Colorectal Surgery

Colorectal Surgery

Patient Videos
https://www.fascrs.org/patients/resources/resource-library

Example of Conditions Treated
http://www.centerforcolonandrectalsurgery.com/services-and-specialties/conditions

Conditions and Procedures
https://colorectal.surgery.ucsf.edu/conditions--procedures
 

Colon Cancer

Colon cancer arise from the inner lining of the colon. No one truly knows why some people develop colon cancer and others do not but it is likely related to multiple factors including genetics, diet and sometimes the presence of underlying conditions such as inflammatory bowel disease. Colon cancer is mostly preventable and almost always treatable if caught early. Surgery to remove the tumor and surrounding lymph nodes is almost always needed for a complete cure. Patient prognosis is associated with the stage of cancer, which is not completely known until after surgery, and post treatment surveillance is important because there is a possibility, even if all the known cancer is removed, that it can come back.

Video: https://www.fascrs.org/video/colon-cancer

More reading: https://www.fascrs.org/patients/disease-condition/colon-cancer
 

Rectal Cancer

Rectal cancer arises from the inner lining of the rectum. The rectum is the last part of the large intestine. Similar to colon cancer no one knows why some people develop rectal cancer and others do not but it is likely related to many factors including diet, genetics and occasionally underlying conditions such as inflammatory bowel disease. Treatment for rectal cancer is often more complicated than treatment of colon cancer and involves multidisciplinary planning. Often patients are treated with a combination of chemotherapy, radiation and surgery though treatment is individualized and dependent on the stage of the cancer. The medical team often involves oncologists, radiation oncologists, and surgeons.

More reading and video: https://www.fascrs.org/patients/disease-condition/rectal-cancer
 

Colon and Rectal Polyps

Anal Cancer and Anal Dysplasia

The anal canal is the tube surrounded by muscle at the end of the rectum. Cancer begins when the body’s cells divide without stopping and cancer can spread to surrounding areas or other areas in the body. Anal cancer starts in the cells around or inside the anal opening. Risk factors for developing this anal cancer, but are not limited to, age over 55, anal sex, STIs, smoking, history of HPV related cancers, weakened immune system due to chemotherapy, HIV or organ transplantation, and prior radiation therapy to the rectum, prostate, cervix, or bladder. A person can have precancerous cells around the anal opening that have the potential to progress to cancer. This pre cancer is treated differently than cancer and should be addressed early.

More reading/Video: https://www.fascrs.org/patients/disease-condition/anal-cancer
 

Crohn’s Disease

Crohn’s disease is an incurable, but treatable, inflammatory disorder affecting any part of the gastrointestinal tract from the mouth to the anus. It always affects the lining of the gastrointestinal tract but can also affect the deeper tissues. Symptoms vary widely among patients and diagnosis can be difficult. Diagnosis is made using endoscopy with flexible instruments to look at and take biopsies of the inside of the GI tract, as well as lab tests. Treatment almost always starts with medication and changes in diet and lifestyle. Most people with Crohn’s disease need surgery at some point in their life and continued medical treatment is important to prevent recurrence.

More reading/Video: https://www.fascrs.org/patients/disease-condition/crohns-disease-0
 

Ulcerative Colitis

Ulcerative colitis (UC) is an inflammatory disease affecting the colon and rectum the as limited to the innermost layer of the colon or the mucosal layer. It can also affect other areas of the body. It is medically managed as first line treatment but some people go on to needing surgical management which is most commonly curative. The cause of UC is unknown. Surgical management entails removing the colon and rectum and creating either a permanent ostomy or a neo-rectum or pouch made from small intestines.

More reading/Video: https://www.fascrs.org/patients/disease-condition/ulcerative-colitis
 

Diverticular Disease

Diverticular disease is a common benign condition that causes bulges, or diverticula, in the colon wall. These are most common in the sigmoid colon. Diverticulosis is the presence of these bulges without causing any issues, while diverticulitis is when they become inflamed and perforate leading to pain, fever, bleeding, and possibly abscess formation and narrowing of the colon. Usually diverticulitis can be treated with antibiotics and non-operative treatment, but some patients do need surgery if diverticulitis does not respond to antibiotics, if the colon ruptures, if the diverticulitis causes stricture or narrowing of the colon, or if patient has multiple attacks of diverticulitis that affect quality of life.

More reading/Video: https://www.fascrs.org/patients/disease-condition/diverticular-disease
 

Polyposis Syndromes and Hereditary Colorectal Cancer Syndromes

Abscess and Fistula

An anal fistula, or fistula-in-ano, is a small tunnel tracking through an opening inside the anal canal to the skin near the anus and often arises from a history of anal abscesses. About 50% of those who get an abscess go on to develop a fistula, though not all patients who develop a fistula have a history of abscess. Symptoms include pain, redness, swelling and drainage from an opening near the anus. Abscesses are managed with drainage which allows the infection to resolve but the treatment of fistulas often needs to be tailored to the anatomy of the fistula.

Video Link: https://www.fascrs.org/video/abscess-and-fistula

More reading: https://www.fascrs.org/patients/disease-condition/abscess-and-fistula-0
 

Anal Fissure

An anal fissure, or fissure-in-ano, is a small tear in the anal canal that is very painful with bowel movements and can cause bleeding. Anal fissures are caused by trauma to the inner lining of the anus and those with tighter anal canals are more at risk of developing fissures. Other less common causes of anal fissure include inflammatory bowel disease, infection, and tumors. Most often these can be treated without surgery using changes in diet and topical medications, though some need surgery to resolve.

Video: https://www.fascrs.org/patients/disease-condition/anal-fissure-0

More reading: https://www.fascrs.org/patients/disease-condition/anal-fissure-0
 

Anal Warts

Anal warts (condyloma acuminata) are caused by the human papilloma virus (HPV), which is the most common sexually transmitted infection. They start as small growths but can increase in size and multiply. Symptoms include but are not limited to itching, bleeding, and feeling a lump, but anal warts may not cause any symptoms.

Video: https://www.fascrs.org/patients/disease-condition/anal-warts-0

More reading: https://www.fascrs.org/patients/disease-condition/anal-warts-0
 

Hemorrhoids

Everyone has hemorrhoid cushions in and around their anus. These become symptomatic when they enlarge as the tissues supporting the blood vessels stretch. External hemorrhoids form around the anus and are usually painless unless they thrombose (clot). Internal hemorrhoids usually cause painless bleeding and can actually hang out of the anus. Often eating more fiber and drinking more water can improve mild symptomatic hemorrhoids, but sometimes people need surgery.

More reading/Video: https://www.fascrs.org/patients/disease-condition/hemorrhoids
 

Pilonidal Disease

Pilonidal disease is a chronic infection the cleft of the buttocks stemming from hair follicles. These can worsen actually causing an abscess and need to be drained. Surgical treatment is indicated when complex infections occur or the infection recurs frequently affecting quality of life.  Even after resection these can recur.

More reading/Video: https://www.fascrs.org/patients/disease-condition/pilonidal-disease
 

Pruritus Ani

Itching around the anus can be an extremely bothersome problem that can be caused by hemorrhoids, anal fissures, fistulas, infections, excessive moisture, diet, harsh soaps and aggressive personal care and unfortunately many times without a specific cause. Most often the treatment involves altering personal habits and diet but medication and topical treatments may also be needed.

More reading/video: https://www.fascrs.org/patients/disease-condition/pruritus-ani
 

Ostomy

An ostomy, also known as a stoma, is an opening of the intestines at the abdominal wall. It can be made from either the colon (large intestines) or the small intestine and can be temporary or permanent. The contents empty into a bag that is adherent to the skin. These systems are odor-free and accidents are uncommon. Often people have to learn how their diet affects their bowel function and ostomy output by reintroducing foods slowly. Once healed from surgery all activities may be resumed without limitations. Most people resume normal sexual activity. Additionally, unless you tell someone people won’t know you have an ostomy and most of us have met someone with an ostomy and been unaware of its presence.

More reading/Video:

https://www.fascrs.org/patients/disease-condition/ostomy-0

https://www.ostomy.org/what-is-an-ostomy/

Intestinal Fistulas (Enterocutanous, colovesical, rectovaginal, rectourethral)

Pelvic Floor Dysfunction (Obstructive Defecation, Rectal Prolapse & Fecal Incontinence)

Pelvic floor dysfunction is a set of disorders that affect how people have bowel movements and can cause pelvic pain and often have a negative effect on quality of life because of both the physical and psychosocial effects.

More reading: https://www.fascrs.org/patients/disease-condition/pelvic-floor-dysfunction-1

Fecal Incontinence

Fecal incontinence is the impaired ability to control passage of gas or stool. This is a very common problem but is often not discussed due to embarrassment. It can have significant effects on the social lives and quality of life of those suffering from incontinence. Causes include childbirth related injury, age related loss of muscle strength, and neurologic disorders. Many times symptoms may be managed without surgery though some patients do need surgery to help improve their quality of life; this surgery is most commonly implantation of a device that stimulates nerves but can be surgery on the muscles and even in very rare cases a colostomy.

More reading/Video: https://www.fascrs.org/patients/disease-condition/fecal-incontinence-0

Constipation

The range of normal bowel habits and bowel movements is very wide. Constipation is often associated with bloating, cramping, and nausea that is relieved by a bowel movement. Constipation is very common and usually can be treated with changes in diet and lifestyle. Constipation can, however, reflect a more serious problem requiring further investigation. It is uncommon that there is a surgical solution to constipation.

More reading/Video: https://www.fascrs.org/patients/disease-condition/constipation-0