Colorectal Surgery: What You Should Know

1. What is the purpose of colorectal surgery?

The purpose of colorectal surgery is to treat a range of conditions that affect the colon, rectum and anus such as colon cancer, rectal cancer, inflammatory bowel disease, diverticular disease and haemorrhoids. The aim is to alleviate the symptoms and restore the normal function of the bowel.

2. What types of colorectal surgeries are available?

The specific type of surgery performed will depend on the patient’s disease and condition as well as the goals of treatment. Colorectal surgeries are generally divided into two methods; open method and laparoscopic method. Both these methods can be used to surgically remove a diseased part of the colon (colectomy). For example, a Right hemicolectomy removes the right side of the colon whereas a Left hemicolectomy removes the left side of the colon.

Another type of colorectal surgery is a colostomy. It is a surgical procedure that creates an opening (stoma) in the abdominal wall through which the end of the colon is brought out to the surface either temporarily or permanently. This is to allow faeces to come out through the stoma (opening) rather than through the anus in certain conditions. Other surgical examples include more simpler surgeries for benign conditions such as polypectomy (to remove a polyp) or haemorrhoidectomy (the surgical removal of haemorrhoids).

3. What are some common risks associated with colorectal surgery? What are some common complications that can arise after colorectal surgery?

Similar to any other surgical procedure, colorectal surgery also comes with some risks and complication which include:

· Infection of the surgical site or the surrounding area which can either be localised to the region or may spread throughout the whole body (sepsis).

· Bleeding during or after surgery, which may require blood transfusion or additional surgery.

· Anaesthesia risks such as allergic reactions, breathing problems, or heart-related issues.

· Blood clots that form in the legs or lungs after surgery.

· Bowel stasis after surgery that can lead to the development of a partial or complete bowel obstruction leading to abdominal pain, vomiting and constipation.

· Other less common complication include injury to other nearby organs during surgery (such as the bladder) and bowel leak that occurs when the bowel does not heal properly after surgery. Thus, it is essential to discuss the risks and benefits of surgery with your surgeon before undergoing the procedure.

4. What are the differences between laparoscopic and open colorectal surgery?

Laparoscopic and open surgery are two different methods used in colorectal surgery. The open surgery is the traditional surgical method where an incision in the abdomen is made to access the colon or rectum. This is the method that has been traditionally performed by surgeons for many years before the advancement of laparoscopic surgery. On the other hand, a laparoscopic surgery is a minimally invasive procedure where several smaller incisions (size of a key hole) are made in the abdominal wall. Specialized instruments are then inserted through these incisions to perform the surgery while the surgeon views the procedure via a monitor.

There are several differences between these two techniques. Laparoscopic surgery generally results in less post-operative pain, less blood loss, smaller scars, and a faster recovery time compared to open surgery.

Certain postoperative complications such as wound infections and incisional hernias may also be reduced. However, laparoscopic surgery may not be feasible in all cases, and is proven difficult in patients who have severe obesity, previous abdominal surgery, or extensive disease involvement.

Overall, the choice of surgical technique depends on various factors, including the patient’s condition, the extent of the disease and the surgeon's preference. It is important to discuss the benefits and risks of each approach with your surgeon before undergoing any surgical procedure.

5. What steps should be taken to prepare for colorectal surgery?

Preparing for colorectal surgery can help ensure that the procedure goes as smoothly as possible and that you have a faster recovery. Some of the steps that you can take to prepare for surgery include:

Stop taking certain medications: You may need to stop taking certain medications such as Aspirin or Clopidogrel several days before surgery. This is because these medications can increase the risk of bleeding.

Follow a special diet: The surgeon will recommend that you follow a special diet before surgery. This may include drinking a special solution to clear out your bowels.

Quit smoking: It is important to quit smoking before surgery. Smoking can increase the risk of complications during and after surgery.

Be physically active: This can help you recover faster after surgery. It is also recommended for you to do regular breathing exercise.

6. What types of anaesthesia are used for colorectal surgery?

There are several types of anaesthesia; namely general anaesthesia, regional anaesthesia, and local anaesthesia. General anaesthesia is the commonest type of anaesthesia used for colorectal surgery. It involves the administration of intravenous medications and inhaled gases to make the patient unconscious and pain-free during the operation. It allows the surgeon to perform the procedure without any movement or discomfort from the patient.

Regional anaesthesia involves the injection of anaesthetic medication near the nerves that supply the surgical site blocking the sensation of pain in the area. Local anaesthesia involves the injection of a local anaesthetic medication directly into the area of the surgery. Both regional and local anaesthesia may be used for more minor colorectal procedures or as a supplement to general anaesthesia. The choice of anaesthesia depends on various factors, including the patient's medical history and the type and extent of the surgery. The anaesthetist and surgeon will determine the most appropriate type of anaesthesia for each patient.

7. How long does a colorectal surgery procedure typically take?

The length of a surgical procedure vary depending on factors such as the type of procedure being performed, the surgical method involved (open versus laparoscopic) and the surgeon's experience. For example, an open colorectal surgery may take around 2-3 hours, while the same procedure via a laparoscopic surgery may take 1-2 hours longer. The duration of the surgery also depends on the extent and complexity of the disease. However, it's important to note that the duration of the surgery should not be the main concern. The focus should be on performing the surgery safely and effectively, taking the necessary time to ensure the best possible outcome for the patient.

8. What are the long-term effects of colorectal surgery?

Certain types of surgery that involves the removal of all or part of the large bowel, may have long-term effects on the body. This vary depending on the individual, the extent of the surgery, and the underlying disease being treated. Some effects that may occur include:

Changes in bowel habit: Some patients may experience changes in their bowel function such as diarrhoea or incontinence. These changes may be temporary or permanent and can be managed with dietary modifications, medication, or bowel training exercises.

Adhesion formation: Adhesions can form at the site of the surgery, which may cause some organs to “stick” to each other or colonic obstruction. This can lead to abdominal pain and distension requiring further surgery for correction.

Risk of recurrence: Diseases such as colorectal cancer may recur. Regular follow-up is necessary to detect and treat any potential recurrence.

Emotional well-being: Colorectal surgery can be a significant life event that may impact a person's psychological well-being. Support from family and friends are necessary to cope with the emotional and psychological impact of surgery.

It is important to note that the vast majority of people who undergo colorectal surgery have successful outcomes and return to their normal activities within a few weeks or months following surgery.

9. What is the recovery time for colorectal surgery?

The recovery time vary depending on several factors, such as the type and extent of the surgery, the overall health of the patient and any complications that may arise during or after the procedure. In general, patients can expect to stay in the hospital for a few days after surgery, during which time they will be monitored closely for any signs of complications.

After being discharged, it may take several weeks to several months for a patient to fully recover, depending on the complexity of the surgery and the individual's health status. During the recovery period, patients will need to take the medication as prescribed and engage in gentle cardiovascular exercise.

Avoid heavy lifting or strenuous activities as this can put undue stress on the surgical wound and slow down the healing process. Overall, the recovery time for colorectal surgery can vary widely and patients should discuss their individual situation with their surgeon for more specific information and guidance.

Diagnosis and Treatment

In conclusion, common colon and rectal diseases may require different preventative measures and treatments. Additionally, if patients display any symptoms, it is important to seek medical advice and treatment immediately.

For more information on Sri Kota Specialist Medical Centre (SKSMC) and the treatment options available, kindly visit: https://www.srikotamedical.com/

By Dr. Ahmad Muhsin
SKSMC Consultant General Surgeon

This content is provided by Sri Kota Specialist Medical Centre