The Daily Schedule Of A Colorectal Surgeon

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.

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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.

The Daily Schedule Of A Colorectal Surgeon

Colorectal surgeons provide post-operative care for their patients on a daily basis. Once these patients have become clinically stable and their surgical wounds are free of infection, they are discharged home and then given follow-up dates to see the surgeon again. The offices of these specialists are located in the hospital so that they have quick access to their patients in the wards and ICUs, as well as patients who need an opinion in the emergency department. The colorectal surgeon will be consulted by other specialists such a general surgeons and gastroenterologists regarding patients' conditions.

The colorectal surgeon will provide on call services during after hours and weekend periods for the hospital they work at. They will consult with patients who present with emergency cases such as a flare-up of Crohn's colitis, perforated diverticules and severely thrombosed haemorrhoids.

Monday

Usually an administrative day, a colorectal surgeon will deal with aspects such as confirming and attending meetings with hospital staff, management and surgical representatives during the morning period.

Once the administrative tasks have been dealt with, the colorectal surgeon will then begin consulting with their patients. The patients that are consulted can be first time patients or patients who are having a follow up after their procedure was done. The specialist will manage these patients conservatively, send them for further investigations which will be followed up and then discussed with the patient, admit them to the ward for further invasive investigations and management or they will receive a date for elective surgery to be done.

Tuesday

The colorectal surgeon will usually be busy in the operating room for the entire day performing surgeries. The surgical procedures that are done on this day include the ones that have been mentioned in 'Surgical forms of treatment' above. 

Wednesday

The colorectal surgeon will use the morning to consult with and manage patients and the afternoon will be used for performing investigative procedures such as the ones mentioned in 'Diagnostic procedures' above.

The afternoon can also be used for filling in surgical motivation letters to the medical aid companies, filling in of patients' chronic prescriptions, doing further research for their own academic needs, sending feedback to referring physicians or reporting on their findings regarding the diagnostic procedures that were done.

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Thursday

The specialist may spend the morning consulting with patients, performing diagnostic procedures or operating in theatre. The afternoon will then be used for training undergraduate medical students and postgraduate general surgical residents and colorectal fellows.

Friday 

The colorectal surgeon will consult with and manage patients for the morning and the afternoon will be used to finish up any unresolved administrative tasks.

The work week can then be finalised once all the patients have been consulted, the administrative tasks have been completed and the specialist has confirmed and printed the surgical list for the following week.