What Is Colorectal Surgery?
It is the branch of medicine which deals with the diagnosis and treatment of diseases of the colon, rectum and anus. These are the organs involved in the passage and expulsion of human excreta after the digestive processes are over and the nutrients absorbed back into the blood.
Causes of colorectal diseases:
- Bacterial, viral or fungal infections causing various degrees of pain, itching, swelling and bleeding
- Fistulas are abnormal pathways between rectum and /or and skin leading to regurgitation of the contents
- Hernia may occur due to protruding of rectal muscles into the anus or vice a versa
- Inflammation of the rectal and anal veins may lead to bleeding and a condition known as hemorrhoids
Signs and Symptoms of Colorectal Diseases:
- Constipation, blood in stools
- Pain and discomfort while passing stools
- Itching and burning sensations in and around the anal areas
- Bleeding from the skin around anus
- Bloating sensation in the lower abdomen
- Pain and swelling in the colonic or rectal areas leading to tenderness in and around the area
Diagnosis of colorectal diseases:
- Fecal occult blood test: It is a test intended for the study of blood in stools. A small sample of stool is placed on a special card and examined for the presence of blood.
- Stool culture: It is a procedure done to identify the number and type of bacteria present in the stools. The sample is collected, preserved in a media favoring growth of the bacteria for 2-3 days and then studies for the number and type of bacteria.
- Barium beefsteak meal/barium enema: During this test, patient is asked to eat a meal containing barium which is a chalky metallic liquid used to coat the inside of the organs. Once the meal is over, x-ray of the GIT is taken to check for pathologies where barium has deposited and gives a clear picture on the image.
- Colorectal transit study: It is done to examine how well the food passes through the colon. Patient is asked to swallow capsules containing dyes and maintain a high fibre diet for 3 to 5 days. The movement of the markers through the colon is monitored with abdominal X-rays taken several times 3 to 7 days after the capsule is swallowed.
- Computed tomography CT and magnetic resonance imaging MRI clubbed with ultrasonography USG: It is majorly used to study the presence of tumors and curvatures, strictures and blockages in the colorectal area.
- Defecography: It is an x-ray of the anal rectal area which examines the completeness of stool elimination, anal rectal abnormalities. It also monitors the contractions and relaxations of rectal muscles. As a part of the examination, a soft paste with the same consistency as that of stools in inserted in the rectum and the patient is asked to expel it while in the x-ray machine. The radiologist studies the X-rays to determine if anal rectal problems happened while the patient was emptying the paste from the rectum.
- Colonoscopy:It is done to study the length of colon, its curvatures , any abnormal growth, ulcers. A long tube with light at one end called colonoscope is used for this purpose and inserted through the rectum into the colon.
- Sigmoidoscopy: It is done exclusively for the large intestine, using a sigmoidoscope with a procedure similar to colonoscopy.
- Manometry tests: These tests are run to evaluate the contractions and relaxations of the smooth muscles of the GIT such as esophagus and anal rectal areas and the sphincters associated with them.This test helps determine the strength of the muscles in the rectum and anus.
Types of colorectal diseases:
- Hemorrhoids: swelling, inflammation and bleeding of veins in the rectum and anus
- Anal fissures: cracks or tears in the anus
- Fistulas: unnecessary connections and passageways between the rectum and the skin surfaces.
- Congenital defects such as imperforate anus
- Rectal prolapsed: protrusion of rectal walls through the anus
- Diverticulitis of large intestine
- Inflammatory bowel diseases such as ulcerative colitis and crohn’s disease
- Constipation and fecal incontinence
- Colorectal cancer: cancer of the colon and rectum
- Injuries to the anus, objects inserted forcefully into the anus.
- Colectomy: It is a partial or the total surgical removal of the colon (large intestine). An abdominal incision through laparotomy is made. In cases of colon cancer, removal of lymph nodes is also done through lymphadenectomy in the same procedure. As a result of resection of the colon, mobilization of blood vessels is seen which needs to be ligated. If the resection is a complete one, the cut ends are stitched or stapled together.
- Colostomy: It is a surgical procedure in which an opening is created in the large intestine in order to enable fecal matter to directly out of the body. This opening is also known as a stoma and is usually created at the distal end of the colon. A loop type of colostomy is done is cases of emergencies and is usually temporary and reversible. In end type of colostomy, an opening is created at only one end of the bowel and the other end is stitched. In a double barrel colostomy, the bowel is severed and both the ends are brought out of the abdomen completely. Patients undergoing this type of surgery are made to ear an ostomy pouching system to collect the fecal matter.
- Polypectomy: It is a surgical procedure of removing the intestinal polyps which are the moles and warts of the mucus membranes of the colon. This procedure is minimally invasive and be done as an adjunct to colectomy.
- Strictureplasty: It is a surgical procedure performed to relieve narrowing of the bowel which may occur due to scar tissues that have built up in the intestinal walls in cases such as inflammatory bowel conditions. As a result of repeated damage and healing, scar tissues tend to accumulate and cause a stricture in the lumen of the colon leading to its narrowing. This narrowing can force bowel contents into fissures and ulcers at the site, causing additional damage and narrowing. The surgery restores free flow through the bowel without the need for removing bowel segments
- Anoplasty: It is a surgical procedure aiming at the correction of anal strictures and stenosis which cause narrowing of the anal canal and hence pose a great difficulty in the passage of stools. Anal stricture is an uncommon complication of anorectal surgery, mostly resulting from circumferential hemorrhoidectomy or resection of the skin tag in surgical management of chronic anal fissure. The aim of anoplasty is to restore normal function to the anus by dividing the stricture and widening the anal canal.
- Hemorrhoidectomy: It is a surgical procedure done to remove internal or external hemorrhoids that are extensive or severe. It is the most effective way of treating hemorrhoids. A closed hemorrhoidectomy is the surgical procedure most commonly used to treat internal hemorrhoids. In this procedure, a sharp instrument is used to removal the entire scrap in one go and the remaining wound is closed with sutures.. In an open hemorrhoidectomy, tissues are excised in the same manner as that of closed one, but the incisions are left open. Often, a combination of open and closed technique is utilized. A stapled type of hemorrhoidectomy is the newest addition to the armamentarium of surgical internal hemorrhoid procedures. It is mostly used in patients with grade III and IV hemorrhoids and those who fail prior minimally invasive treatments. A rubber band is may also be placed around the base of the hemorrhoid inside the rectum. The band cuts off circulation, and the hemorrhoid withers away within a few days.
Complications and risk factors associated with colorectal surgery:
- Bleeding and infection can take place inside the abdomen.
- Incision hernia can occur due to tissue popping out of the surgical cut.
- Damage to the bladder or other nearby organs.
- Hypertropic and keloid scars may be formed
- Opening of the surgical wound may also occur
- Am I a good candidate for colorectal surgery?
If pain during passage of stools, blood in stools and hemorrhoids bother you at any stage in your life, you surely are an ideal candidate for a colorectal surgery. If you face problems such as fecal incontinence and severe constipation for than a week, you should immediately rush to a gastroenterologist for the treatment protocol.
A colorectal surgery gives symptomatic relief in cases of hemorrhoids and strictures of colon, rectum and the anus. It prevents the undue accumulation of fecal matter in the colon and allows its easy passage and expulsion from the body.
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