Colorectal Surgery

When you have bowel (large intestine) problems, colorectal surgery may be the best treatment. This includes many different conditions, like:

• Colorectal cancer.
• Rectal cancer.
• Bowel tumors.
• Inflammatory bowel disease (IBD).
• Intestinal blockages (large bowel obstructions).
• Diverticulitis.
• Colon polyps.
• Anal fissures and fistulas.
• Rectal prolapse.

But before we even book your operating room, we make sure surgery is necessary. We do this by confirming your diagnosis and ruling out other conditions that could be treated without surgery.

What to expect during your consultation

You may feel nervous when you come in for your first appointment. And that’s OK. But it’s important to know our team has you covered. We’re here to help you understand each step of your diagnosis and treatment, and, hopefully, to make you feel more at ease with taking the next step.

That’s why your provider will take time to talk with you before doing a physical exam. They’ll want to hear about any earlier appointments and tests you’ve had to address this condition. And they’ll want to hear about symptoms and how they’re affecting your life. You’ll want to be ready to talk about your personal and family medical history, too.

Tests you may have before colorectal surgery

Many different conditions can cause colon problems. So, your provider will set up some tests to help them confirm a diagnosis.

They’ll send a sample of your poop to the lab to see if you have any rectal bleeding. Our lab pathologists will also look for genetic changes, bacteria or parasites. Blood tests are another way to help us look for signs of infection or inflammation.

If we suspect you have colon cancer, we may also do a test called a carcinoembryonic antigen (CEA) assay. This test looks for a high level of a substance that cancer cells release into your bloodstream.

We’ll also look inside your rectum and colon by doing:

• Colonoscopy.
• Virtual colonoscopy.
• Flexible sigmoidoscopy.
• Proctoscopy (rigid sigmoidoscopy).
• Imaging tests like a CT scan.

And we may do a biopsy to see if any polyps or tumors we find are cancerous.

Meet Our Colorectal Surgery Team

We believe everyone deserves the most personalized care from providers who meet their unique needs. Besides a colorectal surgeon, your care team may also include:

• Gastroenterologists.
• Anesthesiologists.
• Oncologists.
• Nurse anesthetists.
• Nurse practitioners.
• Ostomy nurses.

Your care team uses what they’ve learned from your consultation and testing to build a highly personalized colorectal surgery plan.

As often as possible, we try to use minimally invasive, robotic surgery and laparoscopic surgery. We do this by making several small cuts (incisions) in your belly (abdomen). And then use a tiny camera called a laparoscope and small tools to do the surgery. You’ll have a quicker recovery with less pain. We also can do this surgery using robots.

Other times, we may decide open surgery might be best. This may be necessary if you have a complicated condition or need emergency surgery. We’ll make one long incision on your abdomen. Recovery from open surgery is usually longer than minimally invasive surgery.

Rectal prolapse surgery

Our providers can repair rectal prolapse. This happens when the end of your colon (rectum) slides into your anus (the opening where your poop leaves your body). It can feel like pressure or a bulge in your anus after you poop.

We can put the rectal tissue back in place with a surgery procedure known as a rectopexy. We try to use minimally invasive laparoscopy in your abdomen. Or we may do it in the area between the vagina or penis and the anus (perineum). This is called a proctosigmoidectomy. We go through the last part of your colon that joins with the rectum — the sigmoid colon.

Depending on your diagnosis, your providers may do open abdominal rectopexy — particularly if you also need a bowel resection (colectomy). We can also use robotic surgery to do a rectopexy with a bowel resection.

Bowel resection surgery (colectomy)

If your colon has stopped working, you may need a colectomy. We remove part or all of your colon laparoscopically or as open surgery.

If it’s emergency surgery, our team may do a colectomy called Hartmann’s procedure. This surgery can remove a blockage or cancer or treat a persistent infection. We remove the sigmoid colon and possibly part of your rectum.

When you have a colectomy, we often can reconnect the remaining ends of your large intestine during surgery. Or we may need to find a different way for you to poop, either temporarily or permanently, with an ostomy. This is always the case for Hartmann’s procedure.

Ostomies

When your care team talks about an ostomy, it means waste will now leave your body through a hole in your abdominal wall (stoma). There are two ways to do this:

• Colostomy to connect your large intestine to the stoma.
• Ileostomy to connect your small intestine to the stoma, bypassing your colon.

A pouch (colostomy bag) on the outside of your body collects the poop in either case. You’ll need to regularly empty and clean the pouch. You may be a candidate for colostomy irrigation, which eliminates the pouch. Instead, you’ll flush the colon with water through the stoma. You’ll wear a cover over your stoma between cleanings.

We know that the idea of an ostomy can be unsettling. But our team is here to guide and support you as you adapt to this change. We make sure you learn everything you need to know, no matter whether your ostomy is temporary or permanent.

Proctocolectomy

A proctocolectomy, another type of colectomy, removes your colon and rectum. This makes up the biggest part of your large intestine. If you have this surgery, you’ll need a new pathway for pooping. This means you’ll need an ostomy or an internal solution — an ileal pouch.

Ileal pouch surgery

If you’re a candidate for ileal pouch surgery (ileal pouch-anal anastomosis), you can poop the regular way. You won’t need to wear an external colostomy pouch.

Instead, we’ll use the lowest part of the small intestine (ileum) to form a new reservoir to store waste. The pouch connects to your anus, so stool moves out of your body in the usual way. It won’t be solid like it used to be.

There are three kinds of ileal pouches — J-pouch, S-pouch and K-pouch (Kock pouch). For successful J- or an S-pouch surgery, your intestines, anus, anal sphincter muscles and pelvic nerves must be able to work as usual. Recovery can take up to nine months. The K-pouch, done only rarely, works as an alternative to an ileostomy or if a J- or S-pouch won’t work.

Transanal surgery

We may do transanal surgeries in hopes of reducing the chance you’ll need a permanent colostomy.

• Transanal endorobotic submucosal dissection (ERSD) may be used to treat you if you have rectal tumors. Surgeons use small tools in your anus to reach your rectum. We make no incisions. This is a less-painful alternative to traditional open surgery — with quicker recovery.
• Transanal minimally invasive surgery (TAMIS) treats noncancerous polyps or early-stage cancer in your rectum and sigmoid colon.
• Transanal total mesorectal excision (taTME) uses minimally invasive methods to remove lower rectal cancer tumors without large incisions.

Abdominoperineal resection

During an abdominoperineal resection (APR), we remove your anus, rectum and sigmoid colon. We use this most often to treat advanced cancer low in your rectum. You’ll have a permanent colostomy pouch after this surgery. Or we may recommend colostomy irrigation.

Life After Colorectal Surgery

Now that you’re out of the operating room, you may wonder what your life will be like. Will you need a colostomy pouch? Will you still be able to do all the things you enjoy?

Our team is here to support you every step of the way. We’ll help you manage a colostomy pouch if you have one. We’ll find the right mix of foods for you to eat so you can feel your best.

And we’ll check in with you at regular appointments to make sure you aren’t having complications. And that you’re feeling OK mentally and emotionally. If you want, we can connect you with support groups or counseling. We don’t treat your medical condition — we treat the whole you.

Taking the Next Step

When you learn you need colorectal surgery, you probably have a lot running through your mind. Like where to find the best care for your unique diagnosis. Cleveland Clinic has the people and support you need to make your way through surgery, recovery and follow-up care. We help make complicated things feel less stressful. And we make sure you’re always at the center of everything we do. We’ve got you covered.