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Address: 401 SW 80th St., Suite 101, Oklahoma City, OK 73139 • Phone: 405-605-4265

Anus or Rectum Surgery

Anatomically the rectum is the last 15cm or so of the colon that lies within the pelvis. The anus is the last few centimeters of the GI tract where the lining changes from mucosa to skin.

The rectum is essentially the same as the colon in its disease processes, but slightly different for surgical considerations because of its position in the pelvis. At Southwest General Surgery we are comfortable with most of the operations of the rectum, however, there are some more exotic operations that we believe are more appropriate for care by a dedicated colorectal surgeon. These include complex problems arising from Crohn's Disease and Ulcerative Colitis.

Problems of the anus are many, however, most are very treatable. These include infections of the surrounding skin, fistulas (abnormal communication between the rectum and the skin), hemorrhoids, fissures (tears in the skin), etc. Also, because the anus has the same skin covering as the rest of your body, there are occasionally skin cancers that can arise in this part of the body. We care for many of the common problems related to the anus, and if it is something that we feel would be better treated by a dedicated colorectal surgeon we will be happy to help get you to the right person for your care.

The information below is general and every patient is different. We would be happy to talk about your specific case and discuss the appropriate work-up and treatment of your issue.

Rectal Cancer

As stated above, the diseases of the rectum are essentially the same as the rest of the colon. This includes cancer. Rectal cancer, however, has several unique changes to the treatment algorithm because of its location in the pelvis. The mainstay of treatment remains surgical resection, but there are times when chemotherapy and radiation may be used before surgery. This is usually used when lymph nodes appear to be involved. Also, the distance of the cancer from the sphincters (circular muscles that control continence), are an important surgical consideration.

If a tumor is too close to the sphincter muscles, it may not be possible to remove it and leave the muscles intact. This unfortunately means that the entire anus and rectum are removed, and a permanent colostomy has to be placed. This is called an abdomino-perineal resection or APR. The number one concern of any cancer operation though is to be sure that the cancer is removed completely.

However, if the tumor is higher in the rectum we can often remove it and reconnect the colon. This is called a low anterior resection or LAR. If chemotherapy and radiation are used before surgery we do have to place whats called a diverting ileostomy, which is where a piece of the small intestine is brought out through the abdominal wall as an ostomy for a period of time to allow the new connection between the colon and rectum to heal. We can then perform an operation to reconnect the small intestine through a smaller incision when appropriate.

We try to perform these operations laparoscopically assisted to keep incisions size to a minimum to perform an adequate resection of the tumor.

Anal Cancer

Anal cancer is generally related to to the skin and the types include squamous cell carcinoma and malignant melanoma. The most common is squamous cell carcinoma. The initial treatment of anal squamous cell carcinoma is chemotherapy and radiation unless there is intestinal obstruction from the tumor. These tumors are generally pretty sensitive to the chemotherapy and radiation combination and complete response is not uncommon even for large tumors.

Surgery for squamous cell carcinoma of the anus is reserved for intestinal obstruction before treatment, failure to completely respond to treatment, and recurrence after treatment. For obstructions, a temporary colostomy may be needed. For failure to respond and recurrence, an operation called abdomino-perineal resection or APR, is needed. This unfortunately involves complete removal of the anus and rectum and permanent colostomy.

Hemorrhoids

Hemmorrhoids are actually veins in the lower rectum and anus that are involved in creating a cushion for the anus to squeeze and create a watertight seal. These veins can become engorged and separate from their underlying tissues leading to problems with bleeding, itching, pain, issues with hygiene, and prolapse or protrusion through the anal opening.

Many of the issues with hemorrhoids can be treated non-operatively with some lifestyle modifications and supplemental fiber. However, for some people these changes do not help or they are having issues so severe that operative intervention is warranted.

The traditional operation for hemorrhoids is to make an incision and completely remove the underlying vein along with some of the tissue that is surrounding it. As you can imagine this is a very painful area to have an incision and complete resolution of pain can take 2-4 weeks. Here at Southwest General Surgery we have adopted the transanal hemorrhoidal dearterialization or THD technique for the operative treatment of most hemorrhoids. It involves locating the arteries that feed the hemorrhoids and placing a stitch around it to stop the inflow of blood. This can be done without painful incisions and while there is still some discomfort involved it usually resolves within days instead of weeks.

We would be happy to discuss your issues and help you decide if you are a candidate for THD. For more information on THD visit http://thdamerica.com/.

Anal Fissure

Anal fissues are painful tears in the skin of the anus. They can cause bleeding and excruciatingly painful bowel movements. Most arise posteriorly in the midline, but can happen at any position. Most can be treated without an operation with some lifestyle modifications and application of topical muscles relaxants that allow the area to heal by itself. However, there are times when these interventions don't work and a procedure called a lateral internal sphincterotomy is needed. This is where we cut part of the internal sphincter muscle to allow enough relaxation for healing to occur. The overall function of the sphincter is still preserved though.

Rectal Prolapse

Rectal prolapse happens when part of the rectum protrudes through the anal opening. This typically happens when part of the rectum is redundant and has poor fixation to surrounding tissues. This can leading to bleeding, pain, and problems with hygiene.

The decision to operate is based on symptoms and the overall fitness of the patient for operative intervention. If fit for surgery the most common technique is to remove part of the colon and sew the top of the rectum to the upper part of the pelvis. This helps take some of the redundancy out of the rectum and provides some fixation to prevent further prolapse. The is something that we can generally be done laparoscopically or at least laparoscopically assisted.

The surgeons here at Southwest General Surgery are comfortable with treatment of rectal prolapse as described above. However, if the the patient is not a candidate for that operation because of risk factors, we will refer to a colorectal specialist who can perform another operation called Altemeier procedure.

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