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Laparoscopic Colorectal Surgery
These are operations which often involve the removal of a part or sometimes the entire large bowel. The large bowel consists of the colon and the rectum and is illustrated in the diagram below.
Although these operations are often performed using the traditional ‘open’ method with a large cut across the abdomen, the laparoscopic (key-hole) method has the advantage of causing less post operative pain and patients are able to return to full activity in a shorter time.
The operation involves three or four small cuts in the abdominal wall through which the camera and operating instruments are inserted and then a moderate sized cut is made through which the resected bowel is removed. The two ends of bowel are then joined back with sutures or a special stapling device.
Before the operation
You will be seen in the clinic and will have opportunity to go through the details of the operation including the intended benefits, alternative procedures and potential risks.
Your general health will also be assessed (usually at a separate clinic appointment) with some simple tests and you will be reviewed by the anaesthetist either in this clinic or when you come in for your operation.
You will usually come into hospital a day before the operation.
Bowel preparation (cleansing with laxatives) is not usually required and you can usually eat and drink as normal until about six hours prior to the intended time of the operation. It may be recommended that you have a low residue diet for a couple of days before the operation.
Single Incision Laparoscopic Surgery (SILS)
Single Incision Laparoscopic Surgery (SILS) is a recent form of surgery that i have helped develop. It involves only one cut in the skin, usually at the belly button, which allows even faster recovery than standard keyhole. I have been amongst the first in the world to carry out this surgery enabling several patients to go home on the day of surgery with minimal pain. Here is my presentation on SILS which shows my results from standard laparoscopic cancer surgery (with recent hospital stays of only 3 days) which may be improveable in the future. It also shows me performing a SILS appendicectomy and SILS incisional hernia repair who were both home a few hours later.
Colonoscopy
Colonoscopy is perhaps the most effective method of diagnosing and also preventing colorectal cancer. The way colonoscopy prevents colorectal cancer is by stopping polyps turning into cancers. 1 in 20 people will get colorectal cancer but if there is a close relative who also had the disease then the odds can be as low as 1 in 10. After clearing out the bowels a colonoscopy can be performed under minimal sedation in 75% of patients, and more than 90% of the time the whole colon can be viewed.
As many as 1 in 3 people get polyps (which are wart like growths) in the large bowel. Colonoscopy detects over 90% of polyps, which can be destroyed or snared. It is important you know your surgeons major bleeding and perforation rate for this procedure and the risk to benefit ratio is discussed beforehand. I carry out over 250 colonoscopies every year and currently have a 0% perforation rate.
Introduction
Transanal endoscopic microsurgery (TEMS) is a minimally invasive surgical technique, which is performed endoluminally (inside the lumen of the rectum). It is primarily used for the removal of rectal tumours, both benign and malignant that cannot be removed by colonoscopy. The procedure may also be used on patients who are unfit or unwilling to undergo conventional open surgery. The relatively elderly local Dorset population forms a group perhaps most appropriate for the use of TEMS.
NOTES
NOTES: Because we Can or Because we Should?
Manish Chand and Guy F Nash
The demands of surgical evolution necessitate constant improvement, but may some technological advances be ultimately detrimental to what we set out to achieve? Natural Orifice Transendoluminal Surgery− (NOTES−) is a novel surgical technique which shatters the traditional boundaries of minimally-invasive surgery. Potentially the most exciting surgical innovation since the inception of laparoscopic surgery, encouraging reports of NOTES procedures have been seen in animal models, ranging from diagnostic biopsies to cholecystectomies. But with reports of the first human trials recently published – the operation Anubis – there is a danger that such technological advances, rather than benefit patients, may present safety risks similar to those experienced early in the history of laparoscopic surgery.
Botox for Anal Fissure
BOTOX for Resistant Chronic Anal Fissure
During the past few years there has been renewed interest in the medical management of chronic anal fissure. For those patients who have failed topical GTN and Diltiazem, surgery usually is the next treatment offered. A group of patients who have had previous insults to anal continence, including difficult obstetric deliveries or anal surgery, are most at risk of frank incontinence following fissure surgery. Botox (botulinum neurotoxin) has been recently established as a second or third line treatment, following failed topical treatments in those at highest risk of incontinence. In addition, occasionally patients unable to comply with topical treatment or those unsuitable for a general anaesthetic would be candidates for botox as first line treatment.
Pilonidal Surgery
Pilonidal means “nest of hairs” and between the buttocks is a site that hairs (usually from the scalp) have burrowed deep to the skin and created a foreign body reaction. Once the hairs are beneath the skin in the midline they cause repeated eruptions of infection. Traditionally the surgery for this condition was to make an incision in the midline between the buttocks to remove the hairs, however this cut was an invitation for further hairs and the recurrence rates were high, in fact the surgery was often worse than the disease!
Fistula Plug for High Anal Fistulae
Fistula Plug Treatment for High (Complex) Anal Fistulae
An anal fistula is an abnormal tunnel with an internal (“primary”) opening in the rectum and an external (“secondary”) opening in the skin surface near the anus. Anal fistulae typically arise from an abscess developing in glands adjacent to the anus; these abscesses sometimes form a passage connecting the anal canal to the skin. Other conditions that predispose to fistulae include malignancy, Crohn’s disease, inflammatory bowel diseases, radiation therapy and also as a complication of surgery.
Patient Information
Patient Information
I have written a basic patient information sheet regarding major colorectal procedures. It covers the processes involved in the operation and the known risks.
Please click here for my Colorectal Surgery Information Sheet.
I have also written a Fast Track Recovery Guide which gives self-help information to ensure a speedy recuperation after surgery.
Please click here for my Fast Track Recovery Guide.
The above procedures cover laparoscopic (minimal access or keyhole) surgery. A new type of surgery called Natural Orifice Surgery (NOTES) is gaining popularity as it has no skin cuts at all. For certain patients, Transanal Endoscopic Microsurgery (TEMS) can be performed via the bottom and will aid recovery times
Please click here for a paper I have written on Natural Orifice Surgery (NOTES).
Please click here for a video showing Transanal Endoscopic Microsurgery (TEMS) being performed.
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The Harbour Hospital
Bournemouth Nuffield
