Colorectal Surgery
What is Colorectal Surgery
Subspecialty discipline within General Surgery, focussed on treatment of diseases involving the small bowel, colon, rectum, anal canal and anus.
Diverticulosis
Diverticular disease is a common, chronic condition affecting the large bowel, particularly the left side, where patients experience abdominal pain, altered bowel habits and blood in bowel movements. In severe cases, the bowel can perforate resulting in localised or generalised abdominal infection and may require surgery to remove the diseased area of bowel. This can sometimes require a stoma, but this is fairly rare.
Preventative strategies include high fibre diet and adequate hydration.
A colonoscopy is often performed to ensure no synchronous bowel problems such as polyps or cancer, and can also be useful in quantifying the severity of diverticular disease.
Surgical treatment of diverticular disease involves removal of the diseased section of bowel, and in most cases restoration of the normal continuity of bowel by joining the two ends together, called an anastomosis. In some cases, patients will require a stoma, where the bowel is brought out through the abdominal wall and into a stoma bag, which is an appliance that once can live a normal life with, but will be required to change throughout the day. A stoma can be temporary or permanent depending on a number of factors.
Colorectal Cancer
Colorectal cancer (aka bowel cancer) is the third most common cancer in Australia, and is increasing in prevalence. It also appears to be increasingly common in younger adults. Although there are some genetic and familial predisopositions, the majority of these cancers are sporadic. There are some modifiable risk factors, such as reducing red meat consumption, obesity, alcohol, smoking, and other factors such as a history of bowel polyps.
In Australia, we screen for colorectal cancer with the National Bowel Cancer Screening Program, whereby eligible Australians aged between 50 and 74 are sent a free stool test to be done at home. If this is positive, then patients are referred for a colonoscopy.
In patients with any symptoms including altered bowel habit or bleeding, they are directly referred for a colonoscopy.
Colonoscopy can detect bowel cancer early and address polyps prior to ‘malignant transformation’ in to cancer.
Surgical treatment of colorectal cancer depends on the exact location of the cancer, but ultimately will involve removal of the cancer and draining lymph nodes, and in most cases restoration of the normal bowel continuity. In rare circumstances, patients will require a stoma.
In most cases, the surgery is performed via keyhole surgery (laparoscopically, i.e. minimally invasively).
Anal Cancer
Anal cancer is usually different to colorectal or bowel cancer, and is often related to HPV infection progressing to squamous cell carcinoma.
Risk factors include all risk factors that predispose individuals to HPV infection, such as immunosuppression.
The treatment for anal cancer involves an examination under anaesthetic and mapping biopsies. If anal squamous cell cancer is confirmed, then usually the treatment is definitive chemoradiation, with surgery reserved for salvage if there is failure to respond to the treatment or recurrence. The surgery involved is usually quite complex
Pelvic floor dysfunction
- Pelvic floor dysfunction is a common but complex condition whereby the muscles of the pelvic floor have lost their intrinsic coordination, resulting in difficulties with urination and/or defecation such as incontinence or inability to evacuate, and potentially sexual dysfunction.
- Pelvic floor dysfunction is common post-pregnancy, and therefore affects women more than men. It can also occur in the setting of a complicated pregnancy, pelvic surgery, obesity and advancing age.
- Treatment begins with a thorough clinical assessment including a detailed history and examination, along with wuth anorectal physiology testing where your surgeon will utilise obtain a functional assessment of your anal canal and sphincter complex. You will also most likely require a colonoscopy if you haven’t undergone one in recent times, as this is crucial in the final treatment planning.
- In most cases, treatment involves a multidisciplinary approach, involving pelvic floor physiotherapy and reconditioning, biofeedback retraining and occasionally sacral nerve stimulation. Your surgeon will guide you as to what is most appropriate.
Rectal prolapse
- Rectal prolapse is a condition where the last part of the large intestine protrudes through the anal canal, which can result in pain, bleeding and incontinence. In the majority of cases, the prolapse can be reduced manually, but in some cases, patients will need to present to the emergency department due to irreducibility and refractory pain.
- Treatment of rectal prolapse beings with a comprehensive clinical assessment to determine fitness for surgery, and appropriate investigations including a colonoscopy and anorectal physiology assessments.
- Management is multidisciplinary and multimodal, requiring optimisation of modifiable risk factors such as pelvic floor function, diet and hydration, along with surgical options ranging from abdominal approaches in patients who are medically well enough to undergo a more extensive but more durable operation, to limited perineal approaches for patients who may not be medically well enough to undergo a major operation or general anaesthetic. Your surgeon will outline this in more detail in a personalised consultation.