Colorectal Surgery

What is colorectal surgery?

Colorectal surgery is a subspecialty that includes surgical procedures to diagnose and treat conditions of the colon, rectum, and anus. Treatment usually involves repairing damage caused by disease, or removing obstructions that prevent the elimination of faeces.

Laparoscopic (keyhole) surgery is the most common type of approach used in colorectal surgery. It is minimally invasive, which allows for quicker recovery times after your operation.

General surgeons who perform colorectal surgery work closely with a team of experienced nurses, as well as other specialities such as urology or medical oncology.

When should I see a specialist for colorectal surgery?

There are a number of reasons why you might be referred to a general surgeon for colorectal surgery. You may have been diagnosed with a specific disease such as colorectal cancer, ulcerative colitis, or Crohn’s disease, or you may require intervention to a lesser extent for conditions such as:

● Haemmorhoids
● Rectal prolapse
● Bowel incontinence
● Anal fissures

Symptoms that might require medical treatment include:

● Rectal bleeding for any period of time
● Sudden, unexplained weight loss
● Extreme changes in bowel habits
● Abdominal or rectal pain
● Poor appetite

Your general surgeon will advise you on when you should proceed with colorectal surgery. Although it is your choice on whether you go ahead with surgery or not, appropriate surgical intervention can improve or relieve symptoms for conditions such as:
● Colorectal cancer
● Ulcerative colitis
● Crohn’s disease
● Diverticulitis

Did you know?

Enhanced Recovery After Surgery (ERAS) pathways, which include optimised care before, during, and after surgery including early ambulation, are modern evidence-based approaches to assist with recovery following surgeries. In a 2010 study, it was shown that ERAS pathways resulted in shorter hospital stays and reductions in complications.¹

What are the risks of colorectal surgery?

Like any surgery, colorectal surgery carries some risks. The level of risk involved will depend on the type of surgery you are having, and also whether the procedure is open, laparoscopic, or diagnostic.

Some of these risk factors can include:

Bleeding – which can occur during or after the procedure. Depending on the extent of the bleeding, a blood transfusion may be required or in rare cases, you may need to have additional surgery to get the bleeding stopped.

Infection – this can be at the site of the incision or deeper within the abdominal area (known as peritonitis). Treatment can be with topical, oral or intravenous antibiotics depending on how bad the infection is.

Bladder and bowel problems – sometimes your bladder and bowel can get irritated, inflamed or even damaged. This can result in a number of symptoms such as incontinence, constipation, and varying degrees of obstruction. Most of the time, these problems are not permanent, and often settle as you recover from your surgery.

Injury to other organs – this can include perforation of the stomach or intestines.

Hernias – Following surgery, you may develop a weakening in the wall of the abdomen. This can result in parts of the bowel or other tissue pushing through this weakening.

How do I prepare for colorectal surgery?

If you have been scheduled for colorectal surgery, there will usually be some preparation involved before the day of your operation. This may vary depending on the type of surgery you are having, but you can usually expect the following:

You may need to stop taking certain medications, as some medicine might increase your risk of complications. Talk to your general surgeon or anaesthesiologist about any medication you are taking.

You will usually be expected to stop eating and drinking a few hours, or even a day, before surgery. Your general surgeon will advise you on the specifics of this.

You may be given a solution to drink that will help clear your bowels. This is usually something you can take home and involves mixing the medication with water, and drinking it over several hours. The medication will cause a fairly rapid emptying of the bowels (diarrhoea).

In some cases, you may be prescribed a course of antibiotics. This helps suppress the natural bacteria that is found in the bowel, decreasing your chance of infection.

What can I expect during colorectal surgery?

When the surgical team is ready, you will be taken into the operating theater. Your anaesthesiologist will then administer the anaesthesia or some form of sedation depending on the operation you will be having.

You will be connected to an echocardiogram (ECG) machine, as well as a blood pressure machine, to monitor your heart rate and circulation. Once you are asleep, you may also need a tube inserted into your airway to assist your breathing throughout your operation.

The surgical team will then proceed with the planned surgery.

Due to the nature of anaesthetic medication, you will not have any memory of the procedure.

What happens after my colorectal surgery?

Following your colorectal surgery, you will be taken to a recovery area where you will be carefully monitored to ensure you wake up safely from the anaesthetic. Once you are safely awake, you will be moved to a general ward to continue your recovery.

You will be monitored for bladder and bowel movements. Your bowels should start working normally anywhere from a few days up to a week depending on the surgery you have had.

You might initially be put on a special diet. This will consist of soft foods and fluids.

Once you have been discharged, expect a few days to a few weeks of recovery time at home. Your general surgeon will be able to advise you of when you will be able to return to normal duties.

[1] Ljungqvist, O., Scott, M. and Fearon, K. (2017). Enhanced Recovery After Surgery: A Review. JAMA Surgery, 152(3), p.292.