Rectal polyp surgery

A rectal polyp is a benign neoplasm of the rectum, and some types of it may transform into a malignant neoplasm of the rectum over years. Therefore, it is considered as a precancerous condition. Initially, the rectal polyps are small in size, but they can reach a size of even several centimeters as they grow.

They can be connected to a stalk, or they can be sessile i.e., broad based. The latter type is harder to remove as they require a bigger excision.

What symptoms does a rectal polyp cause?

Polyps, and early stage neoplasms usually do not cause any symptoms. Therefore, screening tests have a special significance. The rectum can be examined with a proctological examination, and the large intestine (colon) can be screened with colonoscopy.

In rare cases, depending on their location and size, polyps may protrude through the anal opening during defecation, or even bleed. Pain usually is not produced because the mucous membrane is not innervated by sensory nerves.

What are the treatment options?

The treatment is exclusively surgical. Smaller rectal polyps can be removed during a proctological examination with a pair of biopsy forceps, while larger abnormalities can be removed in general anesthesia, in a surgical setting. The removed sample is sent for a histopathological analysis, and the grade of the neoplasm (whether it is benign or malignant) can be determined along with its histopathological type based on this.

What happens if the treatment is not performed?

If the abnormality is not removed, it will transform into a malignant neoplasm in one part of the cases. Malignant neoplasms of the rectum and the large intestine sooner or later will completely spread over the intestinal walls, and once they reach the peritoneal surface of the intestine, they may give metastases to the adjacent organs, peritoneum, and also to distant organs (e.g., the liver) through the blood stream and the lymphatic circulation.  They may also cause intestinal obstruction due to their size, and that requires emergent surgical care.

What happens to you before the surgery?

Investigation before admission to inpatient care

General examinations. It is also true for scheduled surgeries that patient’s safety is first i.e., the patient should be in the most optimal state when undergoing surgery. The point of the investigation preceding the surgery is that we get a picture about the known and the potentially unknown diseases of our patient. The general steps of examinations are the laboratory tests, ECG, and imaging studies, which are complemented by further examinations consistent with the patient’s comorbidities, or professional opinions from specialists may be requested regarding the surgical aspect of the concurrent comorbidities, if necessary.
Potential inflammations, which are not related to the surgery have special importance e.g., purulent tonsillitis, urinary tract infections, gynecological inflammations. Their treatment before surgery (preoperative treatment) is important because they may be the focus of an infection from where they can get to the surgical site by blood stream and may cause wound suppuration during the days after the surgery, compromising the success of the surgery.

What happens to you in the operating room?

Rectal polyp(s) are excised with an edge of the mucous membrane, and following surgical hemostasis, the wound surface is closed with an interrupted suture, if necessary. The removed sample is sent for histopathological analysis (if there are several polyps, they are sent one by one with the exact location marked).

What happens to you after the surgery?

Once the surgery is completed, you will stay in the operating room for observation for a certain period of time.
You will be transferred the post anesthesia care unit (recovery room), or to an intensive care unit, depending on your condition.

• Anesthesia wears off gradually a few hours later, and your pain will be reduced by injections, and tablets after that.
• Despite the pain it is important that you shortly start to perform the breathing, vascular, and movement exercises!
• Injections against blood clotting (antithrombotics) are routinely administered.
• On the evening of the surgery, you may start to consume water given that you do not have nausea. It is important to consume sufficient amount of fluids in the forms of fruit juices, soups, and non carbonated mineral water.
• Patients may get up with the help of a physiotherapist usually in the evening, or in the morning next day.
• It is important to comply with the physiotherapist’s instructions!
• In a non problematic case, you may leave our institution 1 2 days after the surgery.
• You will receive dietary advice before discharge.

At discharge:

• 1.  You will receive the discharge summary and the justification for sickness benefit.
• 2. Please ask your treating physician if you have any questions!

After surgery, please protect the wounds from water for 5 days during your personal hygiene routine, and make sure to change the dressing on the wounds every day and keep them clean by using a solution called Betadine. Following this, you may take a shower without the dressing, unless your treating physician orders otherwise!

Suture removal and a follow up examination is due 7 10 days after the surgery, but if you have any symptoms, please immediately contact your treating physician!