Colorectal Surgery (Colectomy, Hemicolectomy, Sigmoidectomy, Proctocolectomy) in Johannesburg

What it involves

The affected segment of colon or rectum is mobilised, its blood supply divided at the origin, and the segment removed with an appropriate lymph-node harvest for cancer cases. The two healthy ends are then rejoined (anastomosis). Depending on the segment removed, the operation is called a right hemicolectomy (right colon), left hemicolectomy (left colon), sigmoidectomy (sigmoid colon), anterior resection (upper rectum), low anterior resection (lower rectum), or total proctocolectomy (entire colon and rectum, usually for ulcerative colitis or familial polyposis).

Diverticular disease is a common reason for elective colon surgery in South African adults. Recurrent attacks of diverticulitis, complicated diverticulitis (abscess, fistula, stricture) or persistent symptoms after an acute episode are all indications for elective sigmoidectomy — usually done laparoscopically or robotically with a same-admission return home in three to five days.

For colorectal cancer, surgery is the single most important treatment. Most colon and rectal cancers are adenocarcinomas that develop from precancerous polyps over years. Once diagnosed on colonoscopy, staging scans define the extent of disease and the surgical plan: which segment to remove, how many lymph nodes need clearing, and whether chemotherapy or (for rectal cancer) radiotherapy is needed before or after surgery. Dr Marais coordinates this multidisciplinary plan with oncology and radiology colleagues.

Rectal cancer surgery — low anterior resection or, rarely, abdomino-perineal resection — is technically the most demanding colorectal operation. The dissection follows a precise anatomical plane (total mesorectal excision, TME) to remove all the lymph-node-bearing tissue around the rectum in one specimen. The pelvis is a narrow bony space, and the robotic platform's articulated instruments and 3D visualisation earn their place here. See the robotic surgery page for more on the da Vinci / DaVinci / Intuitive platform Dr Marais is certified on.

Total proctocolectomy — removal of the entire colon and rectum — is reserved for ulcerative colitis unresponsive to medical treatment and for familial adenomatous polyposis. It can be done in one or two stages and, where appropriate, with construction of an ileal pouch (J-pouch) so the patient does not need a permanent stoma.

Not every colorectal operation needs a stoma. Most colon resections and higher rectal resections are reconnected at the same operation. A temporary loop ileostomy is sometimes used after low rectal surgery to protect the join while it heals, and is reversed a few months later. A permanent colostomy is only required for very low rectal cancers or emergency presentations, and is always discussed in detail before surgery.

When it's indicated

Common indications include recurrent or complicated diverticulitis, ulcerative colitis or Crohn's disease not controlled medically, large polyps that cannot be removed endoscopically, and colon or rectal cancer confirmed on colonoscopy and biopsy. Staging with CT scan (and MRI for rectal cancer) precedes surgery, and cases are discussed in a multidisciplinary meeting.

The approach

Whenever it is safe, Dr Marais uses a minimally invasive approach — laparoscopic or robotic (da Vinci) — through several small port incisions rather than one large midline wound. Robotic assistance is particularly useful in the pelvis (rectal surgery, low anterior resection) where wristed instruments and 3D vision help preserve nerves and achieve a clean cancer clearance. Open surgery is still the right choice for very advanced disease, hostile adhesions, or unstable emergencies.

Recovery

Enhanced recovery pathways get most patients eating, drinking and walking within 24 hours of surgery. Typical hospital stay for a minimally invasive colon resection is three to five days, longer for rectal surgery or if a stoma is fashioned. Return to desk work is usually two to four weeks; heavy lifting at six weeks. Follow-up includes wound checks, histology discussion, and a surveillance colonoscopy programme for cancer cases.