Colon and Rectal Surgery Mohammed Bayasi, MD Department of Surgery Colon and Rectal Surgery What is a Colon and Rectal Surgeon? • Fully trained General Surgeon. • Has done additional training in the diseases of colon and rectum. Why Colon and Rectal Surgery? • Surgical and non surgical therapy for multiple diseases. • Chance to help cancer patients by removing tumor, potentially curing them. • Variety of cases, ages and patient populations. • Specialized area. Colorectal Diseases • Colon • Rectum/Anus – Cancer – Hemorrhoids – Diverticulitis – Anal fistula and – Inflammatory Bowel abscess Disease (Crohn, UC) – Anal fissure – Polyps – Prolapse Symptoms/Signs • Pain • Itching • Discharge • Bleeding • Lump Anatomy Lesson Colon • Extracts water and nutrients. • Helps to form and excrete waste. • Stores important bacteria flora. • Length: 1.5 meters long = 4.9 feet = 59 inches Colon Rectum/Anus • The final portion of the colon. • Area contains muscles important in controlling defecation and flatulence. Rectum/Anus When to see a Colon and Rectal Surgeon • Referral from another physician (Gastroenterology, PCP). • Treatment of anorectal diseases. • Blood with stool, abdominal pain, rectal pain. Hemorrhoids • Internal and external. • Cushions of blood vessels. • When enlarged, they cause bleeding and pain. Treatment • Treatment of symptomatic hemorrhoids is directed by the symptoms themselves. It can broadly be categorized into four groups: − Medical therapy − Office-based procedure − Operative therapies − Emergent interventions Anorectal Abscess • It is a collection of pus in the perianal area. Normal • Causes pain and rectal gland drainage, and if it progresses, fever and systemic Abscess infection. • Treated with incision and drainage. Anorectal Fistula • A tunnel between the inside of the anus and the skin. • Causes discharge, pain, and formation of abscess. • Multiple surgical options depending on fistula complexity. Abdominal Surgery • Colectomy: removal of part or all of the colon • Low Anterior Resection (LAR): removing the lower portion of the colon, the rectum by making an abdominal incision • Abdominoperineal Resection (APR): removing the rectum and anus. Right hemicolectomy Left hemicolectomy Transverse colectomy Sigmoid colectomy A colectomy may be done anywhere within the shaded areas of the diagrams. Right Colon Resection Ostomy • An opening of the intestinal tract at the level of the skin. • Allows passage of stool or enteric content. • Temporary or permanent. Colostomy Colostomy Minimally Invasive Surgery • Performed through small incisions • Less pain • Shorter hospital stay • Faster recovery Laparoscopic Laparoscopic Surgery Robotic Surgery • Minimally invasive surgery. • Improved visualization of tissues. • NOT artificial intelligent. Minimally Invasive Surgery • Laparoscopic: inside the abdominal cavity • Endoscopic: inside the colon or rectum Enhanced Recovery After Surgery • Decreases surgical stress through evidence based measures. • Results – Less complications – Improved “well being” state – Faster recovery Bloodless Surgery • Optimizing blood level prior to surgery. • Using state-of-the-art technologies to minimize blood loss. • Minimally invasive surgery. • Enhanced recovery after surgery. Why Surgery at Georgetown? • Comprehensive Care. • Bloodless Medicine program, ostomy nurses, and experienced staff. • Medical Oncology, Radiation Oncology, Gastroenterology, Surgeons. Why Surgery at Georgetown? • Premiere group of subspecialty doctors available if necessary: Cardiology, Nephrology, Pulmonary, Critical Care, etc. • Cura Personalis: care of the whole person mind, body, and spirit. Thank you .