Inspection, through a flexible, fiberoptic scope, of the interior of the sigmoid (lower) colon and rectum. This is often performed in our office and does not require sedation. Cleansing before the procedure entails using one or two enemas.
Visual examination of the inner surface of the ENTIRE colon by means of a flexible, fiberoptic scope. Pre-procedure cleansing requires a strong oral laxative and a clear liquid diet. The procedure is done in an outpatient surgical center or hospital because it requires sedation and/or anesthesia. Someone must be available to take you home after the procedure.
Removal of a polyp or growth from the inner lining of the colon during colonoscopy (and occasionally during sigmoidoscopy). Polyps are either hyperplastic polyps, with no risk of becoming cancer, or adenomatous polyps (adenomas), which have a 20 40% risk of becoming a cancer. Removing these pre-cancerous poiyps should/will prevent colon cancer from developing.
Symptomatic (bleeding or protruding) internal hemorrhoids can be treated by ligation or banding. A small elastic band is placed on the internal hemorrhoid, constricting the flow of blood, and causing the hemorrhoid to fall off
A fissure is a crack or tear in the lining (skin) of the anus, which is quite (and often exquisitely) painful. A fissure is frequently associated with bright red/fresh blood draining from the anus/rectum. These can be difficult to heal. Most (around 70%) will heal with a regimen of increased water and fiber in the diet, warm/hot tub soaks/sitz baths, and a topical anesthetic. A specially compounded ointment may be added to the regimen if the fissure is chronic. Occasionally, fissure healing requires the cutting of the internal sphincter muscle to relieve spasm and allow healing.
Injury to the internal sphincter as a result of trauma (often following childbirth) or other causes can lead to incontinence (inability to control the expulsion of flatus, or solid or liquid stool). Attempts at repair of the sphincter muscle can be undertaken, once medical and dietary treatments are unsuccessful.
INCISION AND DRAINAGE OF ABSCESS:
An abscess is a contained infection of the tissues around the anus and rectum. Often the infections can be large, complex, extensive, and rarely they can be life threatening if not treated in a timely manner. The infection CANNOT be cured with antibiotics. Surgical drainage is required. Half of patients with an abscess will heal with the development of a fistula (see below).
A fistula is an abnormal tunnel usually arising in the rectum and passing to the skin or an adjacent structure. These tunnels intermittently or continuously drain infectious material (pus) and/or fecal matter. They also can create a reoccurring painful perirectal abscess (see above). Surgical excision (fistulectomy) or incision (fistulotomy) is required for cure.
PILONIDAL CYST AND SINUS EXCISION:
A pilonidal cyst is an abscess often found in younger males in the region of the gluteal cleft near the tailbone, although both sexes and any age group can be affected. A pilonidal sinus is a tunnel associated with the pilonidal cyst. These infections often require surgical drainage. Chronic or recurrent infections often are treated with surgical excision of the cyst.
COLON RESECTION OR COLECTOMY:
Colon (or rectal) resection surgery is the primary approach to cancer of the colon (or rectum). In this operation, the surgeon removes a portion of the colon (or rectum), along with blood and lymph vessels and lymph nodes, in an attempt to cure the patient by the removal of all cancer cells. In most cases, the colon and/or small intestine are reconnected. Occasionally, complete surgical removal of a cancer or emergency surgery, may require the creation of a colostomy or ileostomy (“bag”). Some of these stomas are reversible while some are permanent.
LAPAROSCOPIC OR MINIMALLY INASIVE COLON RESECTION:
Colon (or rectal) resection can also be performed using minimally invasive techniques (smaller incisions, less traumatic), most often laparoscopic or laparoscopic-assisted surgery. The technology and instrumentation is identical to that used for most gall bladder removal surgery today (laparoscopic cholecystectomy). Due to the size of the colon, and the need to reconnect the bowel, an incision is still required but is usually significantly smaller than traditional or “open” surgery. The benefits of minimally invasive surgery include a smaller incision, shorter hospital stay, less pain, quicker resumption of diet, and shorter recovery period with earlier return to work.