What is Colorectal Surgery?

 Colon & Rectal Surgery or colorectal surgery is a specialty that manages a range of pathologies involved in the colon (large intestine), rectum, and anus. The colorectal surgeon is an expert in providing both medical and surgical treatments. 

 The colorectal surgeon can treat a wide range of conditions using non-surgical and surgical treatments. Conditions include:

• Cancer of the colon, rectum, or anus
• Inflammatory bowel disease (IBD) – Crohn’s disease or ulcerative colitis
• Diverticulitis
• Hemorrhoids
• Anal fissures
• Abscesses
• Fistulas
• Rectal prolapse
• Bowel obstruction
• Fecal incontinence
• Pelvic floor disorders
• Rectocele
• HPV/anal warts

Colon and Rectum 

Resections of the colon and rectum are performed through the abdomen with either minimally invasive or open techniques. The minimally invasive approach involves working under a camera and thin surgical instruments to perform the surgery inside the abdomen through small incisions. The surgical instruments can be handled by the surgeon manually or with the assistance of a robotic system. Preference is always made for the minimally invasive approach as long as it is safe and feasible. Otherwise the surgeon approaches the surgery in traditional open fashion with a large incision. Typical procedures a colorectal surgeon may perform include:

• Partial colectomy
• Total colectomy
• Proctectomy
• Abdominal perineal resection
• Creation of ostomy
• Rectopexy

Anorectal

Surgeries involving the anal canal and lower part of the rectum are typically performed in an ambulatory setting, allowing for the patient to go home the same day of the procedure. Typical anorectal surgeries include:

• Hemorrhoidectomy
• Lateral internal sphincterotomy
• Botox injection
• Fistulotomy or complex repair of fistula
• Seton placement
• Anal wart fulguration
• Rectal prolapse repair

 There are overlaps in practice with the medical subspecialty of gastroenterology and the surgical subspecialty of colorectal surgery. Particular common overlaps include anorectal diagnoses (i.e. hemorrhoids, anal fissures, constipation), Crohn’s disease, ulcerative colitis, and colon cancer. The biggest difference is that gastroenterologists primarily manage the medical aspects of gastroenterology disorders while the colorectal surgeon specialize in the surgical management. Oftentimes, there is a need for both specialists to work together for best results.

To become a colorectal surgeon, one must undergo a 5 to 7 year residency training in general surgery, then receive an additional year of subspecialty training (fellowship) in colorectal surgery. To become a gastroenterologist one must go through a 3 year residency training in internal medicine, then undergo 3 additional years of fellowship in gastroenterology.

Both specialists are experts in colonoscopies (lower endoscopies). However the gastroenterologist has a wider armamentarium of endoscopic techniques which include esophagogastroduodenoscopies (EGD or upper endoscopy), endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP), and others depending on their training. Gastroenterologists, however do not perform surgeries.