Treatments

Single incision laparoscopic surgery (SILS) is a new form of laparoscopic or “keyhole” surgery where the entire procedure is completed though a single mini-incision. In SILS surgery only one incision results in less pain and can help with the recovery process. Usually the incision is positioned around the naval and is an alternative to laparoscopy which requires multiple incisions.

SILS procedures can be utilised in cancer operations or procedures for inflammatory bowel disease.

Colonoscopy and Upper Endoscopy are procedures during which a flexible camera inspect the gastrointestinal inner lining. Both of these procedures are usually completed under a sedation anaesthetic and typically are completed as day procedure cases.

In upper endoscopy the flexible camera inspects the oesophagus, stomach and the first part of the small intestine. Depending on the indication of the procedure, biopsies may be taken to analyse for digestion abnormalities, infections of the stomach lining and to analyse for other causes of reflux or peptic ulcer disease.

In colonoscopy the flexible camera inspects the anal canal, rectum, large bowel and end of the small intestine.

Colonoscopy – Pre-operative – PDF Document

Colonoscopy – Post-operative – PDF Document

Historically large polyps found on colonoscopy required major abdominal surgery, however now there are multiple techniques available which avoid the need for major colonic or rectal resections. With some rectal polyps these can either be removed via colonoscopy or if they are large, there are advanced rectal polypectomy procedure.

Transanal Minimally Invasive Surgery (TAMIS) involved a keyhole technique via the anal canal in which polyps can be removed without the need for a resection of the rectum.

Rectal Prolapse refers to a condition where the rectum protrudes out through the anus. The condition is highly variable ranging from mucosa (or superficial) prolapse to full thickness rectal prolapse. The condition can develop through the aging process, but certain weaknesses of the pelvic floor or anal sphincter can predispose to the condition occurring.

Symptoms can range from anal discharge or seepage to patients feeling their rectum protrude to the point where they need to manually press the rectum back into place.

Surgery can help to fix this problem and there are multiple different procedures.

Delorme’s Procedure

A Delorme’s procedure is a procedure where the protruding mucosa (superficial lining of the bowel) is resected and the intestine repaired using dissolving sutures.

Altemeier’s Procedure

An Altemeier’s procedure is a procedure where the prolapsing bowel (both the superficial and deeper layers) are excised and the intestine is repaired using dissolving sutures. Both the Delorme’s and Altermeier’s procedure are completed under a type of general anaesthetic and avoid the need for major abdominal surgery

Laparoscopy Abdominal Procedure

If the rectal prolapse is quite significant with a sizable portion of rectum protruding out, sometimes an abdominal procedure is required. This is completed via laparoscopy (or ‘keyhole” surgery) where the strength of the pelvic floor and rectum is supported to prevent prolapse.

At the Sydney Colorectal Clinic, we can go through the different treatment options and strategies that can best treat this condition

Faecal incontinence is a troubling condition. Many patients have put up with symptoms for quite some time before seeking help. Often patients have had symptoms for years. The condition can range from anal seepage to incontinence of gas or stool. This can occur due to weaknesses of the pelvic floor and or anal sphincter complex.

There are multiple treatment strategies for Faecal Incontinence which include:

• Dietary changes
• Medication management
• Pelvic floor Physiotherapy, and
• Surgery

In the first instance it is worth filling out our incontinence questionnaire to help determine the extent of your symptoms:

Bowel Care Pathway for Incontinence – PDF document

Following on from this we will review your case and arrange preliminary investigations which may include;

• Pelvic floor imaging
• Functional studies, and
• Colonoscopy

Depending on the findings we can then arrange pelvic floor physiotherapy and other biofeedback programs to help with the condition.

In some cases, surgery is required. The surgical option depends upon the findings of our investigations and is tailored to each patient.

Surgery may include;

• Sphincter injection
• Sphincter repair
• Sacral nerve stimulation
• Prolapse surgery

Colorectal cancer surgery refers to surgery of the colon or rectum which aims to remove the cancer and also any potential lymph glands that tumours may spread to. Depending on the site of the tumour, a section of intestine on either side of the tumour will be resected.

The aim of the surgery is to resect the tumour and any potential microscopic tumour cells. Following on from this, in most cases the intestine is then joined back together with a combination of staples and dissolving sutures.

The resected specimen is then sent to our pathology team for analysis. From this the characteristics of the tumour, possible spread to lymph nodes and need for additional treatment is determined.

All of our colorectal cancer cases are discussed in a multidisciplinary meeting at the Kinghorn Cancer Centre. In this meeting, your case is discussed with our group of colorectal surgeons, radiologists, oncologists, radiation oncologists, genetic counsellors and allied health teams.

Hernia surgery involves an operation where the hernia or bulge is repaired and the weakness of the abdominal wall subsequently reinforced with either suture, mesh, graft (or a combination). Occasionally in complex abdominal wall reconstruction; preoperative Botox is required.

These repairs are most commonly completed under a general anaesthesia but occasionally can be completed under simple local anaesthetic. Some hernias can be repairs all through keyhole surgery but in some larger or complex hernias, a classical “open” approach is required.

Symptoms can range from anal discharge or seepage to patients feeling their rectum protrude to the point where they need to manually press the rectum back into place.

Surgery can help to fix this problem and there are multiple different procedures.

Delorme’s Procedure

A Delorme’s procedure is a procedure where the protruding mucosa (superficial lining of the bowel) is resected and the intestine repaired using dissolving sutures.

Altemeier’s Procedure

An Altemeier’s procedure is a procedure where the prolapsing bowel (both the superficial and deeper layers) are excised and the intestine is repaired using dissolving sutures. Both the Delorme’s and Altermeier’s procedure are completed under a type of general anaesthetic and avoid the need for major abdominal surgery

Laparoscopy Abdominal Procedure

If the rectal prolapse is quite significant with a sizable portion of rectum protruding out, sometimes an abdominal procedure is required. This is completed via laparoscopy (or ‘keyhole” surgery) where the strength of the pelvic floor and rectum is supported to prevent prolapse.

At the Sydney Colorectal Clinic, we can go through the different treatment options and strategies that can best treat this condition

Dr Hamish Urquhart is also a Trauma Surgeon at St Vincent’s Hospital. As a Trauma Surgeon, Dr Urquhart is involved in trauma operations and admissions.

We employ a multidisciplinary approach with our other surgical colleagues. At St Vincent’s Hospital we have acute access to Cardiothoracic Surgery, Neurosurgery, Orthopaedic Surgery, Liver/UGI Surgery, Colorectal Surgery, Interventional Radiology, Intensive Care. In addition, the allied health team of physiotherapists, occupational therapists and rehabilitation specialists are on hand for your care.