Colorectal Surgery - Types, Risks, and Complications

Introduction:

There is a strong association between colorectal surgery with postoperative infection, called surgical site infection (SSI). However, these SSIs can be controlled by taking specific preventive measures. It includes preoperative patient preparation, perioperative bowel preparations in patients, following antibiotic prophylaxis correctly, increased oxygen delivery intraoperatively, proper wound irrigation, control of postoperative glycemic control, etc.

Urinary tract infection can be prevented by early removal of a urinary catheter and placement of a sterile catheter intraoperatively. Infections in the respiratory tract can be controlled by cessation of smoking and pulmonary care using the elevation of the head of the bed, coughing, and deep breathing.

What Is Colorectal Surgery?

Colorectal surgery is the surgical treatment or diagnosis of disorders, diseases, and abnormalities of the colon, rectum, and anus. These abnormalities can be cancer, hemorrhoids, or fecal incontinence. It includes colectomy, colostomy, endoscopic surgery, hemorrhoidectomy, ileal pouch-anal anastomosis(J-pouch), inflammatory bowel disease surgery, internal sphincterotomy, rectopexy, and resection.

What Are Different Colorectal Surgeries?

• Colectomy - It is also called colon resection which involves the removal of all or a part of the intestine. Resection is a surgical procedure to remove the diseased part or organ.

• Segmental Colectomies - In this procedure, the surgeon will make a vertical incision in the middle of the abdomen, overlying the diseased portion of the bowel and removing a portion with the disease. If the removal of colon cancer includes the removal of large sections of lymph nodes, bowel ends are joined together to make it water-tight and promote healing.

• Polypectomy - Removal of colon polyp, cancer polyp, and rectal polyp using colonoscopy.

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• Total Colectomy And Total Proctocolectomy - Diseases like familial polyposis require the removal of the full colon and anastomosis of the bowel to the rectum. Diseases like ulcerative colitis require the removal of the entire colon and rectum. A new pouch called the neorectum is created. This pouch is joined with the anus.

• Colostomy - A surgical procedure where the surgeon creates a hole in the abdomen and pulls one end of the colon through it. It is done for colon and rectal disorders. After this procedure, a colostomy bag is attached outside the body to collect waste from the body. It can be temporary or permanent.

• Temporary Colostomy - It allows reattachment of the colon later, as the affected area is allowed to heal as the stool does not pass through the area.

• Permanent Colostomy - Done in chronic diseases like Crohn's disease, where a portion of the rectum or colon is removed.

• Endoscopic Surgery - It is used for diagnostic procedures. It includes using a scope and a flexible tube with a camera at the tip. It is done with a small incision; thus, the recovery phase is easier.

• Hemorrhoidectomy - Initially, non-surgical treatment methods are used, like lifestyle modification, but if it does not reduce, then surgical treatment is required. This procedure gives better relief for hemorrhoids.

• Stapled Hemorrhoidectomy - The procedure for prolapse hemorrhoids reduces blood flow to hemorrhoids and helps to shrink. It is a highly effective procedure.

• Band Ligation - In addition, the surgeon uses rubber band ligation, in which a rubber band is placed around the hemorrhoid to reduce blood supply and destroy the tissue.

• Ileal Pouch Anal Anastomosis (J-Pouch) - It is a procedure to create a pouch from the end of the intestine and attach it to the anus. If the colon is to be removed, then this procedure restores stool function. The benefit of this procedure is that it reduces the opening in the stoma and removes the need for a waste bag. This procedure helps to maintain colon control and remove stool through the anus.

• Inflammatory Bowel Disease (IBD) Surgery - This procedure is for ulcerative colitis and Crohn's disease. In the initial phase, colectomy is done to treat inflammatory bowel disease, which gives better relief in ulcerative colitis and prevents malignant transformation.

• Internal Sphincterotomy - This procedure is done to treat anal fissures. The internal sphincter is a muscle that opens and closes for the stool to pass from the body. This procedure stretches the internal sphincter muscle to weaken it and allow healing. This procedure does not close the anal fissure and is left to heal on its own.

• Rectopexy - A procedure to treat rectal prolapse. Before the surgery, bowel cleaning regime is done, and during surgery, an incision is made on the lower abdomen to separate the rectum from surrounding tissues and lift. After surgery, the incision site is allowed to heal, and complete recovery occurs after six weeks.

• Abdominoperineal (Rectal) Resection - A procedure to treat anal cancer; in this procedure, the anus, rectum, and part of the sigmoid colon are removed. The lymph nodes and blood vessels are also included.

• Small Bowel Resection - This procedure is done for Crohn's disease, tumors, cancer, and polyps. In this procedure, the diseased part of the intestine is removed, and the normal part is sewn together. An opening outside the body called an ostomy is created.

• Low Anterior Resection - In this procedure, a part of the rectum is removed and rejoined. Anastomoses at the deep level increase the risk of a leak. Thus, an ostomy is created to reduce bowel movement pressure. Another complication is nerve injury which causes dysfunction at a later stage.

• Laparoscopic Colon Resection - This procedure uses several techniques to treat colon cancer. It uses a minimal access approach to remove cancerous tissue and lymph nodes.

• Local Full-Thickness Resection of the Rectum - Early-stage cancer can be removed by cutting through all layers of the rectum to remove cancer and surrounding tissues.

What Are the Risks and Complications of Colorectal Surgery?

Colorectal surgery has minimum risk and complications. A few complications are:

• Bloating and cramping after the procedure.

• There is also a small risk of bowel perforation and bleeding, especially if a biopsy sample is taken.

• Urological Complication - After colorectal surgery includes ejaculatory failure. For those individuals, no semen is ejaculated from the penis. This may be from injury to the lumbar sympathetic chain or sympathetic hypogastric plexus. In younger patients, these complications are related to infertility.

Conclusion:

Colorectal surgeries comprise surgical procedures treating diseases affecting the colon, rectum, and anus. Patients who undergo a surgical procedure should consult a surgeon before surgery. This is required to confirm all other non-surgical methods have been exhausted or have failed to provide the desired result. The selection of the technique is based on the patient's condition and disease severity.

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