Coloproctology is a branch of digestive surgery that encompasses the diagnosis and treatment of diseases of the anus, rectum and colon. The special prevalence of colorectal pathology in society, with common conditions such as hemorrhoids or anal fistulas, and sometimes its seriousness -such as cancer- forces coloproctologists to undergo a continuous “fine-tuning” in order to offer their patients the latest advances in diagnosis and treatment, as a result of the constant scientific progress in this area of surgery.
Colorectal cancer
In 2010, the European Journal of Cancer Prevention already warned of the alarming increase in colorectal cancer in Spain. This tumor – the second most frequent after lung cancer in men and breast cancer in women – has shown an increasing prevalence curve over the last fifty years. Unhealthy consumption habits such as alcohol, tobacco, red meat or a deficient intake of fiber in the diet; together with being overweight and lack of physical exercise, as well as a genetic predisposition to suffer from it in some cases, are factors that are related to a tumor that causes more than 13,000 deaths per year in our country.
However, this tumor is curable in a large percentage of cases, especially if an early diagnosis is made by means of simple tests for hidden hemorrhages in the stool or by using endoscopy techniques (colonoscopy). In addition, the Coloproctology Unit of the Hospital Nisa 9 de Octubre has the support of diagnostic imaging methods such as CT, PET or magnetic resonance imaging, “and with a complete laboratory that offers us the possibility of performing even genetic analysis,” Dr. García Armengol points out. All this makes it possible to precisely establish the stage of the tumor, and thus offer a precise diagnosis to each patient.
Functional examinations
The Unit has recently significantly improved its facilities, with a functional examination cabinet for performing endoanal and endorectal ultrasound, rectoanal manometry and sphincter rehabilitation by means of Biofeedback, as well as rigid videoendoscopy and videodefecography, among other procedures. Its location next to the Digestive Endoscopy Unit of the hospital and the close collaboration with oncologists and the Nisa Radiation Oncology Service, among others, favor a multidisciplinary approach.
Thus, in addition to promoting early diagnosis and detailed assessment of polyps and cancer of the colon and rectum, or inflammatory diseases such as Crohn’s disease, ulcerative colitis or diverticula, all investigations of anorectal functionalism are carried out, the diagnosis of anal pathology such as fistulas, hemorrhoids, fissures or strictures, the assessment of complex pelvic floor problems, some as important as anal incontinence, rectocele or rectal prolapse, or anal neoplasms and sexually transmitted diseases among others.
Therapeutic advances
Among the therapeutic novelties applied in the Coloproctology Unit of the Hospital Nisa 9 de Octubre is the minimally invasive treatment of hemorrhoids, with the development of new surgical techniques to reduce postoperative discomfort, sometimes guided by Doppler, or assisted by other sources of energy -ultrasonic scalpel, laser, etc-, to perform more precise treatments and allow an earlier recovery. This firm commitment to less surgical aggression has led to the use of advanced laparoscopic surgery for most colorectal surgery, which achieves minimal discomfort and almost no scarring.
In the case of colorectal cancer, in addition to the seriousness of the disease itself, there is the fear that the treatment may involve a stoma or the creation of an artificial anus. “Our team of surgeons, with extensive experience in rectal cancer surgery, routinely performs ultra-low suture techniques that allow us to avoid a definitive stoma in most patients, except when the anal sphincters are affected,” explains Dr. Roig Vila. Transanal endoscopic microsurgery operations are also performed. This technique manages to treat polyps and rectal cancers in their initial stages with the least possible aggression. The lesion is removed through the anus itself, which reduces the risk of the intervention and avoids the stoma or artificial anus in some cases.