Colorectal surgery

Colorectal surgery is a field in medicine, dealing with disorders of the rectum, anus, and colon. The field is also known as proctology, but the term is outdated in the more traditional areas of medicine. The word proctology is derived from the Greek words Proktos, meaning anus or hindparts, and Logos meaning science or study.

Physicians specializing in this field of medicine are called colorectal surgeons or proctologists. Colorectal surgeons often work closely with urologists. To become colorectal surgeons, these surgical doctors have to complete a general surgery residency, as well as a colorectal surgery fellowship, upon which they are eligible to be certified in their field of expertise by the American Board of Colon and Rectal Surgery or the American Osteopathic Board of Proctology. In other countries, certification to practice proctology is given to surgeons at the end of a 2-3 year subspecialty residency by the country's board of surgery.

Scope of the specialty

Colorectal surgical disorders include:

1. varicosities or swelling, and inflammation of veins in the rectum and anus (Hemorrhoids)
2. unnatural cracks or tears in the anus (Anal fissures)
3. abnormal connections or passageways between the rectum or other anorectal area to the skin surface (Fistulas)
4. severe constipation conditions
5. fecal incontinence
6. protrusion of the walls of the rectum through the anus (Rectal prolapse)
7. birth defects such as the imperforate anus
8. treatment of severe colic disorders, such as Crohn's disease
9. cancer of the colon and rectum (Colorectal cancer)
10. anal cancer (rare)
11. any injuries to the anus
12. removal of objects deliberately inserted into anus

Surgical treatment and diagnostic procedures

Surgical forms of treatment for these conditions include: colectomy, ileo/colostomy, polypectomy, strictureplasty, hemorrhoidectomy (in severe cases of hemorrhoids), anoplasty, and more depending on the condition the patient suffers from. Diagnostic procedures, such as a colonoscopy, are very important in colorectal surgery, as they can tell the physician what type of diagnosis should be given and what procedure should be done to correct the condition. Other diagnostic procedures used by colorectal surgeons include: proctoscopy, defecating proctography, sigmoidoscopy. In recent times, the laparoscopic method of surgery has seen a surge of popularity, due to its lower risks, decreased recovery time, and smaller, more precise incisions achieved by using laparoscopic instruments.

Anesthesia

Anesthesia, or anaesthesia (see spelling differences; from Greekαν-, an-, "without"; andαἴσθησις, aisthēsis, "sensation"), traditionally meant the condition of having sensation (including the feeling of pain) blocked or temporarily taken away. It is a pharmacologically induced and reversible state of amnesia, analgesia, loss of responsiveness, loss of skeletal muscle reflexes or decreased stress response, or all simultaneously. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience. An alternative definition is a "reversible lack of awareness," including a total lack of awareness (e.g. a general anesthetic) or a lack of awareness of a part of the body such as a spinal anesthetic. The word anesthesia was coined by Oliver Wendell Holmes, Sr. in 1846.

Types of anesthesia include local anesthesia, regional anesthesia, general anesthesia, and dissociative anesthesia. Local anesthesia inhibits sensory perception within a specific location on the body, such as a tooth or the urinary bladder. Regional anesthesia renders a larger area of the body insensate by blocking transmission of nerve impulses between a part of the body and the spinal cord. Two frequently used types of regional anesthesia are spinal anesthesia and epidural anesthesia. General anesthesia refers to inhibition of sensory, motor and sympathetic nerve transmission at the level of the brain, resulting in unconsciousness and lack of sensation. Dissociative anesthesia uses agents that inhibit transmission of nerve impulses between higher centers of the brain (such as the cerebral cortex) and the lower centers, such as those found within the limbic system.

Foot and ankle surgery

Foot and ankle surgery is a sub-specialty of orthopedics and podiatry that deals with the treatment, diagnosis and prevention of disorders of the foot and ankle. The typical training of an orthopedic foot and ankle surgeon consist of four years of college, four years of medical school, one year surgical internship, 5–6 years of orthopedic training and a 1 year fellowship in foot and ankle surgery. Training for a podiatric foot and ankle surgeon consists of four years of college, four years of podiatric medical school and 2-4 years of a surgical residency. One can also make the distinction between a podiatric and orthopedic foot and ankle surgeon: an orthopedic surgeon has an allopathic medical degree and training that encompasses both orthopedic residency and a 6-month to one year of fellowship training specific in techniques of foot and ankle surgery, while the training of a podiatrist consist of a 4 year podiatric medical degree and mandatory two to four year residency training specific to foot and ankle medicine and surgery, with a possibility of an additional 1 year fellowship.

Clinical scope

Foot and ankle surgeons are trained to treat all disorders of the foot and ankle, both surgical and non-surgical. One is also trained to understand the rather complex connections between disorders and deformalities of the foot and ankle and the knee and hip and in return, the spine. Therefore, the surgeon will typically see cases that vary from trauma (such as malleolar fractures, tibial pilon fractures, calcaneus fractures, navicular and midfoot injuries and metatarsal and phalangeal fractures.) Arthritis care (primarily surgical) of the ankle joint and the joints of the hindfoot (tarsals), midfoot (metatarsals) and forefoot (phalanges)also plays a rather significant role. Congentital and acquired deformalities include adult acquired flatfoot, non-neuromuscular foot deformity, diabetic foot disorders, hallux valgus and several common pediatric foot and ankle conditions ( such as clubfoot, flat feet, tarsal coalitions...etc.) Patients may also be referred to a foot and ankle surgeon for proper diagnosis and treatment of heel pain (such as a consequence from plantar heel facitis), nerve disorders (such as tarsal tunnel syndrome) and tumors of the foot and ankle. Amputation and ankle arthroscopy (the use of a laproscope in foot and ankle surgical procedures) have emerged as prominent tools in foot and ankle care. A patient may also be referred to a foot and ankle surgeon for the surgical care of nail problems and phalangeal deformalities (such as bunions and buniettes.)