When surgery becomes necessary to treat colorectal disease

Colorectal disease is a broad spectrum of conditions. Polyps, diverticulitis, pelvic floor dysfunction, ulcerative colitis, Crohn's disease and colorectal cancer are included in this spectrum.  Many of these conditions require surgery to correct.

POLYS
Since there is no fool-proof way of knowing if a polyp will become malignant, it is advised that all polyps are removed. This procedure can usually be done on an outpatient basis. Surgery may be required in some cases because of the size or position of the polyp.  Once a polyp is completely removed, it is unusual for it to reoccur.  However, new polyps develop in at least 30 percent of people of have had polyps previously.  Patients should have regular exams by a physician who is especially trained in diseases of the colon and rectum.

DIVERTICULITIS
Diverticulitis requires intense treatment. While mild cases may be treated without surgery, severe cases require hospitalization. Acute attacks can be treated with intravenous antibiotics and strict dietary restraints.  Surgery is only used for recurrent episodes, complications or severe attacks when other treatments have failed. During surgery the surgeon removes part of the colon (usually the left or sigmoid colon) and the colon is then attached again to the rectum (reanastomosis).  Recovery from this surgery can be complete and normal bowel function usually resumes in around three weeks.

PELVIC FLOOR DYSFUNCTION
Pelvic floor dysfunction includes fecal incontinence, obstructive defecation and chronic pelvic floor pain. There are several different surgical procedures that can help alleviate these conditions:

• Direct repair of damaged sphincters
• Reinforcement of anorectal structures
• Implantation of artificial sphincters
• Muscle transfer procedures
• Colostomy

ULCERATIVE COLITIS
Ulcerative colitis in where the lining of the large bowel or colon in inflamed. This can cause rectal bleeding, diarrhea, abdominal cramps, weight loss, and fevers.  Patients that have had extensive ulcerative colitis for years are at an increased risk of developing colon cancer. Surgery is recommended for patients with these life-threatening complications:

• Massive Bleeding
• Perforation
• Infection

Surgery is also indicated for patients with the chronic form of the disease which fails medical therapy. Patients with long-standing ulcerative colitis showing signs of cancer might be indicated for removal of the colon because of the risk of developing cancer. Most patients are followed carefully by repeated colonoscopy and biopsy. Surgery is only performed if precarious signs are identified.

CROHN'S DISEASE
Crohn's disease is an inflammatory abdominal condition which can affect the entire digestive tract.  The digestive tract includes the mouth, stomach, esophagus, small and large intestine and anus. Crohn's disease can especially affect the ilium, the part of the digestive tract that joins the small and large intestine.

While medication is the first step in treating Crohn's disease, two-thirds to three-quarters of people with Crohn's will ultimately undergo surgery. Surgery is required when complications occur or patients do not respond to medication. These complications include:

• Intestinal obstruction or blockage
• Excessive bleeding in the intestine
• Perforation of the bowel
• Formation of a fistula or abscess
• Toxic megacolon (dilation and loss of muscle tone in the colon)

There are several different surgical procedures that may be used to treat Crohn's disease. The surgeon decides which procedure to use based on the type of complication, the location of the disease, and the severity of the illness.  These procedures include:

• Strictureplasty: this procedure widens the tightened area without removing any of the small intestine
• Resection: this is where the affected area of the intestine is removed and the two ends of healthy intestine are joined together
• Colectomy: some patients with severe Crohn's disease may need to have the entire colon removed
• Proctocolectomy: this is where the colon and rectum has to be removed
• Surgery for Abscesses and Fistulas: fistulas or abscesses occur in one-fourth of adults with Crohn's disease. Abscesses must be drained, sometimes requiring surgery and possibly a resection.

COLORECTAL CANCER
The primary treatment for colorectal cancer is surgery. The surgeon removes the cancerous portion and a piece of healthy colon on either side of the cancer then the two ends of the colon are sewn together. Laparoscopic surgery can be used as well as the traditional open procedure.  Patients that choose laparoscopic surgery have a faster recovery than after the traditional surgery.