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The colon, rectum, and anus are part of the digestive tract that facilitate important functions. These organs ensure absorption of water, formation of stool and finally, elimination of waste products.
Colorectal conditions vary from acute and easily manageable concerns, like constipation to chronic or life-threatening diseases including colorectal cancer. The latter conditions are typically addressed through colorectal surgery.
Colorectal surgery refers to the surgical procedures that focus on diagnosing and treating conditions of the colon, rectum, and anus.
Colorectal surgery can be performed open or laparoscopically. Both methods aim to remove cancerous growths and lymph nodes restoring the healthy functions of the digestive tract.
The main distinctive feature between open and laparoscopic (Keyhole) colorectal surgery lies in the way the abdominal organs are accessed. Unlike traditional open surgery which requires a long cut in the abdomen, laparoscopic surgery is executed with tiny incisions (about 0.5 – 1.5cm in length) through which a laparoscope and small surgical tools are introduced. A laparoscope is a thin flexible instrument with a light and camera on the tip that enables the surgeon to fully observe the interior of your abdomen on a monitor. Additionally, air may be blown into the abdominal cavity, ensuring better visualisation and access.
Keeping a nutrition-balanced diet and exercising regularly is vital in the weeks before your surgery. Avoid excessive smoking and alcohol consumption at least a few weeks before your operation.
Preparation guidelines may vary depending on your condition. You will receive instructions from Dr. Sim regarding preparation diet and medications you may need to take or avoid.
Also, you may need to do “bowel prep” prior to your surgery to clear your intestines from stool debris and bacteria. Doing so will help minimise the risk of infection after the surgical procedure.
You should not eat anything after 10:00 PM the night before surgery.
The recovery process following the surgery is different for everyone and depends on such factors as the type of surgery, your age, overall health. The whole process consists of two phases: hospitalisation stay and recuperation phase.
As a rule, if you underwent laparoscopic colorectal surgery, you will be discharged in 3 – 5 days. For open surgeries, hospital stay usually lasts 4 – 10 days.
During this stage, getting back to a normal diet will happen over 2 – 4 days depending on your recovery. You will be able to bathe as soon as a day after your surgery.
All patients will have an intravenous cannula for the first few days for the administration of fluids and medication. Also, some patients will have a surgical drain leading out from the abdomen to eliminate the fluid inside the abdomen.
After you are discharged and get back home, it will take some time until your bowel movements establish a regular pattern. Typically, the pattern will settle down 3 – 6 months after the surgery.
Incisions will heal after about two weeks. Most patients report feeling of weakness and fatigue following the surgery. This is normal and you should be back to your pre-surgery state 1 – 2 months after the operation.
Dr. Sim Hsien Lin’s main sub-specialty is in colorectal surgery. In addition, her sub interests include laparoscopic colorectal surgery, transanal endoscopic microsurgery, management of piles, inflammatory bowel diseases, complex anal fistulas as well as diagnostic and therapeutic endoscopic procedures.
Dr. Sim Hsien Lin is a specialist colorectal surgeon in Singapore with over 10 years of experience in colorectal surgery. Her sub interests include laparoscopic colorectal surgery, transanal endoscopic microsurgery (TEMS), surgical management of piles, inflammatory bowel diseases and complex anal fistulas.
These two operative options are used in the treatment of symptomatic haemorrhoids (also known as piles) and performed by creating an incision around the anus.
Haemorrhoidectomy is the excision of large and prolapsed haemorrhoids, whereas
Haemorrhoidopexy involves excision and stapling the last section of the anorectum reducing blood supply and ultimately causing haemorrhoids to shrink naturally over time.
This method is suitable for people who suffer from severe and persistent anal fissures, small breaks or cuts in the lining of the anus.
During internal sphincterotomy, the surgeon will make a tiny incision around the anus and incise a small portion of the internal sphincter. This is done to relax the muscles and promote the healing process of the fissure. The sphincter is a group of muscles around the anus that controls bowel movements.
Rectopexy is a type of surgery that repairs rectal prolapse. This condition occurs when the rectum stretches and protrudes through the anus becoming visible externally.
The surgery aims to restore the rectum to its normal position within the pelvis. The procedure consists of the following steps:
The surgery alleviates strictures (narrowing) of the intestines by removing scar tissue caused by inflammation from Crohn’s disease which is a type of Inflammatory Bowel Disease (IBD).
Colostomy creates a stoma through which faeces can pass through the intestines and collect in the external bag. Colostomies can be temporary and permanent.
Temporary colostomy is carried out when there is a probability that the diseased part of the intestines will heal over time. It allows the reattachment of the colon later once the diseased areas have healed.
Permanent colostomy is performed in cases of chronic conditions, like inflammatory bowel disease, diverticular disease or colorectal cancer. During the procedure, your surgeon may also excise the affected area of the colon, rectum or anus.
For this method, your surgeon will use a transanal device with a camera to see the interior of your rectum. This allows large polyps or certain tumours to be removed without creating major incisions. Endoscopic surgery is associated with less pain and discomfort and a faster recovery time.
This is an operation to remove a portion or the whole diseased organ or tissue. Resection encompasses the following procedures:
This surgery is performed to treat rectal cancer. During this operation method, the surgeon removes part of the rectum and attaches the remaining sections (anastomoses) back together. Low anterior resection involves dissection deep into the pelvis.
This method is performed to treat anal and distal rectal cancer. It is done by removing the anus, rectum and part of the sigmoid colon with the draining lymph nodes and supplying blood vessels. Finally, the surgeon will conduct a colostomy to link the end of the colon to a stoma bag.
Also referred to as colon resection, colectomy removes only a portion or the whole large intestine. It is widely used to treat IBD, bowel obstruction, and colon cancer. A colectomy can be divided into the following categories:
Partial Colectomy – refers to the removal of a certain segment of the colon.
Total Colectomy or Total Proctocolectomy – Some conditions require surgical removal of the entire colon which is known as a total colectomy. For some severe cases of ulcerative colitis, your surgeon may recommend proctocolectomy which involves removing both the colon and rectum.
Conditions that can be treated with small bowel resection are cancer, polyps, benign growths, ulcers, and Crohn’s disease. The surgeon will remove the affected parts of the small intestine and rejoin the healthy sections.
During IPPA, your surgeon will remove the entire large intestine (the colon and rectum) affected by a disease. He or she will then, use the last section of the small intestine, called the ileum, to create a pouch that stays permanently within the abdomen to collect waste. Lastly, the pouch is linked to the anus.
Alternatively, the ileostomy is created. In this surgical method, the surgeon will make a small incision in the abdomen to create a stoma. Then, they will attach the end of the small intestine, called the ileum, to the skin. This way, the waste exits the intestine through the stoma and collects in the bag.
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Dr. Sim became a Fellow of the Royal College of Surgeons (Edinburgh) in 2011, winning the Gold Medal award at the FRCS Exit Examination that year.
Dr. Sim firmly believes that transdisciplinary care is the key to supporting both the elderly and complex patients through their perioperative and recovery journey.
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Just like any other surgical procedure, colorectal surgeries involve certain risks and complications which are:
Keeping healthy lifestyle habits will give you the best chance to avoid any complications following the surgery and promote a quicker recovery. Eating a nutrition-balanced diet and exercising regularly is crucial in the weeks before your surgery. Avoid excessive smoking and alcohol consumption at least a few weeks before your operation.
Depending on your particular case, Dr. Sim will provide you with recommendations that will help you minimise the risk of complications after the surgical procedure.
Most patients do experience some pain. This is normal and can be managed with pain killers and improve over time.
You will stay at the hospital for 3 – 10 days depending on the surgery method (open or laparoscopic).
During the home recuperation stage, your bowel movement patterns and stool will gradually come back to normal, completely settling down by the 6 months after the surgery. By 1.5 – 3 months, you will be able to get back to your pre-surgery activity except for heavy lifting and intensive sports training.
A total abdominal colectomy removes the large intestine completely. Once this is done, the small intestine will be connected straight to the rectum. Apart from colorectal cancer, this technique is typically performed to treat Crohn’s disease and severe motility disorders such as colonic inertia.
Total proctocolectomy is the complete removal of the large intestine and rectum. It always involves the creation of an ileostomy or ileal pouch anal anastomosis to regulate bowel movements. This method is typically performed to treat polyposis syndromes and ulcerative colitis.
The type of colorectal surgery recommended to a patient depends on the severity of his or her condition, as well as the location and extent of cancer. As with all medical operations, each of these methods come with a set of risks, but in the hands of a skilled and qualified colorectal surgeon, such procedures are safe and effective in dealing with colorectal cancer or diseases.
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Dr. Sim firmly believes that transdisciplinary care is the key to supporting both the elderly and complex patients through their perioperative and recovery journey.
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