Colorectal Surgery

Dr Simon Chew has been a practising Colorectal Surgeon for over 12 years and currently operates at Norwest Private Hospital, Westmead Private Hospital, Nepean Private Hospital and Strathfield Private Hospital.

Since 2007, Dr Kim Loh has held VMO positions at Blacktown, Mt Druitt, Norwest Private and Westmead Private hospitals. Dr Loh is well trained in general and laparoscopic surgery, with special interest in colorectal surgery. He has also received training in robotic surgery. 

Below is a summary of some of the colorectal and general surgical conditions treated by Dr Chew and Dr Loh:

Colon and Rectum Anorectal Conditions Pelvic Floor Disorders General Surgery
  • Colorectal polyps
  • Colorectal cancer
  • Diverticular disease
  • Inflammatory bowel
    disease, Crohn's disease
    and Ulcerative Colitis
  • Haemorrhoids
  • Anal fistula
  • Anal fissure
  • Perianal abscess
  • Anal cancer
  • Faecal incontinence
  • Obstructed defaecation
  • Rectocoele
  • Internal and external
    rectal prolapse
  • Descending perineum
  • Pilonidal sinus
  • Inguinal hernia
  • Incisional hernia
  • Parastomal hernia
  • Recurrent hernia
  • Umbilical hernia

 

Colorectal surgical procedures

Dr Chew and Dr Loh specialise in the following colorectal surgical procedures

 

Anal Fissure

This is an extremely painful anal condition. A fissure is a linear break/tear of the lining of the anal mucosa. The most common position where this occurs is in the posterior midline (80%). Second most common location is anterior midline (20%).  Often patients with fissures described sharp, stabbing pain in the anus that is made worse when opening their bowels. Sometimes, they may also notice a small volume of fresh blood on the toilet paper when wiping.

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Anal Fistula

An anal fistula is an abnormal communication between the innermost lining of the anal canal and the perianal skin.

Anal fistulae are formed as a result of an infection of the anal glands which are located between the two layers of the anal sphincters. The glands usually secrete mucus to lubricate stool. When the outlet of these glands becomes blocked, an abscess can form which can eventually point to the skin surface. The communication between the opening on the skin where the pus drains and the internal opening where the blockage occurred previously forms the anal fistula tract.

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Piles and Haemorrhoids

What are Haemorrhoids?

Haemorrhoids are engorged blood vessels covered by the lining of the anal canal that may slide down (prolapse), enlarge or bleed.

Prevalence

  • About 4-5% of population have haemorrhoidal problems
  • Only 1/3 will go to see a doctor
  • It usually affects people in the age group 45-65 years. The prevalence decreases after 65 years of age
  • It rarely affects people under 20 years of age

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Pilonidal Disease

Pilonidal disease is a skin infection in the natal cleft (the cleavage in the midline between the buttocks). This area is close to the anus and therefore can be difficult to treat as it is often difficult to keep the wound clean. Pilonidal disease is a result of hairs inserted into the skin of the natal cleft and embedded under the skin. This may lead to infection and abscesses with underlying tracts.

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Colonoscopy

A colonoscopy is an examination of the colon performed under anaesthesia. A flexible instrument carrying a video camera is inserted through the anus and passes around the bowel. It is an excellent tool for the diagnosis of a range of bowel problems. In particular, it is used to identify the presence of cancer or to remove polyps from the bowel before they have a chance to develop into cancer. Polyps are small benign growths that grow on the wall of the colon. They occur in about 10% of people and generally have no symptoms. A small proportion of them will eventually turn into bowel cancer. People with a strong family history of bowel cancer and those who have had previous colonic polyps removed are at higher risk of developing polyps and bowel cancer.

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Laparoscopic Surgery

Laparoscopic colorectal surgery is a form of minimally invasive surgery that started in early 1990’s in Australia. However, it became more popular after 2004 when the result of a large US clinical trial was published demonstrating its advantages and safety in cancer surgery.
Laparoscopic colorectal surgery has the following advantages:

Short Term Advantages

  • Quicker recovery
  • Less pain and thus need less pain relief
  • Drink and eat earlier
  • Open bowel earlier
  • Shorter hospital stay
  • Less complications

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Single Incision Laparoscopic Surgery (SILS)

For Right Hemicolectomy (Removal of the Right Colon)

SILS for colorectal surgery started in about 2008. It has also been used in cholecystectomy, appendicectomy and more recently hysterectomy.

SILS uses the umbilicus as the single point of entry for all the laparoscopic instruments via a special device. The device that Dr Chew uses is the Gelport made by Applied Medical.

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Trans Anal Minimally Invasive Surgery (TAMIS)

This is a technique first described by Drs S Atallah, M Albert, and S Larach in 2009. It involves the use of a device that allows introduction of laparoscopic instruments into the anal canal without losing the gas in the rectum (pneumorectum). Carbon dioxide gas (CO2) is pumped into the rectum via a tube in the device to provide the distension necessary for visualisation.

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Robotic Rectal Surgery

Robotic Surgery can be used to treat two conditions in the rectum: rectal prolapse and rectal cancer.

Rectal Prolapse

Rectal prolapse occurs when the wall of the rectum falls into the anus. A mass that sticks out from the anus is the most common symptom. It is a condition which occurs more commonly in elderly women and is often linked to constipation and/or previous childbirth.

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