Each year millions of Americans suffer from some form of colorectal disorder ranging from hemorrhoids to life-threatening colorectal cancer. These conditions can profoundly affect both the health and overall quality of life of those affected. While the diagnosis and treatment of many of these conditions can be relatively straightforward, there are many disorders that present more subtle symptoms that may require complex evaluations and innovative management techniques to resolve.
Anorectal Physiology & Diseases
In conjunction with the departments of Urology and Gynecology, we evaluate and treat patients with pelvic floor disorders, constipation and fecal incontinence. Patients have access to a variety of treatments, many not widely available. The Ochsner Anorectal Physiology and Research Laboratory is capable of computerized anorectal manometry that assesses anal sphincter resting and squeeze pressure, length, rectal function and reflexes. Anorectal ultrasonography evaluates and localizes anal sphincter disruption in patients with fecal incontinence and assesses depth of tumor invasion and lymph node status in rectal cancer or polyp patients. This study also guides the use preoperative adjuvant therapy and sphincter-saving surgery. Anal electromyography and pudendal nerve terminal motor latency assist in evaluating patients with fecal incontinence secondary to obstetrical sphincter injuries or rectal prolapse. In conjunction with Ochsner Radiology, cinedefecography and small and large bowel transit studies help to complete the evaluation of patients with functional disorders such as constipation. Patients also have access to new treatments for hemorrhoids, fissures and anal fistulas. Artificial sphincters and radiofrequency treatment procedures are available to treat incontinence refractory to traditional reconstructive surgery. Ochsner surgeons have pioneered less invasive methods of treating many anorectal conditions including:
- Fibrin glues and endorectal flaps to treat complex fistulas
- Topical medications such as nitroglycerin ointment to treat anal fissures
- Rubber band ligation of internal hemorrhoids
- Catheter drainage of anorectal abscesses
- Transanal excision of anorectal adenomas and tumors
Colorectal Cancer & Polyps
The center is at the forefront of colon and rectal cancer prevention through patient screening, education, detection and treatment. Colorectal cancer can be prevented through regular examinations to detect and remove premalignant polyps. If cancer is diagnosed in its early stages, the latest medical and surgical treatments offer a good chance for a cure. Ochsner physicians have been at the forefront of efforts to expand colorectal cancer screening. Colon polyps and cancer prevention are one of our major research interests. We have several randomized clinical trials on chemo-prevention for colorectal polyps and can cancer in progress. Newer procedures such as CT colongraphy (or "virtual colonscopy") are under evaluation by physicians in the Endoscopy center and the Radiology Department. In addition, innovative multidisciplinary therapies allow many patients to be cured of their rectal cancer while preserving anal muscles and avoiding a permanent colostomy. Collaboration with radiation and medical oncologists has allowed most rectal cancer patients to receive sphincter-saving procedures such as ultralow anterior resections or colanal pullthroughs. To improve postoperative function, colonic pouches or coloplasty techniques are routinely performed.
Inflammatory Bowel Disease
Ulcerative colitis is managed in conjunction with the department of Gastroenterology using state-of-the-art medications. Innovative therapies such as the ileoanal reservoir (J-pouch) allow patient to lead a higher quality of life and avoid a permanent ileostomy. We have performed more than 300 of these complex procedures since 1982. Another option for selected patients is a continent ileostomy or Koch pouch. We are the only surgeons in the Gulf South performing this procedure. In Crohn's disease, we work closely with Ochsner gastroenterologists to maximize the patient's quality of life and to conserve bowel. Conservative operations such as strictureplasty and limited resections can preserve intestinal length.
We pioneered the endoscopic diagnosis and management of colorectal disease. Each year, over 5,000 endoscopic procedures such as colonoscopy, intraluminal ultrasound and ileoscopy are performed in our new endoscopy center. Endoscopic detection and removal of colonic polyps prevents colorectal cancer and allows treatment of a variety of other intestinal disorders. Intestinal obstruction can be managed with intraluminal dilation, laser ablation or stenting. One of the most exciting developments in new technology has been the M2A video capsule. The tiny camera travels the entire digestive tract giving continuous images of the small intestine, a region that cannot be visualized with standard endoscopic procedures.
Laparoscopic and Robotic surgery
Minimally invasive laparoscopic surgery offers patients less pain, a shorter hospital stay, faster recovery and less scarring than traditional abdominal surgery. Laparoscopic surgeons use specialized surgical instruments and a video camera inserted through small incisions to perform a variety of abdominal procedures. Hand-assisted techniques are being used to expand these techniques to a wider variety of abdominal operations. Ochsner surgeons are highly experienced in the latest laparoscopic techniques for intestinal surgery. Among the conditions treated with minimally invasive techniques are:
- Diverticular disease
- Inflammatory bowel disease
- Selected colorectal cancers
Nearly a million people in North America have ostomies and 70,000 new ostomy surgeries are performed each year. Recognizing that people with ostomies, fistulas, pressure ulcers and incontinence have special needs, the center supports an active enterostomal therapy program. Specially trained enterostomal therapy (ET) nurses are devoted to helping both adult and pediatric patients by offering preoperative counseling for ostomy surgery, caring for patients after surgery, and providing education to patients about post-surgery needs and stoma care. Our nurses also counsel patients with complex wounds, intestinal fistulas and urinary and fecal incontinence. Ochsner's ET nurses are board certified by their professional organization and have received special training. They assist patient's in the hospital and in the ambulatory or outpatient settings.