Colorectal surgery

Short description: Field in medicine for disabilities in the rectum

thumb Colorectal surgery is a field in medicine dealing with disorders of the rectum, anus, and colon.[1] 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. The word proctology is derived from the Greek words πρωκτός proktos, meaning "anus" or "hindparts", and -λογία -logia, 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.

## Contents

* 1 Scope of the specialty
* 2 Surgical treatment and diagnostic procedures
* 3 Laser therapies in colorectal surgery
* 4 Mechanical bowel preparation
* 5 Postoperative care
* 5.1 Early enteral nutrition
* 6 See also
* 7 References

## Scope of the specialty

Colorectal surgical disorders include:[2]

* 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)
* pilonidal disease (pilonidal sinus / pilonidal cyst)
* 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

Gross pathology of a tubulovillous adenoma resected by minimally invasive colorectal surgery.

Surgical forms of treatment for these conditions include: colectomy, ileo/colostomy, polypectomy, strictureplasty, hemorrhoidectomy (in severe cases of hemorrhoids), minimally invasive surgery, including laser surgery, as well as 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.[3]

## Laser therapies in colorectal surgery

Minimally invasive laser-based techniques are used in the treatment of hemorrhoidal disease, pilonidal disease, anal fistulas, and anal fissures. Systematic reviews and guideline-based recommendations have evaluated laser-based interventions for these indications, with high-level evidence available for some procedures.[4][5][6][7] Clinical practice recommendations identify symptomatic grade II and III hemorrhoids as standard indications for laser hemorrhoidoplasty as a standalone procedure.[8] For anal fistulas, guideline-based recommendations describe fistula laser closure as a sphincter-preserving option in selected cases, including cryptoglandular fistulas at risk of postoperative continence impairment, as well as fistulas associated with Crohn's disease and in female patients.[9] In the treatment of anal fissures, laser-based approaches have been described as minimally invasive sphincter-preserving alternatives to conventional surgical techniques, with the aim of preserving continence.[10] For pilonidal disease, the 2024 European Society of Coloproctology (ESCP) guidelines state that laser-based techniques such as sinus laser-assisted closure (SiLaC/SiLaT) may be considered as minimally invasive options in selected patients, reflecting an evolving evidence base.[11]

## Mechanical bowel preparation

Mechanical bowel preparation (MBP) involves clearing the bowel lumen before surgery, most commonly using sodium phosphate,[5] though evidence for its routine use is limited. 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.[12]

## 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.[13]

## See also

* Proctalgia fugax

## References

1. ↑ "Colon and Rectal Surgery Specialty Description". American Medical Association. https://www.ama-assn.org/specialty/colon-and-rectal-surgery-specialty-description.
2. ↑ "Digestive Tract: Rectal and Colon Diseases and Conditions". Cleveland Clinic. https://my.clevelandclinic.org/health/articles/4090-digestive-tract-rectal-and-colon-diseases-and-conditions.
3. ↑ "What is minimally invasive surgery?" (in en-US). 5 October 2018. https://www.ccalliance.org/blog/patient-support/what-is-minimally-invasive-surgery.
4. ↑ Ojo, Dotun; Gallo, Gaetano; Kleijnen, Jos; Haas, Susanne; Danys, Donatas; Dardanov, Dragomir; Pellino, Gianluca; Jongen, Johannes et al. (2024-10-01). "European Society of Coloproctology guidelines for the management of pilonidal disease". The British Journal of Surgery 111 (10). doi:10.1093/bjs/znae237. ISSN 1365-2168. PMID 39397672.
5. ↑ Ambe, P. C.; Martin-Martin, G. P.; Vasas, N.; Piponski, I.; Roman, I. H.; Hernandez, J. D. P.; Ma, H.; Lin, H.C. et al. (2024-11-23). "Best clinical practice recommendations for the management of symptomatic hemorrhoids via laser hemorrhoidoplasty: the LHP recommendations" (in en). Techniques in Coloproctology 29 (1): 2. doi:10.1007/s10151-024-03022-1. ISSN 1128-045X. PMID 39579281.
6. ↑ Lie, Hendry; Caesarini, Evelyn Franca; Purnama, Antonius Agung; Irawan, Andry; Sudirman, Taufik; Jeo, Wifanto Saditya; Budiono, Bernardus Parish; Prabowo, Erik et al. (2022-12-01). "Laser hemorrhoidoplasty for hemorrhoidal disease: a systematic review and meta-analysis" (in en). Lasers in Medical Science 37 (9): 3621–3630. doi:10.1007/s10103-022-03643-8. ISSN 1435-604X.
7. ↑ Elfeki, H.; Shalaby, M.; Emile, S. H.; Sakr, A.; Mikael, M.; Lundby, L. (2020-04-01). "A systematic review and meta-analysis of the safety and efficacy of fistula laser closure" (in en). Techniques in Coloproctology 24 (4): 265–274. doi:10.1007/s10151-020-02165-1. ISSN 1128-045X.
8. ↑ Ambe, P. C.; Martin-Martin, G. P.; Vasas, N.; Piponski, I.; Roman, I. H.; Hernandez, J. D. P.; Ma, H.; Lin, H.C. et al. (2024-11-23). "Best clinical practice recommendations for the management of symptomatic hemorrhoids via laser hemorrhoidoplasty: the LHP recommendations" (in en). Techniques in Coloproctology 29 (1): 2. doi:10.1007/s10151-024-03022-1. ISSN 1128-045X. PMID 39579281.
9. ↑ Ambe, P. C.; Martin-Martin, G. P.; Alam, A. A.; Chaudhri, S.; Bogdanic, B.; Ma, H.; Bolik, B.; Roman, I. H. et al. (2025-06-09). "Laser fistula treatment: beyond the controversial aspects: best clinical practice recommendations from an international group of surgeons with extensive experience in the procedure-the FiLaC recommendations". Techniques in Coloproctology 29 (1): 131. doi:10.1007/s10151-025-03164-w. ISSN 1128-045X. PMID 40489006.
10. ↑ Cordeiro Time, Sônia Cristina; Buffara Blitzkow, Ana Carolina; Paz de Oliveira, Fabrício Doin; Perondi, Luana; Marques, Elisa Treptow; Quaresma, Abel Botelho; Marciano, Marcelo; Sampietro, Rodnei Bertazzo (2024). "High-Intensity Laser Therapy - An Option for Managing the Pain in Anal Fissures". Journal of Lasers in Medical Sciences 15. doi:10.34172/jlms.2024.52. ISSN 2008-9783. PMID 39650782.
11. ↑ Ojo, Dotun; Gallo, Gaetano; Kleijnen, Jos; Haas, Susanne; Danys, Donatas; Dardanov, Dragomir; Pellino, Gianluca; Jongen, Johannes et al. (2024-10-01). "European Society of Coloproctology guidelines for the management of pilonidal disease". The British Journal of Surgery 111 (10). doi:10.1093/bjs/znae237. ISSN 1365-2168. PMID 39397672.
12. ↑ 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
13. ↑ 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

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