What Is Colorectal Surgery?

Colorectal surgeries are procedures that are done to correct a damaged or disease section of your lower intestinal tract. This may be a result of cancer, a malformation, another disease process, or some sort of injury or infection.

Colorectal surgeries can be done using a variety of surgical techniques. Your surgeon will work with you to decide which option is best given your overall health and specific medical condition.

Laparoscopic and robotic surgeries have the lowest rate of complications, but open surgeries -where a large cut is made in the abdomen- are still required in some more complicated cases.

If you are having a laparoscopic colorectal surgery, it will be done as an inpatient procedure, and you can anticipate several days in the hospital- based on how well you recover. The following steps may be taken to prepare you for surgery.

• Prophylactic antibiotics to prevent post-operative infections.
• Bowel preparation with a solution to help you clear your intestines before surgery.
• Anticoagulation to prevent post-operative blood clots.

These surgeries may be performed in both adults and children, although they are more common in adults. Some of the most common reasons for needing colorectal surgery are cancers of the lower gut, but there are noncancerous reasons, as well as emergency reasons, for these surgeries, too.

Various Surgery Techniques 

There are several ways colorectal surgery may be performed. Below is an overview of the techniques most often used, and in which situations.

Laparoscopic Surgery

This is the most common method for colorectal surgery, and the one preferred by many healthcare providers. It requires only one incision in most cases, and most of the surgery is done with minimally invasive tools including a camera and surgical instruments operated remotely by the surgeon.

Laparoscopic surgery takes longer than traditional, open procedures, but evidence has shown that this option provides better recovery and fewer post-operative complications.

This option isn’t for everyone, though. People who have other organ involvement—like adhesions that spread to neighboring organs—or who have had multiple abdominal surgeries already are not usually candidates for laparoscopic surgery.

Robotic Surgery

Robotic surgery is another minimally-invasive option. Robotic surgery and laparoscopic surgery have a lot in common, with both using cameras and surgical tools through a single or minimal incisions. This option also provides improved healing and reduced complications after surgery, in most cases

Robotic surgery offers a bit more precision than laparoscopic surgery though, providing the surgeon with a clearer, more detailed view of the surgical area, and more control of the surgical tools.

Open surgery

Open surgery is usually performed when minimally invasive techniques won’t work. This could happen when there is too much damage or too large of an area to repair with laparoscopic or robotic surgery or when the surgeon needs to see a larger area to complete the procedure.

Contraindications

There are rarely contraindications for colorectal surgery, other than for certain techniques. For example, if you need extensive surgical repair or you have had other surgeries in the same area, laparoscopic surgery might not be an option for you.

As far as surgery in general goes, there are a few things to watch out for since you will be undergoing general anesthesia:

• You should have good lung function. Your healthcare provider may perform pulmonary testing to make sure you will recover well from general anesthesia.
• People with significant pulmonary or cardiac disease, or who have a difficult airway, may not be candidates for elective procedures.
• Some of these factors may not be an issue if you need emergent surgery.
• Your healthcare provider may not consider you a candidate for surgery if you have extensive disease, if your cancer has metastasized, or if you are not medically stable enough to undergo surgery. Your surgeon will make a decision on the benefits versus the risks of the surgery.

Potential Risks 

There are a number of risks associated with any surgery—particularly those that require general anesthesia. Some of the risks specific to colorectal surgeries include:

Surgical site infections: Due to the nature of the location of colorectal surgery and the body fluids and functions involved in these body systems, infection is a major concern after colorectal surgery.

Leaks at the connection site: In most colorectal surgeries, something is removed, and a new connection is made. Sometimes, when the surgeons reconnect tissue during colorectal surgery, there can be problems with healing.

Connections that don’t heal properly can leak, and leaked waste products can cause serious problems in the abdominal cavity. This is called anastomotic leakage, and it’s one of the most serious complications of colorectal surgery.

Roughly a third of deaths after colorectal surgery can be attributed to this problem. This complication may need to be repaired with another surgery.

Post-operative bleeding: This is a risk with most surgeries, but is less common than other complications that can occur with colorectal surgery.

Ileus: Ileus is the term used to describe a lack of movement in your intestines. During surgery, anesthesia causes your bowels to stop working for a period of time. This is particularly important in surgeries involving the areas affected during colorectal surgery.

Sometimes, it can take a while for digestion and movement in the bowels to resume after surgery. Medications and time usually resolve this problem.

Purpose of Colorectal Surgery

Colorectal surgery is a procedure that is done to fix a problem like an obstruction, tumor, or tear in the lower gut. If the flow of food or waste through your intestines, colon, or rectum are disrupted, you can become very sick.

In colorectal surgery, obstructions are cleared, tears are repaired, or damaged sections are removed and the ends are reattached. In some cases, your surgeon may have to create an ostomy, or a hole on the outside of your body, so that waste can be removed directly, rather than through your rectum and anus.

How to Prepare

Colorectal surgery is a major surgical procedure. Prior to surgery, you will undergo a number of tests and scans, and your medications may change. You will also need to prepare your bowels by taking laxatives to clear your intestines before surgery.

During bowel prep, you will drink clear liquids and drink a laxative solution. The goal of this process is to clear your lower digestive tract of food and stool. This gives your surgeon a clear and clean surgical field to help prevent post-operative infections.

What to Expect on the Day of Surgery

Colorectal surgeries are major surgical procedures done under general anesthesia. These surgeries can be done with open or minimally invasive procedures. Either option will take several hours and you will have to stay in the hospital for at least a few days.

1. When you arrive at the hospital, you will have intravenous catheters placed so that you can be given medications during surgery.
2. A tube will be placed in your throat to help you breathe while you are under sedation.
3. The surgery will take several hours and you will be taken to a recovery area afterward.
4. When your medical team is certain you have cleared the effects of anesthesia and have no serious complications, you will be moved to a regular inpatient room until you are ready to be discharged.

Recovery

After colorectal surgery, your recovery will depend a lot on what type of surgery you had - open or laparoscopic. The recovery period for an open surgery is more extensive, lasting several weeks.

• ‍In open surgery, your surgeon will make a large incision down the center of your abdomen. You will be watched carefully for signs of infection or poor healing.‍
• With laparoscopic surgery, recovery is usually quicker, with several small incisions to heal rather than one large one. You can usually resume normal activity within days to weeks after your surgery.