Types of Colon and Rectal Surgery

[Mr. Rasel]

Surgeries of colon and rectal include:
•   Colectomy
•   Colostomy
•   Endoscopic Surgery
•   Hemorrhoidectomy
•   Ileal Pouch Anal Anastomosis (J-Pouch)
•   Inflammatory Bowel Disease (IBD) Surgery
•   Internal Sphincterotomy
•   Rectopexy
•   Resection

Colectomy
A colectomy, or, colon resection, removes all or part of the large intestine.
•   Segmental Colectomies: Generally, a vertical incision is made in the middle of the abdomen, overlying the portion of the bowel with disease. The segment of bowel containing the disease is removed. If the excision is for cancer, an effort is made to remove a wider segment to include lymph nodes. The ends of the bowel are joined together (anastomosis) to be water-tight and permit healing.
•   Polypectomy: A surgeon may remove a cancerous polyp or polyps from the colon or rectum using a colonoscope. The colonoscope is inserted into the rectum and a wire loop is passed through the instrument to remove the polyp.
•   Total Colectomy and Total Proctocolectomy: A few diseases, such as familial polyposis, require removal of the entire colon with anastomosis of the end of the small bowel to the rectum. Familial polyposis or ulcerative colitis often require removal of the colon and rectum. A new pouch (neorectum) is created with the small bowel folded and stapled back on itself; this pouch is joined down to the anus.

Colostomy
A colostomy is a surgical procedure during which your surgeon creates a hole in your abdominal wall and pulls one end of the colon through the opening. Surgeons perform colostomy procedures to treat a number of colon and rectal conditions.
A colostomy procedure fundamentally alters how your body excretes waste and fecal matter. While you will need some time to get used to living with a colostomy, you will find that you can live a full life, complete with all the activities you enjoyed previously. The area where the new opening sits is called a stoma. This is where waste matter will exit your body. After your colostomy, you will need a colostomy bag, which collects the waste from your body. The bag lies outside of your body. Before you are discharged, a trained ostomy nurse will teach you how to care for your stoma and manage the bag.
The colostomy is either temporary or permanent:
•   Temporary colostomies are performed for specific conditions that allow for the reattachment of the colon at later point in time. The colostomy allows the affected area to heal because the stool is not passing through the area. Once the affected area has healed, you undergo a colostomy reversal procedure.
•   Permanent colostomies are used in cases of chronic disease, such as Crohn’s disease and diverticular disease. Your surgeon may also remove the infected area of the colon or rectum.

Endoscopic Surgery
Endoscopic surgery is performed using a scope, a flexible tube with a camera and light at the tip. This allows your surgeon to see inside your colon and perform procedures without making major incisions, allowing for easier recovery time and less pain and discomfort. Snaring is the most common surgical procedure that can be performed through any of the endoscopes. A snare is a wire formed like a lasso that is looped over a tumor and tightened; then the wire is electrified to prevent bleeding as it cuts through.
Endoscopic procedures are most often used for diagnosis.

Hemorrhoidectomy
Your doctor may first recommend nonsurgical treatments for hemorrhoids, including lifestyle changes and medications. If you tried home treatments and did not feel sufficient relief, you may be a candidate for surgery. Surgery for hemorrhoids is called a hemorrhoidectomy. During a hemorrhoidectomy, your doctor will place you under local anesthesia and make incisions around your anus to remove the hemorrhoids. A hemorrhoidectomy is generally an outpatient procedure, meaning you can go home the same day. You may feel some tenderness around the incisions. Hemorrhoidectomy often provides the best long-term results for hemorrhoids.
•   Procedure for prolapse and hemorrhoids (PPH), also known as stapled hemorrhoidectomy is a minimally invasive procedure to treat hemorrhoids and prolapse. During PPH, your doctor will use a circular stapling device to reposition the hemorrhoidal tissue back to its original position in the anus and trim the tissue that is causing pain. PPH reduces the blood flow to the hemorrhoids, causing them to shrink. PPH is a highly effective procedure, but surgeons must undergo special training to perform it effectively.
•   In addition to PPH, your surgeon may use rubber band ligation, where a rubber band is placed around the hemorrhoid to cut off its blood supply and destroy the tissue.

Ileal Pouch Anal Anastomosis (J-Pouch)
Ileal pouch anal anastomosis (IPAA), also called the J-pouch procedure, is a procedure to create a pouch from the end of your small intestine and attach the pouch to the anus. If you need to have your large intestine (colon) removed, IPAA restores your stool function. Surgeons perform IPAA for patients who needed their large intestine removed during a procedure called a colectomy, or colon resection. Patients can live without a colon, but bowel control can be problematic. IPAA helps restore control over bowel function.
IPAA is a life-altering procedure. However, you are in expert hands at MedStar Health. Our entire medical team will work with you before, during and after your surgery to help you manage life with a J-pouch. Most patients find that after a period of adjustment, they are able to return to and enjoy all of their favorite activities.
Benefits
The advantage of the J-pouch is that it eliminates the need for the permanent opening (stoma) and waste bag. The procedure preserves the anus, and the internal pouch serves as the storage place for stool. This allows you to maintain bowel control and eliminate waste through the anus.
Procedure
In the procedure,
•   Your surgeon removes your large intestine and create the pouch from the small intestine. He or she then creates a temporary ileostomy, which you will have for two months, during which time your bowel and the new pouch have time to heal.
•   After two months, you have a second operation, and your surgeon reverses the ileostomy. The pouch is now where stool will collect. You retain control of the anal muscles, allowing you to eliminate waste normally.
•   After the procedure, you will probably have more bowel movements compared to those without a pouch, but it does not greatly interfere with your quality of life.

Inflammatory Bowel Disease (IBD) Surgery
Inflammatory bowel disease (IBD), which primarily includes ulcerative colitis and Crohn’s disease, causes flare-ups of intense intestinal pain that may require hospitalization. Your doctor will probably first recommend lifestyle changes and medications to relieve symptoms of IBD. However, if you do not find relief through nonsurgical methods, you may be a candidate for a surgical procedure.
Surgeons perform surgery to remove the colon (colectomy) to treat ulcerative colitis and Crohn’s disease. The surgery is highly effective against ulcerative colitis, curing the disease and removing the risk of colon cancer. For Crohn’s disease, the surgery can provide long-term relief from flare-ups, lasting as long as a few years. Unfortunately, there is no cure for Crohn’s disease, and the disease usually returns.

Internal Sphincterotomy
Surgeons often perform an internal sphincterotomy to treat anal fissures (small tears in the mucous lining of the rectum). Fissures often resolve on their own, through dietary changes and medications. However, if you have not found relief through nonsurgical methods, you may be a candidate for an internal sphincterotomy. The internal sphincter is the muscle in your body that opens and closes to allow stool to pass from the body. The goal of an internal sphincterotomy procedure is to stretch or cut the internal sphincter to weaken the muscle temporarily, allowing it to heal.
During an internal sphincterotomy, your doctor will use a local anesthetic to numb the area, or a spinal anesthetic, which numbs the entire lower body. In some cases, general anesthesia may be used. They will make a small incision in the internal anal sphincter to reduce pressure on the muscle. Keep in mind that a sphincterotomy does not close the actual fissure. Anal fissures must heal on their own; a sphincterotomy lessens the spasms and relaxes the muscle, thus allowing the fissure to heal and close.

Rectopexy
Rectopexy is a surgical procedure to treat rectal prolapse. Some patients with mild cases of rectal prolapse may find relief by altering their diet or using laxatives or stool softeners. However, if these methods did not adequately improve your symptoms, you may be a candidate for rectopexy. This procedure repositions the internal structures and secures them in place.
Before Surgery
Prior to rectopexy, you will need to undergo a bowel-cleansing regimen, so your digestive system is free of stool for the procedure. During rectopexy, your surgeon will make an incision along your abdomen, separate the rectum from the surrounding tissues, and lift the rectum and suture it to the sacrum, or lower backbone, possibly using a mesh-like material to provide extra reinforcement. Your surgeon may perform this surgery in conjunction with anterior resection surgery, during which part of your colon (large intestine) is removed.
After Surgery
Following your surgery, you will need to give your body time to heal. Our medical team will discuss the recovery period with you. You will need to follow a liquid diet until your bowel function returns to normal, restrict certain activities that place strain on your abdomen, including lifting, and avoid coughing and straining during bowel movements. Complete recovery takes about four to six weeks.

Resection
A resection is a surgical procedure to remove all or part of a diseased organ or tissue.
•   Abdominoperineal (Rectal) Resection: This surgery is performed to treat anal and distal rectal cancer. The anus, rectum and part of the sigmoid colon are removed to include the attending vessels and lymph nodes. The end of the colon is then brought through an opening made in the abdominal wall (this is called a colostomy).
•   Small Bowel Resection: This surgery is performed to remove Crohn's disease, cancer, ulcers, benign tumors, and polyps. This surgery removes a portion of the small intestine. The surgeon will remove the diseased parts of the small intestine and sew the healthy parts back together. If necessary, an opening to the outside of the body called an ostomy is created.
•   Low Anterior Resection: In this operation, part of the rectum is removed, but it is rejoined (anastomosed). Entailed in this operation is dissection deep into the pelvis. Anastomoses at this deep level are at increased risk to leak, so often, an ostomy is created above to stop the pressure of bowel movements. Another risk in the deep pelvic dissection is injury to nerves that serve the bladder and sex organs, which may cause later dysfunction.
•   Laparoscopic Colon Resection: Several techniques in laparoscopic colon resection are being used to treat colorectal cancer. The laparoscope is a lighted tubular instrument used to examine abdominal organs when passed through a small abdominal incision. Laparoscopic colon resection uses this minimal-access approach for removing cancerous tissue and lymph nodes.
•   Local Full-Thickness Resection of the Rectum: Very early stage rectal cancer can be treated by cutting through all layers of the rectum to remove the cancer and some surrounding normal tissue.

Source: MedStar Georgetown University Hospital