Colon & Rectal Surgery

Specializing in the care of illnesses of the colon, rectum, and anus with individually crafted medical treatments and advanced surgical techniques.

The Center for Colon & Rectal Surgery at The GW Medical Faculty Associates manages both benign and malignant diseases of the colon, rectum, and anus. Our colon and rectal surgeons diagnose and treat patients for:

1. Colon, rectal, and anal polyps and cancers
2. Surgical complications of inflammatory bowel diseases – Crohn’s disease and Ulcerative Colitis
3. Diverticulitis
4. Pelvic Floor Disorders, including rectal prolapse, fecal incontinence, and chronic constipation
5. Anorectal disorders, such as hemorrhoids, perianal abscesses, anal fissures, and anal fistulas.

We are proud to be the first in metropolitan Washington, DC area to perform robotic colon resections. Our colorectal specialists currently perform more of these procedures than any facility in the region. Our surgeons are trained in the use of the da Vinci surgical system and are honored to serve as a national training center for surgeons around the country. We offer the latest minimally invasive surgical techniques, including, but not limited to, robotic surgery, single incision laparoscopic surgery, Medrobotics flex robot, and transanal minimally invasive surgery (TAMIS).

Colorectal Cancer

Colorectal cancer is cancer that starts in either your colon or your rectum. These make up the lower part of your digestive tract. In most cases, cancer does not start in both the colon and rectum. But both types of cancer have a lot in common. So they are often called colorectal cancer.

More Information About Colon and Rectal Cancer

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a broad term used to describe two disorders that involve chronic inflammation of the gastrointestinal (GI) tract, known as Crohn’s disease and Ulcerative Colitis. This prolonged inflammation results in damage to various portions of the GI tract, including the small bowel, large intestine, rectum, and perianal region.

More Information About Inflammatory Bowel Disease

Pelvic Floor Problems

Surgical & Nonsurgical Options

The specialists with The Center for Pelvic Health develop customized treatment plans to correct pelvic floor problems. Treatment options may include dietary changes, medications, pelvic floor rehabilitation, bowel management procedures, minimally invasive procedures and surgical repair. Treatment options may require a combination of therapies based on the individual needs of the patient.

Non-Surgical Options

Surgery isn’t always the answer to pelvic floor problems. The Center for Pelvic Health offers non-invasive treatment options that can often treat incontinence without surgery.

Behavioral Modification

Often behavioral modifications, such as changing eating and drinking habits, losing weight, or adding or removing medications may be all that is required to restore function to the pelvic floor.

Pelvic Floor Physical Therapy and Biofeedback

Pelvic floor physical therapy uses pelvic exercises and bladder control techniques to help the patient improve muscle control and manage leaks. Biofeedback is often added to assist in retraining key muscles of the urethra, bladder and rectum. Sensors attached to the body send signals to a computerized instrument that records the how well the muscles function. Specialists use the information to determine the appropriate exercises to help strengthen the muscles and possibly reverse or relieve symptoms.

Pessaries

Pessaries are plastic inserts which help support pelvic organs. When properly fitted, they should be comfortable and allow proper bladder and bowel function.

Surgical Options

For more serious conditions, The Center for Pelvic Health offers the full spectrum of care. The specialists treat extreme cases using the latest treatments and surgical procedures, from robotic surgery to treatments not available at other facilities.

Minimally Invasive Surgery

When surgery is required, specialists offer minimally invasive laparoscopic and robotic surgical techniques that use small incisions, typically less than one inch long, to perform advanced surgery.

Laparoscopic Surgery

Laparoscopy uses a tube with a light and a camera lens at the end, a laparoscope, to examine organs and check for abnormalities. Laparoscopy is often used during surgery to look inside the body and avoid making large incisions. Tissue samples may also be taken for examination and testing. Compared with traditional surgery, laparoscopic procedures offer the advantages of a faster recovery with less pain and discomfort.

Robotic Surgery

Robotic surgery offers a minimally invasive surgical option that allows pelvic floor operations to be performed through small incisions. Miniaturized tools and 3D cameras are inserted through the openings and controlled by the surgeon at a nearby console. Using a magnified view of the procedure, the surgeon controls the micro-movements of the robotic instruments, allowing for a greater range of motion and more precision.

The STARR Procedure

The Center for Pelvic Health is one of the only centers in the area to offer Stapled Transanal Rectal Resection or STARR, a new surgical technique for constipation. When thin or weak tissue causes the rectum to bulge into the vagina, it can interfere with normal bowel movements. The procedure straightens the rectum, allowing it to empty more efficiently without the sensation of a blockage.

Anal Cancer

Anal cancer is cancer that starts in the cells of the anus. Different types of tumors can form in the anus.

More Information About Anal Cancer

Diverticulitis

Diverticuli are herniations in the muscular layer of the colon that make small, saclike swellings. Diverticulitis occurs when diverticuli become inflamed and infected. If these areas become infected often or the infections are severe, then surgery may be indicated. The surgical treatment of diverticulitis involves removing the portion of the affected colon, which is called a colectomy. Our GW Colorectal surgeons offer minimally invasive techniques for doing so, including laparoscopic and robotic approaches.

More Information About Diverticulitis

Hemorrhoids

Hemorrhoids are when the veins or blood vessels in and around your anus and lower rectum become swollen and irritated. This happens when there is extra pressure on these veins.

More Information About Hemorrhoids

Anal Fistula

Symptoms, Diagnosis, and Treatment of Anal Fistulas

An anal fistula is an abnormal tunnel under the skin that connects the anal canal in the colon to the skin of the buttocks. Most anal fistulas form in reaction to an anal gland that has developed a pus-filled infection (abscess).

Symptoms

The symptoms of an anal abscess and an anal fistula can be similar and may include:

• Pain and swelling around the anal area
• Fever and chills
• Feeling tired and sick
• Redness, soreness, or itching of the skin around the anal opening
• Pus drainage near the anal opening

Who's at risk

If you develop an anal abscess, you have about a 50% chance of developing an anal fistula. Even if your abscess drains on its own, you have about the same risk for a fistula. Certain conditions that affect your lower digestive tract or anal area may also increase your risk. These include:

• Colitis
• Crohn's disease
• Chronic diarrhea
• Radiation treatment for rectal cancer

Diagnosis

If you have symptoms that suggest an anal fistula, your healthcare provider may refer you to a specialist who specializes in colon and rectal diseases. The specialist will ask about your symptoms and your medical history. During your physical exam, the doctor will look for a fistula opening near your anal opening. He or she may press on the area to see if it is sore and if pus comes out. Different methods may be used to help with the diagnosis, such as:

• Fistula probe. A long, thin probe is guided through the outer opening of the fistula. A special dye may be injected to find out where the fistula opens up on the inside.
• Anoscope. This is a special scope used to look inside your anal canal.
• Imaging studies. These may include an ultrasound, which creates an image of the anal area using sound waves. Or they may include an MRI, which makes images of the area by using special magnets and a computer.

Treatment

Once you have an anal fistula, antibiotics alone will not cure it. You will need to have surgery to cure the fistula. Many surgical treatment options are available and you and your surgeon will discuss which one is appropriate for you. Surgical treatment options include:

• Fistulotomy. This procedure opens up the fistula in a way that allows it to heal from the bottom up. It is usually used for simple fistulas that are close to the surface of the skin.
• Rectal Advancement Flap. This procedure involves freeing a small portion of the top lining of the rectum and pulling it over and closing the internal fistula opening.
• LIFT Procedure. Otherwise known as ligation of intersphincteric fistula tract and involves secure closing of the internal opening and removal of surrounding infected tissue via an incision next to the anus.
• Filling the fistula with a special glue or plug. This treatment involves filling the fistula tunnel with a material that your body will absorb over time, closing the internal opening of the tract.
• Seton placement. This procedure involves placing a suture or rubber band (seton) in the fistula that allows the tract to adequately drain and the associated inflammation to resolve. This procedure is often used as a first stage procedure in a two stage process. Once the inflammation goes away the fistula is now ready to have the seton removed and undergo a definitive repair procedure, such as those listed above, where the site will have a better chance of healing.

Note: Anal fistulas are very common in people with Crohn’s disease. For those with both Crohn's disease and a fistula, medical therapy is often tried before surgery.

Complications

Complications include a fistula that recurs after treatment and an inability to control bowel movements (fecal incontinence). This is most likely if some of the muscle around the anal opening, called the anal sphincter, is removed.

When to call the healthcare provider

Call your healthcare provider if you have symptoms of an anal fistula, especially if you have a history of a previous anal abscess. If you have been treated for an abscess or fistula, let your provider know right away if you have any of the following:

• Fever
• Chills
• Redness
• Swelling
• Bleeding
• Discharge
• Constipation
• Trouble controlling your bowel movements

Managing anal fistula

When recovering from anal fistula treatment, make sure to take pain medicine as directed by your surgeon. Finish all of your antibiotics. Don’t take any over-the-counter medicines without first talking to your provider.

Other important instructions may include:

• Soaking in a warm bath 3 or 4 times a day
• Wearing a pad over your anal area until healing is complete
• Resuming normal activities only when you are cleared by your surgeon
• Eating a diet high in fiber and drinking plenty of fluids
• Using a stool softener or bulk laxative as needed

Robotic Surgeries

Minimally Invasive Surgical Options

Colorectal robotic surgery is a minimally-invasive surgical option that allows our doctors to operate on the rectum, colon, and anus through small incisions ranging from 1 to 5 incisions. Miniaturized tools and 3D cameras are inserted through those openings and controlled by the doctor at a nearby console. At the console, in addition to the magnified and 3D view of the procedure, the surgeon will have controls that translate his or her hand movements into micro-movements for the robotic instruments. These tools can be used for any procedures that would be necessary in a traditional surgical setting, but with a greater range of motion and more precision. This minimally invasive surgical approach is available for selected patients who have conditions such as colon cancer, rectal cancer, diverticulitis, and inflammatory bowel diseases like Crohn’s disease and ulcerative colitis.