Our physicians have earned recognition for their contributions to advancing colon and rectal surgery. At Mount sinai Medical Center, patients can find the most innovative surgical techniques and the most promising, state-of-the-art procedures for a variety of conditions. Our areas of expertise include:
An anal abscess is an infected cavity filled with pus found near the anus or rectum. An anal fistula is usually the result of a previous abscess. It is a small tunnel connecting the anal gland from which the abscess arose to the skin of the buttocks outside the anus.
Symptoms of both include constant pain, sometimes accompanied by swelling that is not necessarily related to bowel movements. Other symptoms include irritation of skin around the anus, drainage of pus, fever, and feeling poorly in general.
An abscess is treated by draining the pus from the infected cavity, making an opening in the skin near the anus to relieve the pressure. Oftentimes, this can be done in a doctor’s office using a local anesthetic. A large or deep abscess may require hospitalization and use of a different anesthetic method.
Surgery is necessary to cure an anal fistula and should be performed by a specialist in colon and rectal surgery. The procedure usually involves cutting a small portion of the anal sphincter muscle to open the tunnel, joining the external and internal opening, and converting the tunnel into a groove that will then heal from within outward. The surgery usually is performed on an outpatient basis; a short hospital stay may be recommended.
Bowel incontinence is the impaired ability to control gas or stool. Causes may include diminished muscle strength with age, injury during childbirth, trauma, or infections around the anal area.
Depending on the severity of the problem, it may be corrected with simple dietary changes, the use of some constipating medications, and exercises to strengthen the anal muscles. In more severe cases, biofeedback maybe used to help patients sense when stool is ready to be evacuated and to help strengthen the muscles. Injuries to the anal muscles may be repaired with surgery. Surgery may entail sphincter repair or reconstruction. Implantation of an artificial device also may be effective.
Diseases such as colitis, which cause inflammation in the rectum, may contribute to anal control problems. Treating these diseases also may eliminate or improve incontinence. Additionally, a change in prescribed medications may help.
A colonscopy is a safe, effective means of visually examining the full lining of the colon and rectum using a long, flexible, tubular instrument. It is used to diagnose colon and rectum problems and to perform biopsies and remove colon polyps. Most colonoscopies are performed on an outpatient basis.
After the colon is thoroughly cleared of all residue with a special preparation prescribed by a physician, a colonoscope is inserted and advanced to the portion of the colon where the small intestine enters. The procedure usually takes less than one hour and there is little pain. When necessary, a mild sedative is given to relieve anxiety and discomfort.
The benefits of colonoscopy include its ability to detect and remove most polyps without abdominal surgery. It is more accurate than an x-ray of the colon to detect polyps or early cancer. Oftentimes, polyps can be removed at the same time, which is a major step towards the prevention of colon cancer.
A colonoscopy is recommended if a patient has a change in bowel habit or bleeding, which may indicate a possible problem in the colon or rectum. It is also necessary to:
- Check unexplained abdominal symptoms
- Check inflammatory bowel disease (colitis)
- Verify findings of polyps or tumors located with a barium enema exam
- Examine patients who test positive for blood in the stool
- Monitor patients with a past history of colon polyps or cancer or those over age 40
It is also recommended as a screening tool for colorectal cancer in all people age 60 and over.
Colorectal cancer is the second most common cancer in the United States. It affects about 140,000 people each year and results in approximately 60,000 deaths. However, the disease is potentially curable if diagnosed and treated in its early stages.
Although colorectal cancer may occur at any age, more than 90 percent of patients are over age 40. At this age, the risk doubles every 10 years. In addition to age, other high-risk factors include a family history of colorectal cancer and polyps and a personal history of ulcerative colitis, colon polyps, or cancer of other organs.
Colorectal cancer is a silent disease. However, as it becomes more advanced, rectal bleeding and changes in bowel habits, i.e. constipation or diarrhea, abdominal pain, and weight loss, may develop. Colorectal cancer requires surgery in almost all cases for complete cure. Radiation and chemotherapy are sometimes used, in addition to surgery. Between 80 and 90 percent of patients are restored to normal health if the cancer is detected early.
Diverticulosis of the colon is a common condition that affects about 50 percent of Americans by age 60 and nearly all by age 80. Only a small percentage of those affected have symptoms and even fewer will ever need surgery.
Diverticula are pockets that develop in the colon wall, usually in the sigmoid or left colon, but may involve the entire colon. Diverticulosis describes the presence of these pockets. Diverticulitis describes inflammation or complications of these pockets.
The major symptoms of diverticular disease are abdominal pain, diarrhea, cramps, alteration of bowel habit and, occasionally, severe rectal bleeding. These symptoms occur in only a small number of patients and can be difficult to distinguish from Irritable Bowel Syndrome. Diverticulitis may cause one or more of the following: pain, chills, fever, and change in bowel habits. More intense symptoms are associated with serious complications, such as perforation, abscess, or fistula formation.
Diverticulosis and diverticular disease are usually treated by diet and occasionally with medications to help control pain, cramps, and changes in bowel habit. More serious cases may be managed with hospitalization, oral or intraveneous antibiotics, dietary restrictions, and stool softeners. Surgery may be recommended for recurrent episodes, complications or severe attacks when there is little or no response to medication.
Familial Polyposis Syndromes
Familial polyposis is an inherited condition primarily affecting the large intestine (colon and rectum). Many polyps, sometimes hundreds, develop on the inner lining of this part of the bowel and eventually become malignant if not treated.
These polyps commonly develop just after puberty. Approximately half of all patients will have polyps by age 14. Ninety percent will have detectable polyps by age 25. By age 35 to 40, one or more of these polyps will become cancerous.
Many individuals develop polyps and have no symptoms. Others experience diarrhea, constipation, abdominal cramps, bloody stool, or weight loss. Patients may also develop other malignant and nonmalignant tumors and/or some bone, skin and dental abnormalities. In addition, they may exhibit a “spot” on the retina of the eye.
The only definitive treatment for familial polyposis is surgical removal of the lower intestine. Since the goal is to prevent cancer, the operation is done as soon as polyps are discovered. There are several types of surgery to treat this condition and the surgeon and patient will determine which is best for his or her particular case.
Hemorrhoids are enlarged, bulging blood vessels in and around the anus and lower rectum. External hemorrhoids develop near the anus and are covered by very sensitive skin. Painful swelling may occur if a blood clot develops in one. An external hemorrhoid feels like a hard, sensitive lump and bleeds only if it ruptures. Internal hemorrhoids develop within the anus beneath the lining. The most common symptom is painless bleeding and protrusion during bowel movements. However, pain may occur if the hemorrhoid protrudes from the anal opening and cannot be pushed back inside.
Treatment of mild hemorrhoids may include increasing the amount of fiber and fluids in a patient’s diet. Additionally, eliminating excessive straining may help and sitting in plain, warm water for about 10 minutes may bring some relief. In more severe cases, the hemorrhoid may be surgically removed. This is done under anesthesia on an outpatient basis.
Inflammatory Bowel Disease
Crohn’s Disease and ulcerative colitis are often grouped together as inflammatory bowel disease.
- Crohn’s Disease
Crohn’s Disease is a chronic inflammatory condition primarily involving the intestinal tract. It most commonly affects the end of the small intestine and/or the large intestine. Because it is a chronic condition, Crohn’s may recur over a lifetime. Although symptoms may vary greatly from patient to patient, more common ones include cramping, abdominal pain, diarrhea, fever, weight loss, and bloating.
Any age group can be affected by Crohn’s Disease, but the majority of patients are between 16 and 40. It occurs equally in men and women and appears to run in families. Initial treatment for Crohn’s usually is the use of medication. Surgery may be recommended for more advanced or complicated cases. The most common procedure for these cases involves removal of the diseased portion of the bowel.
- Ulcerative Colitis
Ulcerative colitis is an inflammation of the lining of the large bowel, or colon. Symptoms include rectal bleeding, diarrhea, abdominal cramps, weight loss, and fever. Patients who have had severe ulcerative colitis for many years are at an increased risk to develop colon cancer.
Like Crohn’s Disease, the initial treatment for ulcerative colitis is the use of medication. Surgery may be necessary for patients who have the chronic form of the disease – not just occasional “flare ups” – and for those in whom medication is not effective. There are various types of surgical treatments that involve the removal of the colon and/or rectum, and a colorectal surgeon will determine which is most appropriate for each patient.
Minimally Invasive Colon and Rectal Surgery
- Laparoscopic Colon Surgery
Also referred to as minimally invasive surgery or keyhole surgery, laparoscopic surgery is a technique that uses a long, thin telescope-like instrument (the laparoscope) attached to a video camera that projects images onto a video monitor. The surgeon performs the operation as he or she watches the image on the monitor. This type of procedure allows surgeons to view a patient’s organs and internal structures and perform entire surgeries through tiny incisions, often no longer than five millimeters. These small incisions are one of the major advantages of laparoscopic surgery, because they result in less discomfort, quicker recovery, and a better cosmetic result. Our colon and rectal surgeons perform various colorectal procedures laparoscopically for a number of diseases. Although considered standard therapy for some benign disorders, this minimally invasive approach is still being used in a limited fashion for highly-select cases.
- Transanal Endoscopic Microsurgery
Mount Sinai Medical Center is the first hospital in Miami-Dade County, and one of only a few in the nation, to offer patients an incisionless option for removal of early stage rectal cancers. Transanal endoscopic microsurgery (TEM) is the first clinically proven and utilized procedure in which a natural opening in the body is used as the entry for performing surgery. TEM allows for the precise removal of rectal polyps and early rectal cancers, which can not be removed via the colonoscope, through the anus. The technique represents an alternative for some patients to procedures performed transabdominally that require a resection of the rectum.
- Stapled Transanal Endoscopic Microsurgery (STARR)
STARR is the first truly effective operation for obstructed defecation syndrome and allows for a short recovery and causes minimal pain and no long-term side effects.