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Areas of Clinical Expertise
Benign Anal & Colorectal Disease
The staff of the Department of Colorectal Surgery offers extensive
experience in the management of benign colorectal diseases, including
inflammatory bowel disease, ulcerative colitis, anal fissures, fistulas,
abscesses and Crohn's disease. These conditions are treated at USC
University Hospital, a 290- bed internationally known tertiary facility.
Fecal Incontinence
Fecal incontinence mostly affects young women following labor,
or older women who have had nerve injury earlier in life and who
now experience more diffuse perineal floor relaxation characterized
by urinary incontinence, cystoceles, rectoceles, and sphincter dysfunction.
In about 80 percent of vaginal deliveries, the two nerves running
along the rectum are injured. The nerves recover in most instances,
but sometimes they do not and may cause problems for these women
as they age. The center offers sophisticated testing to determine
which patients would benefit from surgery or other non-surgical
techniques to restore proper function of the sphincter muscle and
perineal floor.
Colon Cancer
Patients with colorectal cancer benefit from a multi-disciplinary
team including colorectal surgeons, medical oncologists, radiation
oncologists, gastroenterologists, enterostomal therapists, genetic
counselors, and clinical nurse specialists. The Colorectal Cancer
Program is headquartered at the USC/Norris Comprehensive Cancer
Center, one of the only 27 such centers in the country designated
by the National Cancer Institute. The program at USC/Norris is designed
so that patients may be seen by all appropriate specialists during
one visit. Following patient evaluation, the center's team meets
to develop treatment options. The care plan is determined in consultation
with the referring physician and the patient.
Complex or Recurrent Cancer Cases
At the USC/ Norris Comprehensive Cancer Center, patients with difficult
cancer problems have access to new, advanced therapies not widely
available in the community.
Surgeons at the Department of Colorectal Surgery diligently focus
on matching the extent of surgery with the extent of disease, avoiding,
whenever possible, colostomies and ileostomies. Their goal is to
achieve wide margins around tumors and to perform sophisticated
reconstructive procedures that will maximize cure without compromising
the ability to restore intestinal continuity and function.
USC/Norris surgeons are particularly interested in treating locally
recurrent rectal cancer, a problem in 10 to 30 percent of rectal
cancer patients. Since neither surgery, chemotherapy nor radiation
is effective alone, the center takes a multi-modality approach and
has documented local control rates of 70 percent and long-term cure
rates of 25-40 percent.
Innovative Surgical Expertise
For treatment of both benign and malignant colorectal disease,
the center's team offers special surgical expertise:
- Continent Ileostomy (Kock Pouch, Barnett Pouch, T Pouch)
These intestinal reservoirs allow patients to store intestinal
waste and control its discharge from the body after colo-proctectomy,
eliminating the need for an external appliance. These pouch procedures
involve the creation of an internal pouch for storage and a valve
for continence. The pouch is emptied three times a day through
a catheter inserted into the pouch, allowing its contents to flow
directly into the toilet.
- Ileal Pouch-Anal Anastomosis
In this procedure, surgeons create a pouch out of the terminal
ilium and sew it to the anal muscles. Patients can then defecate
through their anus in the usual way. Patients have about five
bowel movements a day and maintain the ability to defer defecation
until a socially convenient time.
- Laparoscopically Assisted Surgery
The Department of Colorectal Surgery offers expertise in performing
laparoscopically assisted colectomy, a relatively new procedure
that allows surgeons to safely and effectively remove segments
of the colon through minimally invasive surgical techniques. Our
preliminary studies indicate this procedure can reduce pain and
the length of hospitalization with low morbidity.
Stapler Hemorrhoidectomy
New hemorrhoid surgery with less pain. About half of the people
in the United States will suffer from hemorrhoids at some time in
their lives. While conventional surgical hemorrhoidectomy is a safe
and reliable procedure, it is often associated with significant
postoperative pain. A new procedure for removing large hemorrhoids,
the stapler hemorrhoidectomy, is less painful and allows patients
to return to work and other normal activities much earlier than
with the conventional procedure. The new technique, which uses a
stapling device, takes advantage of the fact that pain-sensing nerve
fibers are absent higher in the anal canal, where the wound will
be placed.
Dr. Andreas M. Kaiser, Assistant
Professor of Clinical Surgery, and his colleagues are some of the
preceptors for teaching/instructing this new procedure and they
perform this outpatient operation on a regular basis at USC-affiliated
hospitals.
Artificial Bowel Sphincter for Fecal Incontinence
Fecal incontinence can be caused by a variety of factors including
damage to nerves or the muscles that control bowel function. To
the patients, this is an often debilitating situation because the
fear of having an accident limits their daily activities and mobility.
For mild forms of fecal incontinence, physical therapy and biofeedback
training can help to strengthen the anal sphincter and pelvic floor
muscles. Severe cases of fecal incontinence, however, may require
surgical intervention, either direct repair of the anal sphincter,
replacement of the anal sphincter, or even a colostomy.
If conservative treatment or surgical repair of the anal sphincter
muscle fail to improve a patient's situation, the Acticon Neosphincter,
which has now been approved by the FDA, may be a new alternative.
This artificial bowel sphincter is an implantable prosthesis that
simulates the natural function of the anal sphincter muscle, thus
giving the patient back the control over bowel movements.
The USC Department of Colorectal Surgery offers the whole spectrum
of the diagnostic tools for fecal incontinence, as well as conservative
and surgical treatments. Dr. Andreas
M. Kaiser, Assistant Professor of Clinical Surgery, and his
colleagues are some of a few surgeons nationwide, who are performing
this new artificial bowel sphincter procedure at USC-affiliated
hospitals.
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