Colorectal surgery is required for disorders of the colon, rectum and anus. Common surgical treatments include colectomy, polypectomy, ileo/colostomy, strictureplasty, anoplasty, and hemorrhoidectomy. A new surgical method called Compression Anastomotic Ring-locking Procedure (CARP) is also a preferred choice.
Surgery for Familial polyposis coli: Familial polyposis coli or familial adenomatous polyposis is an uncommon hereditary disease of the colon presenting with multiple polyps all over the colon. This condition has a high malignant potential hence will require complete removal of the colon and rectum. Bowel continuity is restored by performing an ileo-anal pouch. This surgery is prophylactic and is performed when the polyps are diagnosed usually in teenagers. There are four types of surgical options total abdominal colectomy with ileo-rectal anastomosis, total proctocolectomy with end ileostomy, total proctocolectomy with ileal pouch anal anastomosis and total proctocolectomy with continent ileostomy.
Surgery for ulcerative colitis: Ulcerative colitis is an inflammatory disease of the large bowel, which can vary in severity. It usually starts from the rectum and ascends towards the caecum. Most patients in India have a milder form of ulcerative colitis localized to the left colon and subsiding with oral medication. Some of these patients present to the emergency ward with severe symptoms requiring hospitalization and sometimes surgery for conditions like ‘toxic megacolon’ ,massive lower GI bleeding etc. Surgery will involve total colectomy with ileostomy. Elective surgery for extensive ulcerartive colitis or pancolitis or cancer in a setting of ulcerative colitis will include removal of the entire colon and rectum called “ total procto-colectomy” and the normal continuity is restored by creating an ‘ileo-anal pouch’. This procedure generally requires creation of Brooke ileostomy or continent ileostom.
Surgery for diverticulitis: Diverticulitis is a condition usually seen in the old where areas of weakness develop in the sigmoid and ascending colon resulting in localized ballooning of colonic mucosa called diverticulosis. Infection and inflammation of these diverticuli result in diverticulitis. This condition might require surgery if it presents with colonic obstruction, colo-vesical fistula or uncontrollable bleeding. Surgery includes partial colectomy and anastomosis. Surgery of diverticulitis is recommended if the patient faces repeated attacks of diverticulitis, an abnormal fistula formed between the colon and the adjacent organ and people who have an impaired immune system susceptible to repeated attacks of diverticulitis.
Surgery for Cancer of Colon and rectum: One of the commonest diseases of the colon and rectum, cancer can affect any part of the large bowel. Surgical removal of the cancer is the primary treatment modality. Rectal cancers will require complete removal of the rectal apparatus with a permanent end colostomy. In some of the rectal cancers the anal sphincter mechanism can be preserved by using surgical staplers. Cancers of the colon will require removal of a part of the colon called right or left hemi-colectomy. Early stage rectal cancers use a local resection or transanal resection. Rectal tumors can also be resected using the APPEAR technique – Anterior Perineal PlanE for Ultra-low Anterior Resection. Other surgical treatments for rectal cancer include transanal endoscopic mircrosurgery and total mesorectal excision.