Cleveland Clinic Colorectal Surgeons, are part of the Cleveland Clinic Digestive Disease Center which has consistently ranked among the top programs in the United States by US News and World Report.
Cleveland Clinic Colorectal Surgeons are specialists in the treatment of a variety of colon and rectal conditions, including Crohn’s disease, ulcerative colitis, diverticular disease, familial polyposis, colon cancer and rectal prolapse.
Crohn's Disease and Ulcerative Colitis
As many as 75 percent of people with Crohn’s disease eventually have surgery. Surgery can repair complications such as abscesses, perforations and blockages and control bleeding. When performed by an experienced colorectal surgeon, surgery for Crohn’s disease is safe and does not cause further complications.
Cleveland Clinic colorectal surgeons offer the latest surgical treatments for Crohn’s disease, with an emphasis on a conservative approach. The most common is a resection, which involves removing the diseased portion(s) of the intestine and reconnecting the two healthy ends. They also perform strictureplasty, which means surgically widening sections of the intestine that have become narrowed due to scarring. These surgical treatments can provide long-term symptom relief and reduce or eliminate the need for medication. Whenever possible, Cleveland Clinic surgeons use small incision (laparoscopic) surgical techniques with Crohn’s disease patients to shorten the hospital stay, reduce postoperative pain and speed recovery.
Even at the hands of the most experienced surgeon, surgery is not a cure for Crohn’s disease. In many patients, the inflammation returns in another section of the bowel, and they eventually need another operation. But, other patients never require another operation and can manage their disease with medication alone for the rest of their lives. Cleveland Clinic colorectal surgeons consider the ileal pouch-anal anastamosis (IPAA) the optimal surgical treatment for ulcerative colitis and have performed more than 3,000 of these procedures. The operation involves removing the colon, forming an internal pouch from the small bowel and joining it to the anal muscle. Following surgery and recovery, patients have almost normal control over bowel movements. This is an extremely complex surgery that should be performed only by a skilled colorectal surgeon with extensive experience in treating ulcerative colitis. Following this surgery at The Cleveland Clinic, the average patient has between six and eight bowel movements per day. More than 97 percent of patients are satisfied with the outcome of their operation, and the majority do not require further medical care related to the surgery, outside of routine post-operative follow-up.
Cleveland Clinic surgeons also are experienced in several other surgical treatments for ulcerative colitis for patients who cannot have the ileal pouch procedure. These options can be discussed between patient and surgeon as needed.
Diverticular Disease and Diverticulitis
Diverticular disease is a common condition, particularly in the Western world, where small pockets develop on the outside of the colon. These are generally thought to be related to high pressures generated within the lumen of the bowel, because of the low fiber diet eaten in the Western world.
Diverticulitis is a condition which occurs when these pockets become inflamed. It accounts for more than 200,000 hospitalizations annually within the United States and healthcare costs of approximately 300 million dollars. Medical management, generally using antibiotics, is successful in most cases of acute diverticulitis however some people require emergency surgery or drainage of an abscess. In fact, intervention like this is required in up to 25 percent of people. When emergency surgery occurs it frequently involves placement of a temporary colostomy.
In an effort to avoid the risks of emergency surgery, patients with severe complications of diverticulitis or with recurrent diverticulitis are often recommended to have elective surgery. This involves removing a segment of the colon, generally the sigmoid colon which is the area most commonly affected by diverticular disease, in an effort to minimize the risk of future problems with diverticular disease.
Anorectal Disease
Our surgeons in the Department of Colorectal Surgery have extensive training and experience in the management of anorectal disease. The typical symptoms of patients suffering from anorectal disease include: bleeding, pain, discharge and itch (or pruritus). Descriptions of the conditions commonly seen by specialists in anorectal disease are below.
Hemorrhoids - A normal part of the anal anatomy, which helps control bowel motions and gas. When enlarged they may cause discomfort or bleeding and need assessment. Treatment is usually performed in the office with either dietary instructions or application of local hemorrhoid treatments which can be performed at the time of the initial office visit. Larger hemorrhoids may require an operation and, if so, an admission for a day case surgical procedure is arranged.
Anal Fissure - Patients have severe pain and sometimes bleeding after passing a bowel motion. Generally, medical treatments can be prescribed in the office. For cases which do not respond to this, a minor surgical procedure can be performed in the office under local anesthetic.
Pilonidal Disease - Patients may develop abscesses between the buttocks, which can be treated in the office and, in rare cases, a general anesthetic required. Definitive later therapy may require a general anesthetic and subsequent wound care.
Anorectal Sepsis and Fistula - Patients may have severe pain and swelling caused by an abscess in the anal region. The usual initial treatment involves insertion of a small plastic drain under local anesthetic in the office. This gives almost instantaneous relief of symptoms. Some patients with an abscess will later develop a fistula, which requires further treatment. Patients who require further treatment, or patients who have a fistula at their initial visit may require surgery under general anesthetic, which is often arranged at the initial outpatient visit. These fistulas, or abnormal tracts connecting the anal canal or rectum to skin around the anus, sometimes require more than one treatment to heal completely.
Malignant Tumors - In rare cases, patients develop a swelling or mass in the anal area which is caused by a cancer. Surgeons in this department are experienced at defining the treatment regimes for such tumors which may involve chemotherapy or radiation prior to surgery, or simply proceed with the surgery if needed. The treatment plan is based on individual patient assessment.
Colon and Rectal Cancer
In most cases, patients with a cancer of the colon require a colectomy to remove the segment of the bowel where the tumor lies. In more advanced cases, this may include removal of a contiguous organ to maximize the chance of a cure. Cleveland Clinic colorectal surgeons are experienced in the complexities of such major surgery and have ready access to collaborate with surgeons in other specialties when necessary.
They have extensive experience treating rectal cancer, with one of the highest volumes of patients with this condition in the world. What sets these surgeons apart is the number of treatment options available to save the sphincter and avoid the need for colostomy. These options include transanal excision and radical surgery with anastomosos of the colon to the anus incorporating a J-pouch or Coloplasty.
Laparoscopic Surgery (Minimally Invasive Surgery)
Our colorectal surgeons provide state-of-the-art laparoscopic surgery for a variety of colon and rectal conditions, including Crohn’s disease, ulcerative colitis, diverticular disease, familial polyposis, chronic constipation, colon cancer and rectal prolapse.
A minimally invasive approach to surgery, laparoscopic procedures afford patients the benefit of smaller incisions, less pain, fewer heart, lung and wound complications and shortened hospital stay. “The best thing about laparoscopic colon surgery is that we can offer patients the results of a traditional, open surgery, but with incisions that are only two inches long,” remarks Cleveland Clinic Chairman of the Department of Colorectal Surgery Victor Fazio, M.D.
Databases, Registries and Research
The Cleveland Clinic Digestive Disease Center houses one of the world’s largest collections of medical data. Our databases contain information that we use to continuously refine our approach to the treatment of colorectal cancer, diverticular disease, Crohn’s disease, ulcerative colitis, hepatitis and many other gastrointestinal diseases. The David G. Jagelman Inherited Colorectal Cancer Registry is the largest registry of this type in the world. Clinical and laboratory research in the complete spectrum of gastrointestinal diseases has kept our physicians and surgeons on the cutting edge of patient care.