Colon & Rectal Surgery

Inside the abdomen lives the small bowel and the colon (large intestine/bowel). The colon can get cancer, polyps or diverticulitis, which may require the surgeon to remove a section of the colon. A colectomy is the resection and removal of a diseased portion of the colon and then carefully putting the healthy ends back together. There are several different areas of the colon that can be diseased and therefore several types of colon resection that can be performed:

• Sigmoid colectomy
• Right hemicolectomy
• Left hemicolectomy
• Low anterior resection
• Abdominoperineal resection
• Total Colectomy
• Transverse colectomy

During the first part of the surgery, your surgeon will concentrate on the resection or removal of the diseased portion of the colon. It takes a skilled surgeon to perform a resection, as there are many organs and nerves near the colon and often times there may be scar tissue or an abscess caused by the disease. The surgeon must carefully dissect the area ensuring not to displace any nearby organs or nerves.  This is where robotic surgery has a big advantage. Performing this surgery robotically, gives the surgeon ten times the level of magnification and four different “arms” with wristed instruments so that they can skillfully and precisely complete their work. Additionally, the robot allows for other technological advancements, allowing the surgeon to highlight and isolate the ureters (carry urine from your kidneys to your bladder) and other areas that can help the surgeon be more accurate in performing the surgery while avoiding any complications.

Once the diseased section of the colon is removed, the surgeon uses staples or sutures to put the colon back together/reattach the healthy ends. A robotic approach also allows for many advantages in this part of the surgery. It allows the surgeon to suture the colon inside the abdomen and it also allows suturing in several different layers.  This is believed to reduce leak rates.  Once the colon is reattached, the surgeon will often test that it is airtight and there are no leaks. To do this, they fill the colon with air while it is submerged under saline (salt water). Other tests include confirming that the anastomotic rings are whole, that both ends of the new connection have a good blood supply and that there is no tension on the anastomosis.  All of these tests, when appropriate, help us reduce complications.

Robotic surgery is better surgery which reduces complications.  Many times, these surgeries are bloodless and less traumatic because we are using the best robotic technology.  From a cancer perspective the technology also allows us to achieve high ligations of the vessels which maximizes our lymph node harvest.  Another benefit of a robotic approach is that it allows the surgeon to go so low in the pelvis sometimes avoiding a permanent colostomy.  Reducing the leak rates, which robotic surgery does, often helps us avoid temporary or permanent colostomy bags.

The outcome for patients undergoing this procedure is good and the recovery time is fairly short, with most times patients only spending two to three days in the hospital. By the time they leave they are eating, drinking and walking. They are limited to no heavy lifting for six weeks. Generally, we ask patients to take two to four weeks off work and restrict flying when they can.

Infection, cancer, leakage, pathology, poor blood supply or other reasons can lead to the need for a temporary or permanent colostomy bag or ileostomy. In this procedure the surgeon re-routes the colon or the small bowel and its contents through a hole in the abdominal wall and into a bag or pouch on the outside of the body. Many times, this is done as a temporary procedure to allow the colon or small bowel to heal from a disease or injury. In a temporary case, the surgeon can go in at a later date and reverse the colostomy or ileostomy by re-connecting the colon or small bowel inside the body and rerouting the waste once again through the colon.

Hemorrhoids are swollen veins in the anus or rectum that can be extremely painful. Hemorrhoid surgery removes the swollen veins that are bulging, similar to varicose veins in the legs.  This surgery is performed by general and colorectal surgeons. The most important thing for the patient is to find a surgeon who is experienced in this surgery. SSOC surgeons perform many of these surgeries leading to a very low complication rate. Because there are a lot of nerves in the area hemorrhoid surgery is very painful. Often the doctor will explain this to the patient and offer other options before turning to surgery. Patients often try cremes or banding, if that does not work and the patient still has consistent bleeding or constant pain, it is time to consider a surgical repair. The surgeon usually uses Exparel, which is a local anesthetic that lasts 48 to 72 hours to perform the hemorrhoidectomy. This is usually an outpatient surgery; however, patients can experience pain for two to six weeks after surgery.

An anal fistula may develop when the mucus glands at the anus get blocked or plugged. They can also develop from a perianal abscess. In 40 – 60% of these abscesses an individual may also develop a fistula or an abnormal opening in the skin that allows wastes to get inside the body and form a bacterial infection. To repair this the surgeon will perform a fistulotomy, flap, seton or a lift procedure. Some patients may need more than one surgery to fully correct the issue.

A J-Pouch surgery is generally performed as a treatment for ulcerative colitis, when traditional medications have failed. This surgery can be performed in one, two or three stages and should only be done by a colorectal surgeon. In this procedure, the colon and the rectum are removed, and the end of the small intestine is used to form an internal pouch. Because the small bowel takes the shape of a J as it is connected directly to the anus, it is called a J-Pouch. For patients who have suffered from life-altering, chronic diarrhea and bleeding, this procedure can help.