Colorectal Surgery Treatment
Colorectal Surgery
Surgery is a common treatment for a range of benign conditions and cancers affecting either the colon – also called the large intestine or large bowel - or rectum. A colorectal procedure called large bowel resection is used to treat many of these conditions. Large bowel resection (colon resection) is surgery to remove all or part of your large bowel (colon). The digestive track is then reconnected by a technique called an intestinal anastomosis. This surgery is also called colectomy.
Removal of the entire colon and rectum is called a proctocolectomy.
More procedures in this category of surgery include ascending colectomy; descending colectomy; transverse colectomy; right hemicolectomy; left hemicolectomy; low anterior resection; sigmoid colectomy; subtotal colectomy; colon resection; partial colectomy and perineal resection.
The goal of large bowel resection and other colorectal procedures is to treat the condition while preserving normal bowel function. Some of the conditions that may be treated with large bowel resection or colectomy are: 1
- Colon cancer
- Diverticular disease (disease of the large bowel)
- A block in the intestine due to scar tissue
Other reasons to perform bowel resection are:
- Crohn's disease2
- Ulcerative colitis
- Injuries that damage the large bowel
- Precancerous polyps (nodes)
- Familial polyposis (an inherited condition in which numerous pre-cancerous polyps form) 3
Surgery for Ulcerative Colitis
Surgery to remove the colon will cure ulcerative colitis and removes the threat of colon cancer. Patients may need an ostomy (a surgical opening in the abdominal wall), or a procedure that connects the small intestine to the anus to help the patient gain more normal bowel function. 4
Surgery is usually reserved for patients who have colitis (inflammation of the colon) that does not respond to complete medical therapy, or patients who have serious complications such as: 4
- Rupture (perforation) of the colon
- Severe bleeding (hemorrhage)
- Toxic megacolon ( acute, severe inflammation of the colonic wall accompanied by stretching that can lead to perforation)
Surgery for Crohn's Disease
If medicines do not work, bowel resection may be needed to treat Crohn's disease. Surgery may be used to remove a damaged or diseased part of the intestine or to drain an abscess. A procedure called anastomosis is done to connect the remaining two ends of the bowel. 2
According to the Crohn's and Colitis Foundation of America, two-thirds to three-quarters of patients with Crohn's disease will need bowel surgery at some time. However, unlike ulcerative colitis , surgically removing the diseased portion of the intestine does not cure the condition. 2
Patients who have Crohn's disease that does not respond to medications may need surgery, especially when there are complications such as: 2
- Bleeding (hemorrhage)
- Fistulas
- Infections (abscesses)
- Narrowing (strictures)
Some patients may need surgery to remove the entire large intestine (colon), with or without the rectum.
Surgery for Diverticulitis
While acute diverticulitis is treated primarily with antibiotics, the affected portion of the colon may need to be removed with surgery if you have any of the following symptoms: 5
- Abscess
- Hole (perforation) in the colon
- Fistula (abnormal connections between different parts of the colon or the colon and another body area)
- Repeated attacks of diverticulitis
After the acute infection has been treated, eating high-fiber foods and using bulk additives such as psyllium may help reduce the risk of diverticulitis or other symptoms.5
Cancer Surgery
Colorectal cancer requires surgery in nearly all cases for complete cure. 6 Radiation and chemotherapy are sometimes used in addition to surgery.6
Between 80-90% of patients are restored to normal health if the cancer is detected and treated in the earliest stages. 6 The cure rate drops to 50% or less when diagnosed in the later stages.6
Thanks to modern technology, less than 5% of all colorectal cancer patients require a colostomy, the surgical construction of an artificial excretory opening from the colon.6
Depending on the type/location of your cancer, you may have one of the following types of colorectal surgical procedures:
Resections for Colon Cancer
- Right/Left Hemicolectomy Resection: Removal of the ascending (right) colon and the descending (left) colon, respectively.
- Sigmoid Resection (Sigmoidectomy): Resection of the sigmoid colon, sometimes including part/all of the rectum.
Resections for Rectal Cancer
- Low Anterior Resection: The tumor is removed without affecting the anus; the colon is attached to the anus and waste leaves the body in the usual way.
- Abdominal Perineal Resection: Removal of the anus , the rectum and part of the sigmoid colon along with the associated lymph nodes , through incisions made in the abdomen and perineum . The end of the remaining sigmoid colon is brought out permanently as an opening, called a stoma , on the surface of the abdomen.
Surgical Options
Today, the vast majority of colorectal procedures are still performed via a large abdominal incision which often extends from the pubic bone to just below the sternum. Open colorectal surgery can be quite painful, involving an increased risk of complications including infection and requiring an extended hospital stay.7
A recent study found that between 2003 and 2004, less than four percent of colorectal surgery in the U.S. was performed using minimally invasive technique. The study of the largest all-payer inpatient-care database in the United States comparing open and laparoscopic (minimally invasive) colorectal surgery found that laparoscopic surgery was associated with a lower rate of complications as compared with open resection (18% vs 22%); a shorter length of stay (6 vs 7.6 days); a reduced need for skilled care after surgery (5% vs 11%), and a lower mortality rate (0.6% vs 1.4%). 9
Fortunately, there are now more minimally invasive surgical options for colorectal cancer and a range of benign conditions affecting the colon and rectum.
While surgical resection to treat colorectal conditions is a relatively safe procedure, it may not be appropriate or necessary for all individuals and conditions. Always ask your doctor about all treatment options, as well as their risks and benefits.
Finding a Colorectal Surgeon
Colon and rectal surgeons are experts in the surgical and non-surgical treatment of colon and rectal problems. They have completed advanced training in the treatment of colon and rectal problems in addition to full training in general surgery. Colon and rectal surgeons treat benign and malignant conditions, perform routine screening examinations and surgically treat problems when necessary.
Board certified colorectal surgeons have attained Certification by the American Board of Colon and Rectal Surgery (ABCRS) and have specialized knowledge and skill with regard to problems of the colon, rectum, anus and small bowel.
The American Society of Colon and Rectal Surgeons is a professional association of 2,600+ surgeons, many of whom specialize in the research, diagnosis and treatment of diseases of the colon and rectum.
Read about da Vinci Surgery , a superior approach to minimally invasive colorectal surgery.
Locate a da Vinci general surgeon now.
2. Crohn's disease. http://www.nlm.nih.gov/medlineplus/ency/article/000249.htm#Symptoms
3. http://en.wikipedia.org/wiki/Familial_adenomatous_polyposis
4. Ulcerative colitis. http://www.nlm.nih.gov/medlineplus/ency/article/000250.htm
5. Diverticulitis. http://www.nlm.nih.gov/medlineplus/ency/article/000257.htm
6. American Society of Colon & Rectal Surgeons. Colorectal Cancer..http://www.fascrs.org/patients/conditions/colorectal_cancer/
7. Roxanne Nelson. Laparoscopic Colorectal Surgery May Improve Outcomes in Some Patients. Medscape Today. June 28, 2007. http://www.medscape.com/viewarticle/558988
While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.