COLORECTAL SURGERY

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Colon is nothing but the large intestine, which helps carry out the process of digestion, helps in absorption of water and excretion of waste products in the form of stools. Rectum is the most terminal part of the colon, which acts as a reservoir for stools before they are emptied. A combination of disorders affecting thecolon and rectum is what is known as colorectal disorders. Colorectal surgery is a specialized field of surgery dealing with diseases of the colon and rectum.

 Broadly surgical procedures on the colon and rectum are done for

Colorectal surgery involves a close collaboration with the gastroenterologist and would require performance of sigmoidoscopy or colonoscopy to diagnose colorectal diseases and decide the type of treatment needed. Most of the colorectal surgical procedures except those related to hemorrhoids and other perineal problems are performed by minimally invasive surgery laparoscopic surgery these days

Common procedures include: Laparoscopic resection of colorectal cancers –Here the involved part of the colon or rectum, along with its blood supply and involved lymph nodes( glands) are removed through laparoscopy and rest of the intestines are sutured back together. Minimally invasive surgery in such cases involves a very small incision to remove the affected portion of intestine, and is associated with a faster recovery time and less requirement for pain killers and rarely very few postoperative problems like wound infections, ileus (sluggish movement of the intestines) or anesthesia related issues like chest infections. Laparoscopic surgery for colorectal cancers has been around for quite some time. It has been tested and compared with open surgery and results have been found to be better than open surgery in terms of recovery and similar when it comes to long term survival.

Surgery for Inflammatory Bowel Disease: The common inflammatory bowel diseases - Crohn’s Disease and Ulcerative Colitis may require surgery at some time of the disease. When these diseases are severe they may be associated with symptoms related to obstruction, bleeding, perforation or abscess formation and at this time may require emergency laparoscopic or open surgery to drain the abscess, remove the segment of colon that causes obstruction, perforation or bleeding. Sometimes, depending on the clinical condition of the patient, the bowel ends may need to be brought out and fixed to the skin as Ileostomy or colostomy and this will be closed once the patient is completely alright, say in 6- 8 weeks. Diverticular disease of the colon, which predominantly affects the sigmoid colon (situated on the left side) is managed in similar lines, depending on the clinical condition of the patient. 

Total Colectomy and Ileo anal Pouch Anastomosis: This is a surgical procedure performed in few special situations like long standing or severe Ulcerative colitis and Familial adenomatous polyposis. In these situations the entire colon is involved in the disease process and on the long term can develop cancerous changes. Hence early on, say at the age of 20 -40 yrs., entire colon and rectum needs to be removed. Once the colon is removed, the surgeon creates a pouch from the small intestine to resemble the rectal reservoir and this pouch is joined to the anal canal, so that the patient can pass stools normally. The surgery is usually performed in two or three stages depending on the clinical condition of the patient. In most of the patients, they need to pass stools at least 7- 8 times per day and this usually settles to around 2 -3 times per day. Today the entire procedure is performed by laparoscopy in most tertiary gastrointestinal surgery centers with good cosmetic outcome, excellent recovery and long term results. Laparoscopic rectopexy is a procedure that’s performed for rectal prolapse – a condition where the patient has constipation for a long time, has to strain for prolonged period to pass stools and this eventually results in protrusion of the rectum through the anal canal. During surgery the rectum is sutured and fixed to the sacrum. 

Perineal procedures :Common procedures in the perineum include stapler hemorrhoidectomy for grade 2 / 3 piles, fistulotomy for peri anal fistula and sphincterotomy for fissure in ano.

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