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A colorectal surgeon is a specialist surgeon who deals with conditions and diseases that specifically affect the colon, rectum and anus. This article will discuss the training these specialists receive as well as their daily schedule.

A colorectal surgeon is a surgeon who focuses on the diagnosis and management of diseases and disorders that affect the large intestine (colon), the rectum and the anus. The management offered by these specialists can be conservative where the patient is managed with oral medication or admitted for intravenous therapy, or surgical intervention where the patient has investigative procedures performed on them such as colonoscopies or major surgery to remove pathological tissue.

Training

A colorectal surgeon needs to complete a series of training programmes in order to become a sub-specialist surgeon. These include completing a 5-6 year undergraduate medical and surgical degree to become a qualified doctor, and a 1-2 year internship phase where the doctor works in the various medical and surgical disciplines. Thereafter, the doctor is allowed to specialise.

The doctor will then take part in a 5 year surgical residency programme where they will qualify as general surgeons, and they can then proceed to enter a 2 year fellowship programme in colorectal surgery where they will qualify as such surgeons.

Conditions managed by Colorectal Surgeons

There are many diseases and conditions that can affect the colon, rectum and anus. A lot of these issues can be managed conservatively, and there are those that overlap with the management which is offered by non-surgical specialists such as the gastroenterologists, but the majority of these conditions and of those where conservative therapy fails are managed surgically.

  • Severe constipation.
  • Anal fissures, which are non-natural tears or cracks in the anus.
  • Swollen or inflammed veins (varicosities) in the rectum and anus known as haemorrhoids.
  • Managing diverticular disease (smooth muscle herniations in the colon) conservatively or surgically.
  • Fecal incontinence.
  • Anal fistulas, which are abnormal passageways or connections between the rectum, or other anorectal anatomy, to the skin surface.
  • A rectal prolapse, which is the protrusion of the walls of the rectum through the anus.
  • Severe colic disorders such as Crohn's disease.
  • Birth defects such as the imperforate anus (an anus with no opening).
  • Colon, rectal or anal (rare) cancer.
  • Removing foreign objects inserted in the rectum or anus.
  • Any injuries to the anus.

Diagnostic procedures and surgical treatments performed by Colorectal Surgeons 

The following are procedures performed by colorectal surgeons either for investigative purposes or as surgical therapies to manage pathologies.

Diagnostic procedures

  • Colonoscopy - this investigative procedure of the colon is very important as it can help the colorectal surgeon in determining the diagnosis of the patient and what procedure should be done to correct the pathology.
  • Sigmoidoscopy (used to visualize the rectum and sigmoid colon)
  • Proctoscopy (used to visualize the anus and rectum).
  • Defecating proctography.
  • Recently, laparoscopic surgery has been performed as an investigative procedure due to its advantages of a decreased recovery time and having less risks than open surgery. 

Surgical forms of treatment

  • Haemorrhoidectomy
  • Colectomy
  • Polypectomy
  • Ileo/colostomy
  • Anoplasty 
  • Strictureplasty
  • The CARP method (Compression Anastomotic Ring-locking Procedure), done for colorectal anastamosis after a colectomy is done, is a new technique that is being researched in Europe. This procedure is fast becoming the preferred choice due to the advantages to patients as it is more reliable, results in faster healing times, it has a quick leak-detection potential and there's a reduced need for a protective stoma.
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