Other Procedures Performed by Dr Ho

Colorectal Surgery

What Is Colorectal Surgery?

Colorectal surgery, also known as proctology, involves various surgical procedures to diagnose, treat, and manage diseases and conditions that affect the colon, rectum, and anus. The colon and rectum play critical roles in the digestive system. Surgery may be necessary to alleviate symptoms or treat the underlying problem when diseases or disorders affect these areas.


Who Is Suitable for Colorectal Surgery?

Colorectal surgery is considered when non-surgical treatments are ineffective or when the condition is severe or life-threatening. Here are some scenarios in which colorectal surgery may be suitable:

  • Colon Cancer: Individuals diagnosed with colon cancer may undergo surgery to remove cancerous tumours and affected portions of the colon. The surgery's suitability depends on the cancer stage and the patient's overall health.
  • Inflammatory Bowel Disease (IBD): Patients with severe Crohn's disease or ulcerative colitis that does not respond to medications may require surgical intervention, such as removal of damaged portions of the intestine.
  • Diverticular Disease: Severe cases of diverticulitis involving inflammation or infection of small pouches in the colon wall may necessitate surgery to remove affected colon sections.
  • Rectal Prolapse: Patients with rectal prolapse, where the rectum protrudes through the anus, may require surgical repair.
  • Haemorrhoids: Surgical removal of haemorrhoids is considered when conservative treatments like dietary changes and medications do not provide relief.
  • Anal Fistulas or Fissures: Surgery may be needed to treat complex anal fistulas or chronic anal fissures.


Benefits of Colorectal Surgery

  • Cancer Treatment: For patients with colorectal cancer, surgery can be curative when cancer is detected early. It may eliminate cancerous growth and prevent further spread.
  • Symptom Relief: Surgery can relieve abdominal pain, rectal bleeding, and bowel dysfunction associated with colorectal conditions.
  • Improved Quality of Life: Many patients experience an improved quality of life after colorectal surgery, especially if they have been living with chronic pain or discomfort.
  • Disease Management: Surgery can effectively manage conditions like Crohn's disease and ulcerative colitis, helping to reduce inflammation and complications.
  • Prevention of Complications: In cases of diverticular disease, surgery can prevent complications such as abscess formation and perforation.
  • Functional Restoration: Some surgeries, such as rectal prolapse repair, aim to restore normal anatomy and function.
  • Hemorrhoid Relief: Hemorrhoidectomy can alleviate the pain and bleeding associated with haemorrhoids, improving the patient's comfort.


Types of Colorectal Surgery

Colorectal surgery encompasses a range of procedures, each designed to address specific conditions affecting the colon, rectum, and anus. Here are some common types of colorectal surgery:

  • Colectomy: This surgery involves the removal of a portion or the entire colon. Types of colectomies include:
  • Partial Colectomy: Removal of a portion of the colon.
  • Total Colectomy: Removal of the entire colon, often followed by creating an ileostomy or a connection of the small intestine to the rectum or anus.
  • Rectal Resection: A portion or the entire rectum may be removed for conditions affecting the rectum, such as rectal cancer or severe rectal prolapse.
  • Colostomy or Ileostomy: In some cases, when the colon or rectum needs to heal, a stoma (an opening in the abdominal wall) is created, and the end of the colon or small intestine is brought to the surface. Waste is collected in a pouch attached to the stoma.
  • Hemorrhoidectomy: Surgical removal of haemorrhoids, swollen blood vessels in the rectum or anus.
  • Anal Fistula or Fissure Repair: Surgery to treat complex anal fistulas or chronic anal fissures.


Preparation Before a Colorectal Surgery

Preparing for colorectal surgery is essential to ensure a safe and successful procedure. Here are some steps to take before surgery:

  • Consultation: Have a detailed discussion with your surgeon to understand the specific procedure, its risks, benefits, and expected outcomes.
  • Medical Evaluation: Your healthcare team will conduct a comprehensive medical evaluation, including blood tests, imaging, and a physical examination, to assess your overall health.
  • Medications: Inform your doctor about all your medications and supplements, as some may need to be adjusted or temporarily stopped before surgery.
  • Diet and Bowel Preparation: Follow your surgeon's instructions regarding dietary restrictions and bowel preparation, which may involve cleansing your bowels with a special solution or enemas.
  • Smoking and Alcohol: If you smoke or consume alcohol, quitting or reducing these habits before surgery is advisable, as they can impact healing.
  • Infection Prevention: Follow hygiene practices and take any prescribed antibiotics to reduce the risk of infection.
  • Arrangements: Arrange for transportation to and from the hospital on the day of surgery, as well as post-operative care and support at home.


Colorectal Surgery Procedure

The specifics of colorectal surgery can vary depending on the type of procedure and the patient's condition. However, here's a general overview of what happens during colorectal surgery:

  • Anaesthesia: You will be administered anaesthesia to ensure you are unconscious and pain-free during the surgery.
  • Incision: The surgeon makes an incision in the abdominal or rectal area, depending on the type of surgery.
  • Surgery: The surgeon performs the necessary procedure, which may involve removing damaged tissue, reconnecting healthy bowel segments, or creating a stoma.
  • Monitoring: Throughout the surgery, your vital signs, including heart rate, blood pressure, and oxygen levels, are closely monitored by the surgical team.
  • Closure: After the surgery, the incision is closed with sutures or staples, and a dressing is applied.


Colorectal Surgery Recovery Plan

Recovery from colorectal surgery is a critical phase that requires careful attention and adherence to your doctor's instructions.

  • Hospital Stay: Depending on the type and complexity of the surgery, you may need to stay in the hospital for a few days to a week.
  • Pain Management: Pain management is crucial during the initial recovery period. Medications will be provided to control pain and discomfort.
  • Diet: You will initially be on a clear liquid diet and gradually transition to solid foods as tolerated. Follow your surgeon's dietary recommendations.
  • Stoma Care (if applicable): If you have a stoma, you'll receive guidance on how to care for it and manage the ostomy pouch.
  • Activity: Start with gentle walking and gradually increase your activity level as your healthcare team advises.
  • Medications: Continue taking prescribed medications as directed, including antibiotics if prescribed.
  • Follow-up Appointments: Attend all scheduled follow-up appointments with your surgeon to monitor your progress and address concerns.
  • Dietary and Lifestyle Changes: Depending on your condition, you may need to make dietary and lifestyle changes to support long-term recovery and health.
  • Wound Care: Keep the surgical incision clean and dry, and watch for signs of infection.
  • Monitor for Complications: Be aware of potential complications such as infection, bleeding, or changes in stoma function, and report any concerns to your doctor.


Colorectal Surgery Prognosis

In many cases, colorectal surgery can be curative, especially in the early stages of diseases like colorectal cancer. Here are some general considerations:

  • Colorectal Cancer: For early-stage colorectal cancer, surgical removal of the tumour can lead to a favourable prognosis, with a good chance of complete recovery. The prognosis may be less favourable in advanced stages, but surgery can still provide palliative relief and improve quality of life.
  • Inflammatory Bowel Disease (IBD): Surgery can effectively manage severe cases of Crohn's disease or ulcerative colitis when medications are insufficient. It can help reduce inflammation and alleviate symptoms, improving long-term outcomes.
  • Diverticular Disease: Surgery for diverticulitis can prevent complications like abscess formation or perforation. The prognosis is generally good when surgery is performed before such complications arise.
  • Rectal Conditions: The prognosis for rectal conditions, such as rectal prolapse or anal fistulas, is often positive when surgical interventions are carried out effectively.


Colorectal Surgery Risks and Complications

While colorectal surgery can have positive outcomes, it carries certain risks and potential complications. Some common risks include:

  • Infection
  • Bleeding
  • Anaesthesia Risks
  • Adverse Reactions
  • Stoma Complications (if applicable)
  • Bowel Obstruction
  • Functional Changes
  • Pain and Discomfort
  • Blood Clots
  • Anastomotic Leak


What if Colorectal Surgery is Delayed?

Delaying colorectal surgery can affect the patient's health, depending on the underlying condition. It's essential to understand that the consequences of delaying surgery vary based on the specific diagnosis:

  • Colorectal Cancer: Delaying surgery for colorectal cancer can allow the cancer to progress to more advanced stages, potentially reducing the chances of a complete cure. Early detection and prompt treatment are crucial for better outcomes.
  • Inflammatory Bowel Disease: Delaying surgery for severe IBD can result in continued inflammation, worsening symptoms, and an increased risk of complications such as bowel strictures, fistulas, and abscesses.
  • Diverticular Disease: Delaying surgery for diverticulitis may increase the risk of recurrent episodes and complications, such as abscess formation or perforation.
  • Rectal Conditions: Delaying surgery for rectal conditions can lead to ongoing discomfort, worsening prolapse, or complications associated with conditions like anal fistulas or fissures.

Appendicectomy

What is an Appendicectomy?

Appendicectomy, or appendectomy, is a surgical procedure to remove the appendix, a small, finger-shaped organ located in the lower right side of the abdomen.

 

Who Is Suitable for Appendicectomy?

Appendicectomy is typically performed when a patient is diagnosed with acute appendicitis, a condition in which the appendix becomes inflamed and infected.


Benefits of Appendicectomy

  • Relief from Acute Appendicitis: The primary benefit of appendicectomy is that it relieves the painful symptoms of acute appendicitis. Removing the infected appendix prevents it from bursting, which can lead to a life-threatening condition called peritonitis.
  • Prevents Complications: Appendicitis can lead to various complications if left untreated. These include abscess formation, peritonitis, and the spread of infection to other abdominal organs. Appendicectomy eliminates the source of infection, reducing the risk of these complications.
  • Short Recovery Time: Appendicectomy is a relatively straightforward surgical procedure; most patients can expect a relatively short recovery period. Many patients can return to their normal activities within a few weeks.
  • Low Risk of Recurrence: Once the appendix is removed, there is no chance of developing appendicitis in the future.


Types of Appendicectomy

There are two main types of appendicectomy procedures:

  • Open Appendicectomy: In an open appendicectomy, the surgeon makes a single incision in the lower right side of the abdomen. Through this incision, the appendix is removed. This procedure is commonly used when the appendix is severely inflamed or when complications are suspected.
  • Laparoscopic Appendicectomy: Also known as minimally invasive surgery, laparoscopic appendicectomy uses several small incisions and a specialised camera and instruments. The surgeon inserts a laparoscope (a thin tube with a camera) and small surgical tools into the abdomen. They view the internal organs on a monitor and remove the appendix. Laparoscopic appendicectomy is preferred when the diagnosis is clear and there are no complications, as it offers several advantages, including smaller incisions, less postoperative pain, and a shorter hospital stay.


Preparation Before an Appendicectomy

  • Medical Consultation: If you are experiencing symptoms of appendicitis, such as abdominal pain, fever, and nausea, it's crucial to seek medical attention promptly. A healthcare professional will conduct a physical examination and may order imaging tests (like ultrasound or CT scan) to confirm the diagnosis.
  • Discuss the Procedure: Once appendicitis is confirmed, your surgeon will explain the procedure to you, including the type of appendicectomy (open or laparoscopic) that will be performed. You should ask your questions and discuss any concerns with your healthcare team.
  • Preoperative Preparation: Before the surgery, your surgeon may instruct you to stop eating solid food and only consume clear liquids. This helps to reduce the risk of complications during the procedure.
  • Medication Review: Inform your surgeon about any medications you take, including prescription, over-the-counter, and herbal supplements. Some medications may need to be adjusted or temporarily discontinued before surgery.
  • Arrangements: Plan transportation to and from the hospital on the day of the surgery. You should also arrange for someone to stay with you during the initial recovery period, as you may be unable to perform daily activities independently immediately after the procedure.


Appendicectomy Procedure

  • Anaesthesia: You will be given general anaesthesia to ensure you are unconscious and pain-free during the surgery.
  • Incision: The surgeon will make the necessary incisions depending on whether you are undergoing an open or laparoscopic appendicectomy. In an open procedure, there will be a single incision in the lower right abdomen, while in laparoscopic surgery, several small incisions will be made.
  • Appendix Removal: The surgeon will carefully locate and remove the inflamed appendix. If the appendix ruptures, the surgeon will clean the abdominal cavity to remove any infected material.
  • Closure: After removing the appendix, the incisions are closed with sutures or staples. In laparoscopic surgery, the small incisions are typically closed with dissolvable stitches or surgical glue.


What to Expect After an Appendicectomy

You will be monitored in the recovery room for a few hours after the surgery. You may be discharged on the same day if you underwent a laparoscopic appendicectomy without complications. For open surgery or if complications arise, you may need to stay in the hospital for a few days.


Appendicectomy Recovery Plan

Your specific recovery plan will depend on your case, but here are some general guidelines:

  • Follow-Up Appointments: Attend all scheduled follow-up appointments with your surgeon to monitor your progress and ensure that you are healing properly.
  • Medication: Continue any prescribed medications, such as antibiotics or pain relievers, as directed by your doctor.
  • Gradual Return to Normal Activities: Slowly resume your normal activities as your surgeon advises. Avoid heavy lifting and strenuous exercise until you receive clearance.
  • Diet: Gradually transition back to a regular diet, but avoid heavy or fatty foods initially. Ensure you stay hydrated.
  • Listen to Your Body: Pay attention to your body's signals. If you experience severe pain, fever, or any unusual symptoms, contact your doctor immediately, as these could indicate complications.


Appendicectomy Prognosis

The prognosis after an appendicectomy is generally very good, especially when the surgery is performed promptly after diagnosing acute appendicitis. 

Most patients experience relief from the symptoms of acute appendicitis after the surgery. The abdominal pain, fever, and other discomforts typically resolve quickly.


Appendicectomy helps prevent complications associated with appendicitis, such as the rupture of the appendix, peritonitis (inflammation of the abdominal lining), and the formation of abscesses. Timely surgery reduces the risk of these serious complications.


Once the inflamed appendix is removed, there is no chance of experiencing appendicitis in the same appendix again.


Appendicectomy Risks

While appendicectomy is generally considered a safe procedure, there are some risks and potential complications. Risks may include:

  • Infection
  • Bleeding
  • Anaesthesia Complications
  • Organ or Tissue Damage
  • Adverse Reactions to Medications
  • Scar Tissue


What if Appendicectomy is Delayed?

If appendicitis is left untreated, the inflamed appendix can rupture. This rupture can lead to the following complications:

  • Peritonitis: Ruptured appendicitis, known as peritonitis, can cause infection and inflammation throughout the abdominal cavity. Peritonitis is a medical emergency and can be life-threatening.
  • Abscess Formation: Pus can collect in the abdominal cavity, forming an abscess. This abscess may require drainage and further treatment.
  • Sepsis: In severe cases, untreated appendicitis and its complications can lead to sepsis, a widespread and potentially deadly infection throughout the body.
  • Extended Hospital Stay: Delayed appendicectomy often results in a longer hospital stay and a more complicated recovery.
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