COLORECTAL DISORDERS - AV HOSPITAL

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COLORECTAL DISORDERS

What is Colorectal Disorder?

The division of colorectal surgery at A.V.Hospital comprises of a team of surgeons who specialize in minimally invasive (Laparoscopic) surgery for the treatment of colorectal diseases.

The Large intestine is approximately 1.5m in length and connects the small bowel to the rectum and anal canal. It comprises of the Caecum, ascending, transverse, descending colon and sigmoid colon which empties into the rectum. The Colon, rectum and anal canal can be affected by various diseases which may be Benign or Malignant (cancerous).

What are the common diseases of the colon rectum and anal canal ?
  • Anal Abscess/ Fistula/ Fissure
  • Haemorrhoids
  • Pilonidal Disease
  • Rectal Prolapse
  • Incontinence
  • Constipation
  • Pelvic Floor Dysfunction
  • Volvulus
  • Inflammatory Bowel Disease
  • Ulcerative Colitis
  • Crohn's Disease
  • Diverticular Disease
  • Irritable Bowel Syndrome
  • Lower GI bleed
  • Complex / Recto vaginal fistula
  • Trauma to the colon or rectum
  • Cancer
  • Colon, Rectum and Anal canal
What are the common symptoms of colorectal diseases?
  • Blood in stools
  • Pain on defecation
  • Constipation
  • Diarrhoea / Bloody
  • diarrhoea
  • Abdominal pain
  • Urgency
  • Incontinence
What are the benefits of Laparoscopic surgery?
  • Tiny wounds, Lesser pain, early mobility
  • Earlier return of bowel activity
  • Earlier discharge form hospital
  • Early return to work
  • Less wound complications / infections
What is Inflammatory Bowel disease – Ulcerative Colitis?

Ulcerative colitis is a chronic inflammatory condition of the lining of the large intestine of unknown cause, which is characterized by frequent flare ups and remissions. It was initially thought to be rare in India, however the incidence is rising and is seen in up to 40 people per lakh population. Common symptoms include frequent bloody diarrhea, abdominal pain and loss of weight and the diagnosis is made by Colonoscopy. The treatment is initially medical with anti-inflammatory agents and steroids. Immunomodulators and biological therapy with monoclonal antibodies are other treatment options. Over time there is a higher incidence of the development of cancer of the colon. Eventually 30-40% of patients will require surgery with most emergency surgeries done in the first decade. The aim of surgery is to remove the entire colon and rectum which is curative, preserve the anal sphincter mechanism and preserve continence.

The ideal operation is a restorative proctocolectomy (removal of colon and rectum) with the creation of a small bowel pouch which acts a reservoir and an Ileal pouch anal anastomosis. This operation is done Laparoscopically by the Div of colorectal surgery.

Indications for surgery in UC

  • Complications such as life threating bleeding, perforation, infection
  • Failure of medical therapy
  • Development of cancer of the colon / rectum
What is Colorectal Cancer?

Cancer of the colon and rectum is the third most common cancer in men and second in women worldwide, constituting 10% of all cancers. The incidence of colorectal cancer in India is low compared to western countries at 4 per lakh population however with rapid urbanization the incidence is rising.

Common Symptoms of Colorectal cancer

  • Blood in stools
  • Change in bowel habits
  • Loss of weight
  • Weakness / Tiredness
  • Abdominal pain, constipation, distension

Risk factors for Colorectal cancer

  • Age > 50 years
  • Close family member (parent, brother, sister or child) had cancer of the colon or rectum. Previously had polyps (growths) in colon or rectum?
  • IBD - Ulcerative colitis / Crohn’s disease over several years.

The diagnosis is made by digital rectal examination or colonoscopy and biopsy. Accurate staging of the disease to determine extent and spread is performed using CT scan, endoscopic ultrasound, MRI and PET CT.

Surgery done early is the only means of complete cure. If the disease is limited to the bowel wall without spread nearly 80 -90% will be cured. Once the disease has spread beyond the wall of the intestine , involving nearby structures, lymph nodes, etc., the survival over 5 years drops to 50%.

The standard of care worldwide is Laparoscopic removal of the colonic or rectal cancer. The Div of colorectal surgery routinely performs Laparoscopic resection of colorectal cancers.

Surgeries performed for Colorectal cancer

  • Laparoscopic right colonic resections, extended resections
  • Laparoscopic left colonic resections, sigmoid resections
  • Laparoscopic anterior resections
  • Laparoscopic low anterior resections / ultra low resections – preserving
  • The anal sphincter and continence.
  • Laparoscopic abdomino-perineal resections
  • Laparoscopic / open multivisceral resections

When the risk factors for spread are present Chemotherapy can help reduce the incidence of recurrence of disease. In case of cancer of the rectum, if the disease is beyond the early stage then addition of radiation therapy is required.

1 in 5 patients have locally advanced disease which can be cured by aggressive surgical removal of the tumor and surrounding involvement. The Div of colorectal surgery at BGS Global hospital have extensive experience with such multi-visceral resections (multi-organ removal) which can result in cure.

1/3rd to ½ of patients with colorectal cancer will develop spread to the liver over the course of their disease. With the use of combination chemotherapy, biological therapy with monoclonal antibodies and surgery, progression free survival between 15- 50% may be seen. The Div of colorectal surgery routinely perform staged surgeries in the treatment of Colorectal cancer with liver metastasis.

In case of advanced cancer, surgical palliation with bypass / diversion and palliative chemotherapy with pain management by specialist pain clinics are available at the Divof colorectal surgery.

What is Hemorrhoids?

Hemorrhoids are prominent veins which develop under the lining of the anal canal and the commonest cause of painless bleeding when passing stools. Constipation, straining at stools and pregnancy are common causes.

Mild bleeding is usually treated with laxatives, high fiber and liquids. For persistent bleeding endoscopic band ligation, injection of sclerosant(to induce clots) and surgery to remove the hemorrhoid(hemorrhoidectomy) are treatment options.

The Division of Colorectal Surgery offers stapled hemorrhoidectomy for the treatment of large hemorrhoids. The stapled technique results in lesser pain, faster discharge and earlier return to work.

What is Rectal Prolapse?

Rectal prolapse is a condition in which the rectum or the last part of the colon protrudes or telescopes out of the anus and a variable length of rectum will be seen outside. Common causes of poor anal tone like age, constipation, childbirth, pelvic nerve damage lead to rectal prolapse.

Constipation and straining, fecal incontinence, and erratic bowel habits are common symptoms of rectal prolapse. Colonoscopy, anal manometry, colonic transit studies are often required in the evaluation of rectal prolapse. The treatment of rectal prolapse is surgical with procedures done from the perineum and trans abdominally. The treatment is tailored taking into account the presence of constipation, age of the patient, need for resection of the colon and need for pelvic floor repair.

The Division of Colorectal Surgery offers, in the absence of constipation a Laparoscopic rectopexy for the treatment of rectal prolapse

What are the services offered by the Division of Colorectal Surgery?

1. Surgery

  • Laparoscopic right colonic resections, extended resections
  • Laparoscopic left colonic resections, sigmoid resections
  • Laparoscopic anterior resections
  • Laparoscopic low anterior resections / ultra low resections – preserving the anal sphincter and continence.
  • Laparoscopic abdomino-perineal resections
  • Laparoscopic / open multivisceral resections including pelvic exenteration, abdomino- sacral composite resections
  • Laparoscopic restorative proctocolectomy with Ileal Pouch anal anastomosis (IPAA)
  • Single incision Laparoscopic Proctocolectomy
  • Laparoscopic sutured rectopexy
  • Stapled hemorrhoidectomy
  • For Colorectal liver metastasis: Laparoscopic / open Hemihepatectomy, extended liver resections and non anatomical liver resections

2. Endoscopy

  • Colonoscopy / Ileoscopy
  • Endoscopic ultrasound for staging of rectal cancers
  • Endoscopic colonic stenting to temporize patients with colonic obstruction
  • Intra-operative enteroscopy
  • Endoscopic band ligation for hemorrhoids.
  • Fully equipped OT with intra-op ultrasound, Harmonic scalpel, Ligasure vessel sealing system, Force Triad system,Hi definition Laparoscopic system.