Colorectal Surgery in Sydney

The colon and rectum (also known as large intestine) are organs situated at the end of the gastrointestinal tract, between the distal part of the small intestine (ileum) and the anus.

It is shaped like an inverted ‘U’ starting on the right lower side of the abdomen, where the appendix is and finishes in the pelvis (rectum) just before the anus. The function of the large intestine is to absorb certain vitamins, salts, nutrients and remaining water that were not assimilated earlier in the small intestine. Finally to eliminate solid wastes (faeces) from the body.

Several disease may develop into the large intestine, the most common being diverticular disease (‘outpouching’ of the colon mucosa through the muscle wall alongside small blood vessels) most of the time arising from the sigmoid colon, polyp formation (cheery-shape lesion arising from the lining of the large intestine), and bowel cancer.

Diverticular Disease (Diverticulosis)

A video camera with fibre optic cables is inserted into the abdominal cavity via a canula (or port). It is usually inserted at the umbillcus (belly button), but can be placed elsewhere, depending on the procedure.
The abdomen is usually insufflated (inflated) to create a working and viewing space. The surgeon, through additional side ports can then use thin specialised surgical insruments and safely perform the operation.

Diverticular disease consists of ‘outpouching’ of the colon mucosa through the muscle wall alongside small blood vessels, most commonly arising from the sigmoid colon, just before the rectum. The size of these diverticulae (pockets) may vary from few mm to about 1cm. It is more common in Western countries where fibre diet is poor.

Complications

Diverticulitismay occur when a diverticulum becomes blocked causing infection. This generally occurs in the sigmoid colon causing localised pain in the left lower abdomen and fever. Abdominal CT-scan is the diagnostic of choice and initial treatment consists of intravenous antibiotics and bowel rest.

Severe diverticulitis may be complicated by an abscess formation outside the bowel wall or in worst cases may result in bowel perforation and peritonitis (general abdominal infection).

Bowel obstruction from narrowing of the colonic lumen generally occurs as a result of recurrent episodes of diverticulitis that lead to progressive thickening and scaring of the bowel wall.

Fistula formation represents a delayed complication of contained perforated diverticulitis where an abnormal connection develops between the colon and a bordering organ, mainly the bladder, the small bowel and the vagina in female patients.Who needs bowel resection (colorectal surgery)?

Who needs bowel resection (colorectal surgery)?

Patients with recurrent attacks of severe diverticulitis
Patients with peritonitis from perforated diverticulits
Fistulae formation (colovesical, colovaginal, coloenteric)
Colonic stricture causing large bowel obstruction
Inability to rule out an underlying colonic cancer

How is colorectal surgery performed?

The sigmoid colon is the most commonly affected segment of large bowel.
Removal of the sigmoid colon (sigmoid colectomy) is the treatment of choice.
The procedure is performed under general anasthaesia and the patient stays in hospital between 4-5 days.
Prof. Berney’s preferred surgical approach is a laparoscopic (keyhole) sigmoid colectomy as it offers clear advantages to the patient, compared to open surgery:
- Colon function normalizes faster
- Faster recovery time and shorter hospitalisation
- Less postoperative pain and significant reduction of complications
- Quicker return to normal activities
- Excellent cosmetic result

The procedure is achieved using a laparoscope (tiny telescope attached to a video camera) and thin long instruments inserted into 4 small skin cuts (5-12mm).
The aim of the operation is to safely remove the sigmoid colon and join the descending colon to the upper part of the rectum. This ‘end-to-end anastomosis’ is performed with a special circular stapling device.
Once the sigmoid colon has been retrieved from the abdominal cavity (via a small transverse incision), a drain (plastic tube) is left in the pelvis until time to the return of first bowel movement.
Once discharged home, the small waterproof dressings covering the wounds can be safely removed 5 days later and there is no need to cut off the stiches as they spontaneously dissolve within few weeks.
Patient may eat and drink normally and follow-up appointment is made for 2 weeks after surgery.

Polyp Formation

Colorectal polyp is a small non-cancerous (benign) outgrowth of tissue arising from the inside lining (mucosa) of the colon or rectum. It can vary in size and shape, from few mm to several cm in diameter. Some polyps are quite flat whereas others are attached to a small stalk (or pedicle).

The majority of polyps do not cause any symptoms, but on some occasions may become cancerous (malignant). The larger the polyp is, the likelier the risk of transformation into cancer.

Most polyps can be removed endoscopically with a colonoscope, which is a long flexible and narrow tube with a light and a small camera on the end. Special instruments can be introduced through the scope to excise (snare) the polyps.

Some of these polyps cannot be resected endoscopically due to technical or anatomical (large polyps with wide base) reasons, or when the polyp has already transformed into cancer. In those situations a surgical bowel resection is necessary and the type of procedure will depend on the lesion location.

Bowel (Colorectal) Cancer

Bowel cancer is a malignant growth that develops in around 85% of the cases from polyp lesions. Excluding skin cancer, this is the third most common cancer in the Western world and is generally diagnosed in patients between 50 and 80 years of age.

Although in the majority of the cases there are no identifiable risk factors (sporadic), it seems that inactive lifestyle, poor diet (low vegetable and fresh fruit intake, high consumption of red and processed meats) and obesity may promote bowel cancer development.

Symptoms

Fresh or dark rectal bleeding
Blood or mucus mixed with stools
Unexpected change of bowel habit
Feeling of incomplete bowel emptying
Abdominal pain and/or distension
Progressive weakness or lethargy (iron deficiency anaemia)
Weight loss and/or loss of appetite

Who needs bowel resection (colectomy or proctectomy)?

Patients with colon or rectal cancer
Patients with malignant (cancerous) polyp
Patients with large polyp, not suitable for endoscopic (colonoscopy) removal
Patients with rectal cancer will sometimes need other form of treatment before surgery, such as radiotherapy.

How is colectomy or proctectomy (rectum) performed?

The type of bowel resection will depend on the cancer location.
The colorectal surgeon Prof. Berney’s preferred surgical approach is laparoscopy (keyhole) as it offers clear advantages to the patient, compared to open surgery:
- Colon function normalizes faster
- Faster recovery time and shorter hospitalisation
- Less postoperative pain and significant reduction of complications
- Quicker return to normal activities
- Excellent cosmetic result
The most common procedures performed by Prof. Berney include:
- Laparoscopic right hemicolectomy
- Laparoscopic partial colectomy
- Laparoscopic anterior resection (proctectomy)
- Laparoscopic subtotal, total colectomy
- Laparoscopic Hartmann’s or reversal of Hartmann’s procedure
- Laparoscopic formation of colostomy or ileostomy

The procedure is performed under general anasthaesia and the patient stays in hospital between 3-5 days, depending on the type of procedure.
The procedure is achieved using a laparoscope (tiny telescope attached to a video camera) and thin long instruments inserted into 4 or 5 small skin cuts (5-12mm).
The aim of the operation is to safely remove the segment of diseased bowel and re-join both remaining ends of the large bowel together. The mechanical ‘end-to-end anastomosis’ is performed with special stapling devices.
Once the cancer has been retrieved from the abdominal cavity (via a small transverse incision), a drain (plastic tube) is often left in the pelvis until time to the return of first bowel movement.
Once discharged home, the small waterproof dressings covering the wounds can be safely removed 5 days later and there is no need to cut off the stiches as they spontaneously dissolve within few weeks.
Patient may eat and drink normally and follow-up appointment is made for 2 weeks after surgery.
Bowel specimens are looked at under the microscope and depending on the results patients may require additional anti-cancer treatment (adjuvant chemotherapy). This treatment generally consists of six cycles over a period of 6 months.

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Colorectal Surgery

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