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Home - System of Care - Surgical Services - Colorectal Surgery

Colorectal Surgery

St. Joseph’s colorectal surgeons perform nearly 1,000 procedures a year at St. Joseph’s and its two outpatient surgery centers – North Surgery Center and Northeast Surgery Center.

Using the latest technologies and minimally invasive approaches, the six surgeons are able to treat cancerous growths and polyps in patients who traditionally were not able to undergo surgery. In fact, surgeons have used the da Vinci® Surgical System more than 50 times to remove polyps related to colon cancers.

Visit our Colorectal Services page for more information on surgical alternatives to colorectal issues.

Conditions

Anal Cancer
Anal cancer is cancer that starts in the anus, the end of the rectum. Anal cancer is rare and most people who get it are between ages 50 and 80.These are the most common symptoms of anal cancer:

  • Bleeding from the rectum
  • Pain or pressure in the anal area
  • Discharge from the anus
  • A lump from swollen lymph nodes in the anal or groin area
  • Itching around the anus
  • Change in bowel movements

Although these are symptoms of anal cancer, they may also be caused by other, less serious medical problems. People with these symptoms should talk to a doctor.

Anal Fissures
Anal fissures are tears, or cracks, in your anus. Fissures result from the stretching of your anal mucosa beyond its normal capacity. Once the tear occurs, it leads to repeated injury. The exposed internal sphincter muscle beneath the tear goes into spasm, which causes severe pain.

You may have these symptoms with an anal fissure:

  • Pain during and after a bowel movement
  • Visible tear or cut in the area
  • Bright red bleeding during or after a bowel movement

Anal Fistulas
An anal fistula is an abnormal connection between the surface of the anal canal and the skin. If the outlet of the anal glands becomes blocked, an abscess can form which can eventually point to the skin surface. The tract formed by this process is the fistula.

Crohn's Disease
Crohn's disease is an inflammatory bowel disease (IBD). It is a chronic condition that may recur at various times over a lifetime. It usually involves the small intestine, most often the lower part called the ileum. However, inflammation may also affect the entire digestive tract, including the mouth, esophagus, stomach, duodenum, appendix, or anus.

Unlike ulcerative colitis, "skip" lesions can be found in Crohn's disease. This means there can be normal areas in between areas that are inflamed. Also, all layers of the intestinal wall can be affected and that may lead to particular complications seen only in Crohn's disease including:

  • Fistula - an abnormal connection between the intestine and other organs
  • Abscess - collection of pus
  • Stricture - an area of narrowing that can lead to intestinal blockage

The following are the most common symptoms for Crohn's disease. However, each individual may experience symptoms differently. Symptoms may include:

  • Abdominal pain, often in the lower right area
  • Diarrhea, sometimes bloody
  • Rectal bleeding
  • Weight loss
  • Fever
  • Failure to grow
  • Joint pain
  • Rectal fissure
  • Rashes

Some people have long periods of remission when they are free of symptoms, sometimes for years. There is no way to predict when a remission may occur or when symptoms will return. The symptoms of Crohn's disease may resemble other conditions or medical problems. Because Crohn's disease usually comes back after surgery, it is generally not curable.

Colon Cancer
The wall of the colon is made up of layers of tissue. Colon cancer occurs when abnormal cells form in the inner layer of this tissue. Because the majority of colon cancers begin as precancerous polyps, colon cancer is a potentially preventable disease. Screening and early detection can catch colon cancer at an early stage or before polyps turn into cancer.

A common symptom of colon cancer is a change in bowel habits. Specific symptoms may include:

  • Diarrhea or constipation
  • Feeling your bowel does not empty completely
  • Blood (either bright red or very dark) in your stool
  • Stools are narrower than usual
  • Frequent gas pains or cramps
  • Feeling full or bloated
  • Losing weight with no known reason
  • Constant fatigue
  • Nausea or vomiting

Most often, these symptoms are not due to cancer. Other health problems can cause the same symptoms. However, anyone with these symptoms should see a doctor to be diagnosed and treated as early as possible.

Colon Polyps
Polyps are growths on the inner wall of the colon. They are common in people over age 50. Most polyps are benign (not cancer), but some polyps can become cancer. Finding and removing polyps through a colonoscopy  may reduce the risk of colon cancer.

Diverticulitis
Many people have small pouches in the lining of the colon or large intestine that bulge out through weak spots. Each pouch is called a diverticulum. Multiple pouches are diverticula and are most often found in the lower part of the large intestine. Having diverticula is a condition called diverticulosis. When the pouches become inflamed, the condition is called diverticulitis. The conditions of diverticulosis or diverticulitis are referred to as diverticular disease.
 
Diverticulitis can lead to bleeding, infections, small tears (perforations), or blockages in the colon. These complications always require treatment to prevent them from progressing and causing serious illness. The most common symptom of diverticulitis is abdominal pain and tenderness in the lower left side of the abdomen. Usually, the pain is severe and comes on suddenly, but it can also be mild and become worse over several days.

Other symptoms to be aware of include:

  • Cramping
  • Nausea
  • Vomiting
  • Fever
  • Chills
  • Change in bowel habits

People with chronic symptoms should visit their doctor or health care provider.

Fecal Incontinence
Fecal incontinence is the inability to hold stool in the rectum.

Hemorrhoids
Hemorrhoids are enlarged, bulging blood vessels in and about the anus and lower rectum. There are two types of hemorrhoids: external and internal, which refer to their location.

External (outside) hemorrhoids develop near the anus and are covered by very sensitive skin. If a blood clot develops in one of them, a painful swelling may occur. The external hemorrhoid feels like a hard, sensitive lump. It bleeds only if it ruptures.

Internal (inside) hemorrhoids develop within the anus beneath the lining. Painless bleeding and protrusion during bowel movements are the most common symptom. However, an internal hemorrhoid can cause severe pain if it is completely prolapsed or protruding from the anal opening.

Inflammatory Bowel Disease
Inflammatory bowel disease (IBD) refers to two related but different diseases: ulcerative colitis and Crohn's disease . These diseases cause chronic inflammation of the intestinal tract, which lead to a variety of symptoms. The inflammation can also affect organs other than the intestines.

IBD is a lifelong disease with spans of time when it is active and other times when it is under control and inactive. IBD is very common, but it has been difficult to pinpoint how many people worldwide suffer from the disease because of a lack of standardized guidelines for making a diagnosis and also misdiagnosis.

Perirectal Abscess
A perianal abscesses (a collection of puss) can be seen in patients with IBD, Crohn's disease  or diabetes. Often the abscess will start as an internal wound, which becomes infected as a result of the normal presence of feces in the rectal area. The wound then develops into an abscess. This often presents itself as a lump of tissue near the anus which grows larger and more painful with time. Like other abscesses, perianal abscesses may require prompt medical treatment, such as an incision or lancing.

Pruritus Ani
Pruritus ani is the irritation of the skin at the exit of the rectum, known as the anus, causing the desire to scratch. The intensity of anal itching increases from moisture, pressure and rubbing caused by clothing and sitting. At worst, anal itching causes intolerable discomfort that often is accompanied by burning and soreness. The irritation can be caused by intestinal parasites, anal perspiration, frequent liquid stools, diarrhea, residual stool deposits or the escape of small amounts of stool as a result of incontinence or flatulence.

Radiation Proctitis
Radiation proctitis is inflammation and damage to the lower parts of the colon after exposure to x-rays or other radiation as a part of radiation therapy. Radiation proctitis most commonly occurs after treatment for cancers such as cervical cancer, prostate cancer and colon cancer.

Rectal Cancer
Rectal cancer is the development of cancerous cells in the lining of the rectum (the last several inches of the large intestine closest to the anus). The stage of the cancer depends to a great degree on how deep the cancer goes into and beyond the wall of the rectum. Because the majority of rectal cancers begin as precancerous polyps, rectal cancer is a potentially preventable disease. Screening and early detection can catch rectal cancer at an early stage or before polyps turn into cancer.

A common symptom of rectal cancer is a change in bowel habits. Those specific symptoms may include:

  • Diarrhea or constipation
  • Feeling your bowel does not empty completely
  • Blood (either bright red or very dark) in your stool
  • Stools are narrower than usual
  • Frequent gas pains or cramps
  • Feeling full or bloated
  • Losing weight with no known reason
  • Constant fatigue
  • Nausea or vomiting

Most often, these symptoms are not due to cancer. Other health problems can cause the same symptoms. However, anyone with these symptoms should see a doctor to be diagnosed and treated as early as possible.

Rectal Prolapse
Rectal prolapse is a condition in which the rectum (the lower end of the colon, located just above the anus) turns itself inside out. In the earliest phases of this condition, the rectum does not stick out of the body, but as the condition worsens, it may protrude. Weakness of the anal sphincter muscle is often associated with rectal prolapse at this stage and may result in leakage of stool or mucus.

Ulcerative Colitis
Ulcerative colitis is an inflammatory bowel disease (IBD) in which the inner lining of the large intestine (colon or bowel) and rectum become inflamed. Inflammation usually begins in the rectum and lower intestine and spreads upward to the entire colon.

Common symptoms are diarrhea, blood or mucus in the stool, and, in more severe cases, anemia. Symptoms may vary from mild to life threatening and may be cyclic (periods of symptoms followed by symptom-free periods) or continuous. Systemic symptoms include fatigue, malaise, loss of appetite and weight loss. Intermittent fever is not uncommon. People with ulcerative colitis have a higher risk for colon cancer.

Procedures

Anal Incontinence Stimulation
As opposed to major surgery like a sphincteroplasty, colostomy or sphincter replacement, St. Joseph's is one of the only hospitals in Central New York to offer sacral nerve stimulation with InterStim® Therapy. The minimally invasive treatment option is performed by implanting a small electric device to help control the anal sphincter and restore anal continence.


Colectomy
A colectomy consists of the surgical resection of any extent of the large intestine (colon). The surgery can be open (large incision through the abdominal wall to gain access into the abdominal cavity) or minimally invasive through small incisions with the aid of a camera.

Some of the most common indications for colectomy are:

Hemorrhoidectomy
A hemorrhoidectomy is surgery to remove hemorrhoids. It is the most complete method for removal of internal and external hemorrhoids. A hemorrhoidectomy It is necessary when clots repeatedly form in external hemorrhoids; ligation fails to treat internal hemorrhoids; the protruding hemorrhoid cannot be reduced; or there is persistent bleeding.

A hemorrhoidectomy removes excessive tissue that causes the bleeding and protrusion. It is done under anesthesia using either sutures or staplers, and may, depending upon circumstances, require hospitalization and a period of inactivity.

Ostomy
An ostomy is a surgically created opening connecting an internal organ to the surface of the body. The most common types of ostomies in intestinal surgery are an ileostomy (connecting the small intestine to the skin) and a colostomy (connecting the large intestine to the skin). An ostomy may be temporary or permanent. The most common reasons for an ostomy are low rectal cancer and inflammatory bowel disease.

Proctectomy
Proctectomy is a surgical operation to remove the rectum, often as a result of cancer. If you have been diagnosed with rectal cancer, your treatment will depend on how far along your cancer is, as well as other factors. It may also be used to treat IBS or ulcerative colitis.

Rectopexy
A rectopexy traditionally is performed by opening a vertical incision in the abdomen, separating the colon from the tissue surrounding it and pulling the rectum back inside the body, stitching it securely to the sacrum, a bony structure near the end of the spine. The operation also can be done laparoscopically with a few small incisions made in the abdomen instead of a single large one. A video camera and small surgical instruments are maneuvered through the incisions.

Sphincterotomy (Lateral)
A lateral internal sphincterotomy is an operation performed on the internal anal sphincter muscle for the treatment of chronic anal fissures. The internal anal sphincter is one of two muscles that comprise the anal sphincter, which controls the passage of feces. The procedure helps by lowering the resting pressure of the internal anal sphincter, which improves blood supply to the fissure and allows faster healing.

This operation is generally carried out as a day case procedure. It can be performed with either open or closed techniques:

  • The open technique involves making an incision across the intersphincteric groove, separating the internal sphincter from the anal mucosa by blunt dissection, and dividing the internal sphincter using scissors.
  • The closed technique involves making a small incision at the intersphincteric groove, inserting a scalpel with the blade parallel to the internal sphincter and advancing it along the intersphincteric groove, and then rotating the scalpel towards the internal sphincter and dividing it.

Stapled trans-anal rectal resection (STARR)
STARR is a surgical procedure which is used in rectal prolapse, internal intussusception (funnel shaped infolding of the rectal wall) and prolapsed hemorrhoids.

Resources
Colon Rectal Associates of CNY

St. Joseph's Hospital Health Center
Resource Line
Phone: (315) 703-2138
Toll Free: 1-888-785-6371