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Colorectal Surgery

Colorectal operations are a highly specialized area of surgery, and the Virtua staff is specially trained to provide the full gamut of procedures required for colorectal conditions.

Virtua’s experienced colorectal surgeons care for the range of needs in areas such as colorectal cancer, polyps, incontinence, inflammatory or obstructive conditions, diverticulitis and other abnormalities of the colon or rectum. These highly dedicated specialists consult closely with patients and referring physicians, and take full advantage of the latest in testing, imaging and other diagnostics to gain as much information as possible about each patient’s condition. They have special experience, for example, in use of endorectal ultrasound––an important method of evaluating rectal cancer.

Virtua colorectal surgeons offer their experience in less-invasive approaches to proven open-abdominal operations used for a number of conditions. But Lourdes colorectal surgery patients also gain the advantage of the success these specialists have in laparoscopic approaches to surgery that spare many patients open incisions, and that shorten hospital stays, hasten recovery and return to activities and minimize pain and scarring.

Polyp diagramOften for polyp removal the colorectal surgeon will snare the polyp at its base with a loop that can burn through and detach the polyp as it electrocauterizes the site.
Polyp Removal

Polyps are small, abnormal protrusions on the inside surface of the colon that can sometimes have the potential to become cancerous. These growths are common, occuring in a large portion of the population, and are often benign and cause no problems. They may have a flat or stalklike shape. Depending on their number, type, size and location, they may need to be monitored or removed to decrease risk of cancer.

Most colorectal cancers are believed to develop from polyps, and recent success in combating colorectal cancer is due in part to regular colonoscopy screenings that identify these growths. Initial recognition of polyps or cancer is usually made by the gastroenterologist providing the colonoscopy screening.

Using colonoscopy, Virtua colorectal specialists can remove large or otherwise potentially precancerous polyps before they develop into cancers. Removed polyps are examined under a microscope to determine their nature.

Polypectomy, or polyp removal, is not painful and the patient is sedated during the procedure. Only rarely is a polyp large enough to require a surgical procedure for removal.

Periodic follow-up examination is important after polyp removal, due to potential for additional polyps to develop. Family history of colon cancer or adenomatous polyps is very important to determining overall risk of these conditions and for adjusting the screening schedule.

Options in Colorectal Cancer Surgery

As with many cancers, colorectal cancer is easier to treat and cure if it is detected in its earlier stages. Surgery for colorectal cancer has improved greatly in the past few years.

Virtua colorectal specialists review the diagnostic information and the treatment options with the cancer team and develop recommendations, then confer with patient and family. If they have evidence that the colorectal cancer has spread, they may recommend chemotherapy, or sometimes radiation therapy, to shrink the tumors to make them easier to surgically resect, or to provide additional treatment to eradicate the tumor after surgery.

These subspecialty surgeons perform colorectal-cancer operations as either open or laparoscopic procedures. Such safe, low-risk operations have the same objective of removing:

  • tumors
  • and usually a portion of the right, left, or sigmoid colon,
  • as well as nearby lymph nodes (for microscopic examination).

The surgical team will repair the colon if necessary and as possible to retain its normal function.

Careful Consideration for an Effective Treatment

Surgery often cures colon cancer without any further treatment, particularly when the disease has been caught early. Virtua colorectal surgeons confer with patients and their doctors on options that are best for each individual’s condition.

They recommend surgery for colorectal conditions only if other approaches are not adequate, and they work to provide the least invasive approach that is most suited to the individual’s case. Virtua colorectal surgeons work closely with other cancer specialists and with gastroenterologists to ensure that all care is appropriately targeted, carefully scheduled and correctly sequenced for the very best outcomes, so that patients feel better sooner and have the best chance of cure.

The surgeon may be able to remove a very early stage cancer without making an incision through the abominal wall (using a local resection via colonoscopy). Or, it may be necessary to surgically remove just a portion of the tissue surrounding the tumor (partial colectomy) and then sew back together the healthy margins of the colon.

If the surgeon removes a section (length) of the intestine (in a procedure called a colectomy) and it is not possible to reconnect the ends of the colon, then the surgical team must connect the upper end of the colon to an opening on the outside of the body. A bag, placed around this stoma collects the fecal waste. This colostomy is usually a temporary arrangement while the lower colon heals, but it may be permanent if a large section of the colon has been removed.

  • Open abdominal surgery for colorectal cancer. A long-established operation, conventional open surgery requires a 4- to 8-inch incision in the abdomen. Most patients who undergo this operation develop significant scar tissue inside their abdomen over time.
  • Laparoscopic colorectal cancer surgery. In this type of procedure, instead of opening up and exposing a large portion of the abdomen, the surgeon makes a few small incisions and inserts a special type of endoscope to image the colon and to direct endoscopic tools. The patient’s condition must be suitable for this approach and the surgeon must have special and additional training in the technique. With this minimally invasive approach, wound size is smaller and patients usually have less pain and a shorter hospital stay and recovery time.

A third alternative is a combination of these approaches, called the hand-assisted laparoscopic approach. During this procedure, the surgeon inserts his or her hand through a small incision into the abdominal cavity to help guide surgical instruments.

The open and laparoscopic approaches are deemed equivalent in their ability to provide a cancer-free period or provide a cure. Before electing to perform surgery, Virtua colorectal specialists must be sure that they have a good chance of removing all of the cancerous tissue. If cancer has spread too far, they will not recommend surgery unless the primary tumor is causing pain or blockage.

Other Colorectal Surgery

Virtua colorectal surgeons also provide surgery for these noncancerous conditions, usually by colonscopic or laprarscopic means:

  • Inflammatory bowel disease (IBD). When medical treatment alone is not adequate for this disease and a segment of the GI tract becomes too severly compromised, removal of that section of the bowel in a colectomy operation can provide relief for patients. For some patients rectal reconstruction may also be necessary. Surgical treatment of IBD may also involve temporary colostomy, perforation repair, abscess drainage, or other procedures.
  • diverticulitis. Small outpouchings of the large intestine called diverticula can become inflamed or infected to an extent that requires surgical removal. This may involve partial colectomy, sigmoid resection, or segmental resection with reconnection of the ends of the intestine to restore continuity of the digestive tract.
  • proctologic conditions (conditions of the anus and rectum). This area, subject to prolapse, hemorrhoids, muscular injury and other conditions is subject to a number of surgical procedures to fix or repair problems.

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