Gastrointestinal and Colon and Rectal Conditions
Mount Sinai surgeons have extensive experience in minimally invasive laparoscopic surgical techniques for disorders of the small and large bowel. Instead of using one large abdominal incision typical of traditional “open” surgery, laparoscopic methods involve making several small (5 mm) peripheral incisions through which the laparoscope and surgical instruments are inserted. Compared to open surgery, laparoscopic bowel surgery offers less post-surgical pain, fewer post-operative small bowel obstructions, fewer wound infections, shorter hospital stays, and less recovery time.
At Mount Sinai our surgical team is highly skilled in laparoscopic bowel procedures including colon resection, colostomy and colostomy closure, small bowel resection and strictureplasty, ileostomy creation, J-pouch surgery, and lysis of adhesions. These procedures treat a range of intestinal and colorectal disorders.
Inflammatory Bowel Disease Treatments
Mount Sinai is a national leader in the surgical treatment of inflammatory bowel disease (IBD). IBD refers to conditions—such as Crohn’s disease and ulcerative colitis—that involve inflammation of the digestive tract and may cause diarrhea, rectal bleeding, abdominal cramps, pain, fever, and weight loss.
Crohn's Disease Treatments
Since Dr. Burrill B. Crohn first described Crohn’s disease (CD) at Mount Sinai in 1932, our institution has been considered a world authority on this condition. Crohn's disease can affect the entire digestive tract, causing symptoms that may include cramping, abdominal pain, diarrhea, fever, weight loss, bloating, anal fistulae, and anal abscesses, as well as skin rashes, joint pain, eye inflammation, and liver problems. If medications do not control symptoms, surgery is required to remove the diseased part(s) of the intestine.
The majority of people with Crohn's disease will ultimately require surgery. Although surgery does not cure CD, it can allow you to resume a normal lifestyle. Most patients will need to continue medical therapy after surgery. Between 85-90 percent of people have no symptoms in the first year after surgery. Although Crohn's disease will likely recur in most patients, up to 20 percent of people have no symptoms 15 years after surgery.
At Mount Sinai, our surgeons have pioneered minimally invasive surgery for Crohn's disease, and the majority of our patients with CD now receive laparoscopic operations.
The most common procedures our surgeons perform for Crohn's disease include bowel resection and stricturoplasty. Bowel resection may involve the large intestine or the small intestine, depending on the location of the disease; stricturoplasty is typically employed in cases where the small intestine is blocked.
Ulcerative colitis is a disease in which the lining of the large intestine becomes inflamed and develops sores, leading to bleeding and diarrhea. The inflammation almost always affects the rectum and lower part of the colon, but it can also affect the entire colon. Common symptoms of mild disease include intermittent rectal bleeding, mucus discharge from the rectum, mild diarrhea, and crampy abdominal pain. Patients with moderate to severe disease often experience multiple loose bloody stools, anemia, abdominal pain, fever, and weight loss.
Although ulcerative colitis cannot be cured, and some people do not respond well to conservative therapy, medications typically improve symptoms in up to 90 percent of people and even induce remission.
At Mount Sinai, we consider surgery for patients who have life-threatening complications of inflammatory bowel diseases, such as massive bleeding, perforation, or infection. It may also be necessary for those who have the chronic form of the disease, which fails to improve with medical therapy, or for those with a precancerous lesion in the colon. Historically, the standard operation for ulcerative colitis was removal of the entire colon, rectum, and anus with creation of an ileostomy (an artificial opening in the abdominal wall) and need for a permanent ostomy bag to collect bowel movements.
At Mount Sinai, however, for the vast majority of patients, we construct a new rectum from the small intestine, called a J-pouch, which is connected to the anus and the intestinal system. Most patients will experience at least six bowel movements per day with the J-pouch in place, but will not need a permanent ostomy bag. The operation is usually conducted in two to three stages depending on the patient's severity of illness and may involve a temporary ileostomy. At Mount Sinai, these operations are often performed laparoscopically when appropriate, leaving the patient with a virtually scarless abdomen.
The fourth most common cancer in the United States (behind lung, prostate, and breast), colorectal cancer causes symptoms that include abdominal pain, change in bowel habits, blood in the bowel movements (black or dark-colored stools), weight loss, and anemia.
The treatment of colorectal cancer usually involves surgery, which may be offered in conjunction with chemotherapy and radiation therapy. Mount Sinai offers advanced surgical and minimally invasive options to treat the disease and preserve normal function.
In most people, the two ends of the colon can be reconnected immediately after the cancerous portion has been removed, but in cases where the surgeon feels that the tissues are inflamed and need time to heal, a temporary ostomy may be created.
A diverticulum is a pouch-like area that can form in the wall of the colon. If diverticula become inflamed or infected, you may develop diverticulitis, which causes symptoms including pain in the left lower side, nausea, vomiting, and diarrhea. While most people have simple diverticulitis (which typically responds to antibiotics), complicated diverticulitis (which may involve abscesses, fistula, or a blockage) occurs in 15 percent of cases and usually requires surgery.
Mount Sinai surgeons are highly skilled in various surgery options for the treatment of diverticulitis. Emergency surgery typically requires colon resection, which involves removing the diseased portion of bowel and a temporary ostomy prior to a second surgery for reconnection. However, patients who come to Mount Sinai for elective surgery are often candidates for laparoscopic surgery, and the majority do not require an ostomy. The type of surgery chosen for you depends on the severity of your symptoms and your personal preferences.
It is not uncommon to see blood while wiping after a bowel movement. It is important to note that this blood—gastrointestinal (GI) bleeding—is not a disorder, but a symptom of a disorder. While it is possible for this blood to be related to serious conditions such as colorectal cancer, the vast majority of cases are due to benign conditions such as hemorrhoids, anal fissures, diverticulitis, colitis, and polyps.
Mount Sinai has a variety of state-of-the-art tools to investigate GI bleeding. Diagnosis typically involves an initial rectal exam, and may require more extensive testing ranging from anoscopy (inspection of the anus and lower rectum done in the office without sedation) to colonoscopy, depending on the patient's age and symptoms. In cases of obscure bleeding, our physicians at Mount Sinai are experienced in providing additional imaging studies such as bleeding scans, angiography, multiphase CT enterography, and capsule endoscopy.