The New Generation of Surgery

            Colorectal surgery conjures up a variety of images for patients and physicians alike – many of them less than pleasant. Today, thanks to an assist from advanced technology and specialized training, the physicians of UK HealthCare’s new Section of Colon and Rectal Surgery are sending some of those preconceived notions into medical history.

            The enhanced services offered by H. David Vargas, M.D., associate professor of surgery, and Jon S. Hourigan, M.D., assistant professor of surgery, provide additional opportunities for improved patient outcomes through minimally invasive procedures.

            “A big emphasis within our specialty is the ability to treat rectal cancer, specifically in a multi-disciplinary partnership with the UK Markey Cancer Center,” Vargas said. “As a result of specialty training, we have improved our ability to treat rectal cancer successfully without having to perform colostomies. There are a variety of techniques we’re able to employ without sacrificing a person’s continence.”

            Vargas and Hourigan’s clinical practice is limited to diseases of the colon, rectum and anus. Preservation of the sphincter is a focus of the specialty, and their incidence of permanent colostomy creation is significantly lower than typically available through general surgery.

            While the percentage of minimally invasive procedures they perform is a source of pride, Vargas and Hourigan practice a breadth of colorectal surgery from minor hemorrhoid treatments through major cancer procedures.

TEM is a Kentucky first

            A technique that’s contributing to the higher rate of favorable outcomes is transanal endoscopic microsurgery (TEM). The only operating system of its kind in the Commonwealth of Kentucky, TEM enables physicians to operate on tumors in the mid- to upper rectum that previously were beyond reach. The system’s video imagery generates a magnified view of the affected area and enhances the surgeon’s skills.

            Combined with radiation and medical oncology services available in UK’s multi-disciplinary clinic setting, TEM is proving to be a valuable asset in the battle with rectal tumors.

            “For an elderly patient who’s not going to tolerate major abdominal surgery, TEM provides another way to remove tumors with a curative intent,” Vargas said. “Recovery is fast, and the procedure can be done outpatient or with an overnight stay.”

            Both surgeons employ laparoscopic techniques for the vast majority of their abdominal procedures. The resulting incisions are a fraction the size needed for major surgical procedures and dramatically shorten the length-of-stay statistics.

            “Hospital utilization of beds is decreased, and minimally invasive procedures help preserve the independence of patients,” he said. “In cases where the patient is not fit – and with our aging population, that’s increasingly becoming the case – this gives us another way of treating them. We’re very excited about the results.”

            While colon and rectal screening rates continue to struggle toward the 50-percent level, it’s an improvement over the historical rate of about 30 percent.

Colonoscopies remain the primary screening tool, providing benefits for both cancer detection and treatment. Early-stage detection decreases the likelihood that tumors have spread to the lymph nodes.

            “Patients that undergo screening are less likely to develop rectal tumors,” Vargas said. “Even if they have them, they’re more likely to have a lower-staged disease and a better prognosis. We can safely use TEM to remove tumors without having to subject the patient to an abdominal operation.”

Benefits of specialty care

            As with all medical specialties, colorectal specialists are best suited to generate optimal patient outcomes in their narrowly defined field. Functional disorders such as fecal incontinence as well as physiological issues such as anal fissures fall under their area of expertise.

            “Fecal incontinence can be a very traumatic and debilitating condition,” Vargas noted. “It can devastate a young person’s life and make it so they no longer can maintain social activities.”

            Anal fissures – often misdiagnosed as hemorrhoids – can make patients fearful of even having a bowel movement because of the severe pain. The majority of patients are young females with birth injuries.

            Vargas and Hourigan also treat inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis, using the J-Pouch procedure or restorative proctocolectomy.

            Endorectal and endoanal ultrasound, along with anal manometry, are now available in UK’s anal-rectal physiology lab to evaluate patients with fecal incontinence and severe constipation issues. Endorectal ultrasound is a new, state-of-the-art modality used for pre-operative staging of rectal cancer.

UK’s colorectal surgeons are among the few in Kentucky with the ability to identify rectal tumor patients who would benefit from pre-operative chemotherapy and radiation treatment.

            “If we can identify which patients have extension of the tumor through rectal musculature or enlarged lymph nodes, they can best be treated by pre-operative chemotherapy and radiation,” Vargas explained. “Those patients experience fewer side effects from radiation therapy and have improved cancer outcomes in terms of decreased recurrence of their cancer. They’re also much more likely to have sphincter-preserving surgeries.”

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