COLORECTAL SURGERY BLOG

Irritable bowel syndrome (IBS) is a common disorder which may affect as many as 30% of all Americans at some point during their lives. A ‘syndrome’ is a pattern of symptoms, such as pain and bloating, which tend to occur together. IBS is not a ‘disease’ in the sense that it can be acquired or transmitted, like a cold. It is not life-threatening.

Fiber is an edible material that is derived from the cell wall of plants. It is an essential part of a well-balanced diet whose importance is being increasingly recognized. Studies show that dietary fiber may help prevent such diseases as colon cancer, diverticular disease, elevated cholesterol, chronic constipation and hemorrhoids. We know, for instance, that different countries with higher fiber intakes have lower rates of colon cancer and diverticular disease. A word of caution: these studies are not conclusive or final. They are open to interpretation and need verification.

A 15- to 35- minute minimally invasive procedure is the new gold standard for hemorrhoidectomy, according to American and European experts in the field. The procedure, known as PPH (procedure for prolapse and hemorrhoids) stapled hemorrhoidectomy, combines hemorrhoidal devascularization and repositioning to return the veins to the anal canal. “This year, this is the revolutionary new procedure in the United States,” Gary Hoffman, MD, clinical faculty member in general and colorectal surgery, Cedars-Sinai Medical Center, Los Angeles, told General Surgery News after moderating a live PPH telesurgery at the 2003 annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons. “PPH stapled hemorrhoidectomy will supplant the traditional open operations in patients with symptomatic grades 3 and 4 hemorrhoids, because it results in a tremendous reduction in postoperative pain, and in a rapid return to work and to activities of daily living.”

Minimally invasive surgical techniques have gained popularity in the treatment of many benign diseases. However, there have been concerns surrounding the laparoscopic approach in the removal of colorectal carcinomas.Recently, these questions have been addressed in well-controlled, prospective, randomized studies.

Approximately 150,000 new cases of colorectal cancer are diagnosed each year in the United States. It is the second leading cause of cancer mortality, resulting in almost 60,000 deaths every year.1 Cancer of the colon and rectum most commonly develop from precursor adenomatous polyps that increase in size over time.2,3 Early detection and removal of these premalignant polyps usually prevents them from developing into invasive cancer.4,5 This is the rationale behind the colorectal cancer screening recommendations from the American Cancer Society and the American College of Gastroenterology.

Located at the most inferior part of the abdominal cavity, the pelvic floor is a network of muscles, ligaments, and tissues that act like a hammock to support the organs of the abdomen and pelvis. Caused by weakness or injury to this pelvic sling, pelvic floor disorders result in a prolapse of the rectum, small bowel, bladder, or uterus.

The rectum is a specialized reservoir which provides vital sensory and storage functions for the gastrointestinal system. When diseases such as inflammatory bowel disease, cancer, polyposis or congenital anomalies require the surgical removal of the rectum, an important part of the body is lost. Quite often, these disease processes occur in young patients between the ages of 30 and 45. Physical and emotional adjustments must be made to compensate for this loss. Research has been directed toward finding a suitable replacement for the surgically removed rectum. The major focus of investigation has been on the creation of a neorectum, or rectal pouch.

The anorectum is a specialized region of the gastrointestinal tract, performing sensory, storage and elimination functions. The mucosal lining in the rectum is columnar. It transitions to a squamous mucosa in the anal canal. It is richly endowed with discriminatory nerve endings to allow the body to distinguish between flatus, liquid and solid waste. While sturdy, the mucosal surfaces are vulnerable to trauma and infections. With or without an anal or rectal injury, sexually transmitted disease may be the source of considerable morbidity. While symptoms may be found in patients with normal immune systems, they are found in increasing frequency in the immunocompromised population. In patients with pre-existing systemic conditions such as AIDS or HIV, common pathogens may take on an even more ominous clinical significance. Part I of this two-part article contains a discussion of the anorectal manifestations of the most common sexually transmitted diseases.

At any given time in the United States, twenty million men and women have an active Human papillomavirus (HPV) infection. Five million new cases are diagnosed each year. These represent one third of all cases of newly diagnosed sexually transmitted infections. In addition to the morbidity of the disease itself, HPV is strongly associated with the development of squamous cell carcinoma of the anus. Hence, this ubiquitous virus has taken on a more menacing significance than simply that of an inconvenient sexually transmitted disease.

With the development of a new material and a relatively painless technique to close a perianal or perirectal fistula, it is useful to review the pathophysiology and treatment options for anal abscesses and anorectal fistulae. The new material, Surgisis®, is composed of po­­­rcine small intestinal submucosa ­rolled into a conical shape and inserted into an existing fistula (figure 1). This allows for tissue ingrowth and fistula closure.