakdown or disruption of the abdominal wall.

Research shows that age can be a risk factor for colorectal surgery. Older patients typically suffer more complications and might not enjoy the full benefits of the surgical treatment.

References:

  • Cima RR, Pemberton JH. Ileostomy, colostomy, and pouches. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 113.

  • Cunningham D, Atkin W, Lenz HJ, Lynch HT, Minsky B, Nordlinger B, et al. Colorectal Cancer. Lancet. 2010;375:1030-1047. PMID: 20304247 www.ncbi.nlm.nih.gov/pubmed/20304247.

  • Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Colon and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2007:chap 52.

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