Colorectal surgery
Colorectal surgery is a field in medicine dealing with disorders of the rectum, anus, and colon.<ref>Template:Cite web</ref> The field is also known as proctology, but this term is now used infrequently within medicine and is most often employed to identify practices relating to the anus and rectum in particular.Template:Clarify The word proctology is derived from the Greek words Template:Lang Template:Transliteration, meaning "anus" or "hindparts", and Template:Lang Template:Transliteration, meaning "science" or "study".
Physicians specializing in this field of medicine are called colorectal surgeons or proctologists. In the United States, to become colorectal surgeons, surgical doctors have to complete a general surgery residency as well as a colorectal surgery fellowship, upon which they are eligible to be certified in their field of expertise by the American Board of Colon and Rectal Surgery or the American Osteopathic Board of Proctology. In other countries, certification to practice proctology is given to surgeons at the end of a 2–3 year subspecialty residency by the country's board of surgery.
Scope of the specialty
Colorectal surgical disorders include:<ref>Template:Cite web</ref>
- varicosities or swelling, and inflammation of veins in the rectum and anus (hemorrhoids)
- unnatural cracks or tears in the anus (anal fissures)
- abnormal connections or passageways between the rectum or other anorectal area to the skin surface (fistulas)
- severe constipation conditions
- fecal incontinence
- protrusion of the walls of the rectum through the anus (rectal prolapse)
- birth defects such as the imperforate anus
- treatment of severe colic disorders, such as Crohn's disease
- cancer of the colon and rectum (colorectal cancer)
- repositioning of the rectal area if fallen out
- anal cancer
- any injuries to the anus
- removal of objects inserted into anus
- performing colonoscopies
- performing hemorrhoidectomies
Surgical treatment and diagnostic procedures
Surgical forms of treatment for these conditions include: colectomy, ileo/colostomy, polypectomy, strictureplasty, hemorrhoidectomy (in severe cases of hemorrhoids), minimally invasive surgery, anoplasty, and more depending on the condition the patient has. Diagnostic procedures, such as a colonoscopy, are very important in colorectal surgery, as they can tell the physician what type of diagnosis should be given and what procedure should be done to correct the condition. Other diagnostic procedures used by colorectal surgeons include: proctoscopy, defecating proctography, sigmoidoscopy. In recent times, the laparoscopic method of surgery has seen a surge of popularity, due to its lower risks, decreased recovery time, and smaller, more precise incisions achieved by using laparoscopic instruments.<ref>Template:Cite web</ref>
Mechanical bowel preparation
Mechanical bowel preparation (MBP) is a procedure lacking evidence in literature,<ref>Template:Cite journal</ref> wherein fecal matter is expelled from the bowel lumen prior to surgery, most commonly by using sodium phosphate.<ref>Template:Cite journal</ref> However, recent evidence indicates that combining mechanical bowel preparation with oral antibiotics before elective colorectal surgery probably reduces the risk of surgical site infections and anastomotic leakage compared with mechanical preparation alone, without clear effects on mortality, postoperative ileus, or hospital stay.<ref>Willis MA, Toews I, Soltau SLV, Kalè JC, Meerpohl JJ, Vilz TO. Preoperative combined mechanical and oral antibiotic bowel preparation for preventing complications in elective colorectal surgery. Cochrane Database of Systematic Reviews. 2023;2:CD014909. doi:10.1002/14651858.CD014909.pub2</ref>
Postoperative care
Early enteral nutrition
Evidence suggests that initiating enteral nutrition within 24 hours after lower gastrointestinal surgery may reduce hospital stay, though effects on postoperative complications and mortality remain uncertain.<ref>Herbert G, Perry R, Andersen HK, Atkinson C, Penfold C, Lewis SJ, Ness AR, Thomas S. Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications. Cochrane Database of Systematic Reviews. 2019;7:CD004080. doi:10.1002/14651858.CD004080.pub4</ref>
See also
References
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