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It is a term that encompasses a number of different surgical procedures to treat the problem in the colon (large intestine), rectum and anus. The different procedures involved can be performed on both children and adults to treat conditions such as colon and rectal cancer, congenital disabilities, injuries to the anus, inflammatory bowel disease, piles, haemorrhoids, fistula, severe constipation and more. The focus of this topic is on the following conditions. Colorectal Surgery in Bangalore is available at Manipal Hospitals, visit today.
Colon cancer
Colon cancer can develop along different sections of the large intestine; therefore, the type of surgical procedure depends on the location and the extent of the cancer. If the cancer is in the early stages (stage 0 and a few stage 1 tumours), it is often removed using colonoscopy. The frequently performed procedures include,
Polypectomy: The cancer polyp (which looks like the stem of a mushroom) is removed from its base using a wire loop sent through the colonoscope charged with an electric current.
Local excision: A bit more extensive procedure which uses tools via the colonoscope to remove the tumours along with some healthy tissue on the lining of the colon.
The cancer polyps that are in the early stages are taken out with a minimally invasive surgical procedure. If it is found that the tumour has spread throughout the colon, a colectomy might be performed.
Colectomy
Colectomy is a procedure to remove some parts of the colon or all of it along with the nearby lymph nodes. The procedure can be performed both as an open colectomy or a laparoscopically assisted colectomy. Depending on the stage of cancer, it can be,
Partial removal of the colon: It is also called a partial colectomy, hemicolectomy or segmental resection. The procedure involves removing the part of the colon with cancer and a small amount of normal tissue on either side. Depending on the size and location of the tumour, about 1/4th or 1/3rd of the colon can be removed. Some of the nearby lymph nodes are also removed to check for tumours.
Total removal of the colon: Complete removal of the colon is called total colectomy. The procedure is only performed if there are other issues with the colon where the cancer is absent such as inflammatory bowel disease or hundreds of polyps.
If the tumour blocks the colon, a stent (hollow expandable metal tube) can be put in place to clear the colon before the surgical procedure.
Inflammatory bowel disease (IBD)
Inflammatory bowel disease is a collective term for disorders that involve chronic (long-term) inflammation of the tissues in the digestive tract. IBD can be classified into two main types:
Ulcerative colitis
As the name suggests, the condition is characterised by inflammation and ulcers (sores) along the lining of the colon and rectum. Proctocolectomy is the standard procedure used to treat ulcerative colitis. The procedure involves removing both the colon and rectum. There are two ways in which it is performed,
Proctocolectomy with ileal pouch-anal anastomosis: In the procedure, both the colon and rectum are removed, and a pouch connected to the small intestine is placed inside. You will be able to have bowel movements out of the natural anal opening.
Proctocolectomy with Ileostomy: The colon, rectum and anus are removed in this procedure. The small intestine is led out of the abdomen into a colostomy bag, where the waste is collected.
Crohn's Disease
Crohn's disease is a type of IBD in which the inner lining of the digestive tract gets inflamed, and the inflammation can go deeper into the tissues of the digestive tract. The condition mainly affects the small intestine but can also affect the colon. Depending on the severity and the location of the disease, various types of surgeries might be performed, such as,
Ostomy: After a portion of the small or large intestine is removed, an opening is created for a stoma to excrete the digestive waste.
Ileostomy: In an Ileostomy, a small portion of the small intestine is led out of the abdomen as a stoma to excrete the digestive waste.
Colostomy: A colostomy is similar to an Ileostomy; the surgeon directs a small portion of the colon outside the abdomen to eliminate waste.
Colectomy: In colectomy, the damaged portion of the digestive tract is removed, which could involve the small and large intestines and the rectum. When the procedure is partial, it is also called a bowel resection, and the procedure involves removing only the damaged section of the colon.
Proctocolectomy: The colon and rectum are often removed in this procedure, and a pouch is used to collect the digestive waste.
Strictureplasty: In this procedure, the intestines are shortened or widened without removing any sections to decrease the effects of scarring.
Rectal surgery (Hemorrhoid, fissure and fistula)
Rectal surgeries are used to treat various conditions such as,
Haemorrhoids
Haemorrhoids are characterised by swollen veins towards the lowest part of the rectum and anus. More commonly known as piles, the condition leads to rectal bleeding and pain. The surgical procedure to remove haemorrhoids in severe cases is called hemorrhoidectomy. There are two types of hemorrhoidectomy,
Excisional hemorrhoidectomy: The procedure involves the removal of hemorrhoidal tissue, and the wound is left opened or sutured.
Stapled hemorrhoidectomy: In this procedure, the hemorrhoidal tissue is removed, and the wound is stapled with a special type of stapling device.
Anal fissure
Anal fissures are small tears in the mucus tissue in the anus. Fissures can open up when passing hard stools or through physical damage. Most fissures respond well to simple treatments and medications, while severe cases need surgical intervention.
The procedure usually performed is called lateral internal sphincterotomy (LIS). It involves making a small cut in the anal sphincter muscle, which relieves spasms and pain so the tissue can heal.
Anal fistula
The anal fistula is an abnormal tunnel that develops between the anus and the skin of the buttocks outside the anus. The fistulas start as an infection of the anal gland, and the abscess from the infected region drains out by itself or has to be drained surgically through the skin close to the anus. The surgical options for treatment include,
Fistulotomy: The procedure involves cutting into the fistula's internal opening and draining the infected tissue. A more complicated fistula would require a two-stage procedure.
Endorectal advancement flap: in this procedure, a flap is first created from the rectal wall before the fistula's abscess is drained. The flap then becomes a cover for the repair.
Ligation of the intersphincteric fistula tract (LIFT): A two-stage procedure for complicated fistulas. The surgeon accesses the fistula without having to cut the sphincter muscle.
Consult with the best doctors at Manipal Hospitals.
