Colorectal Surgery Program

Laparoscopic colorectal surgery, a type of minimally invasive surgery, encompasses a variety of techniques that offer an alternative to open surgery, ultimately allowing for colorectal surgeons to treat conditions via smaller incisions using delicate tubes, cameras, and other surgical instruments. In general, minimally invasive surgery is associated with less pain, a shorter hospital stay, and fewer complications.

Another type of minimally invasive colorectal surgery is robotic surgery. Mass General is home to the fastest growing robotic surgery program in New England, and colorectal surgery is one of several surgical specialties that can be performed robotically. Using the robot, our colorectal surgeons have enhanced three-dimensional visuals of the surgical area, more delicate surgical precision, and a superior range of motion in hard-to-reach spaces in the human body. Benefits of robotic surgery include smaller incisions, minimal scarring, and quicker recovery.

Whenever possible, Mass General colorectal surgeons will recommend robotic colorectal surgery to treat your condition. To make the final determination, they will consider your health history, lifestyle, and goals for treatment.

In cases when minimally invasive techniques are not recommended, traditional colorectal surgery will be offered as a safe, effective approach. Also known as an open surgery, traditional surgical techniques involve a larger incision to allow full access to the affected area.

Mass General colorectal surgeons are also experts in transanal endoscopic surgery, using techniques such as transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS). In this way, they are able to remove rectal tumors without needing to make any incisions on the abdomen. These techniques also help spare some patients from needing to have their entire rectums removed for certain types of rectal tumors.

Our colorectal surgeons also specialize in techniques that preserve the anal sphincter, allowing for restoration of bowel continuity and, in some cases, avoiding the need for permanent ileostomies or colostomies. For example, for certain patients with low rectal cancers, our surgeons can perform transanal total mesorectal excision (taTME) and colo-anal anastomoses, which allows patients to avoid permanent colostomies.

An anal fistula is an irregular tunnel that develops between the anal canal and the skin near the anus. It often occurs when an anal gland becomes clogged and later infected, leading to an abscess.

Surgery is almost always needed to cure an anal fistula. An anal fistula repair can be performed by either surgical opening of an anal fistula (fistulotomy), less invasive techniques such as anal fistula plugs, or a ligation of intersphincteric fistula tract (LIFT) or endorectal advancement flap procedure. Most patients can go home the same day.

Colectomy, or a colon resection, is a surgical procedure in which all or part of the colon (large intestine) is removed. The surgeon will often reconnect the remaining parts of the colon to ensure normal bowel function.

Colectomies are performed for various reasons, including to treat colon cancer, inflammatory bowel disease (IBD), and diverticulitis. The type of colectomy performed may also depend on the location of the affected area in the colon.

Colectomies can be performed by traditional, laparoscopic, or robotic surgery. Your physician will determine which type of surgery is best for you.

Cytoreductive surgery (CRS) is a procedure to remove cancer that has spread to the abdomen, a type of cancer known as peritoneal carcinomatosis. Many patients with this cancer are told that surgery will not completely remove it. However, CRS can be effective for some patients when done by specialized surgeons. During CRS, hyperthermic intra-peritoneal chemotherapy (HIPEC), a heated medication, is sometimes used. The surgery and the medication work together to eliminate the cancer cells. 

For patients with ulcerative colitis or familial adenomatous polyposis—both of which often require surgical removal of the entire colon and rectum—bowel function can be restored by fashioning a pouch using the small intestine (J-pouch) to create a reservoir that holds stool, similar to a rectum. This procedure enables patients to avoid permanent ileostomies (stomas).

Parastomal hernias, bulges that occur around ileostomies and colostomies (stomas), can expand over time. These hernias can be repaired with and without mesh, and sometimes involve moving the stoma to a different location on the abdomen.

A proctectomy is a surgical procedure to remove all (total proctectomy) or part (partial proctectomy) of the rectum, which is the lowest part of the colon (large intestine). During a proctectomy, Mass General surgeons work hard to preserve the many important pelvic organs surrounding the rectum.

Proctectomy is a surgical treatment for rectal cancer and inflammatory bowel diseases (IBDs) such as Crohn’s disease.

After a proctectomy, a patient may have a permanent or temporary opening (stoma) in the abdomen as a new way for stool to flow out of the body and into a disposal bag. The colorectal surgeons at Mass General are focused on sphincter-sparing procedures to preserve the muscles that are responsible for closing openings such as the anus.

Proctectomies can be performed by traditional, laparoscopic, or robotic surgery. Your physician will determine which type of surgery is best for you.

For patients with rectal prolapse, MGH colorectal surgeons participate in the MGH Pelvic Floor Center, where we have a multidisciplinary approach to treating patients with pelvic organ prolapse. For those patients who require surgery, we offer suture rectopexies and ventral mesh rectopexies, which involve pulling the rectum up and securing it to the sacrum. This procedure can be done traditional, laparoscopic, and robotic, and is often done as part of a combined procedure with MGH urogynecologists if patients also need suspension of their cervix.

Implantation of sacral nerve stimulation (SNS) devices has been shown to help treat fecal incontinence, which is the inability to control bowel movements. Mass General is one of the few hospitals in Massachusetts to offer this procedure that helps countless patients, particularly older women who have had children.

A sphincteroplasty is surgery to repair torn or weakened anal sphincters, which are the muscles that control bowel movements. This is a common procedure for women after childbirth and fecal incontinence. During a sphincteroplasty, the surgeon will repair the torn ends of the muscle by stitching them together. In some cases, a tissue graft may be needed to reinforce the repair.

Mass General is one of the few hospitals in New England to offer placement of an artificial bowel sphincter (ABS) for patients who cannot have a sphincteroplasty as another treatment for severe fecal incontinence.

A stricturoplasty is a surgical procedure to correct a narrowing in the intestine where tissue scarring has occurred and is preventing normal intestinal function (digestion). This procedure is a less invasive alternative to traditional removal of the narrowed portion of the bowel and aims to improve a patient’s quality of life.

Stricturoplasty is a surgical treatment for inflammatory bowel diseases (IBDs) such as Crohn’s disease.

Total mesorectal excision (TME) is a robotic procedure to treat rectal cancer by removing the area of the rectum with the tumor along with the surrounding lymph nodes and blood vessels (mesorectum).

This surgery requires particular precision to ensure that bowel and bladder function is preserved, and use of the robot allows the surgeon to more precisely visualize and remove the tumor through a smaller incision. This technique is associated with better survival, lower recurrence, and improved sphincter preservation when compared with traditional techniques.

Transanal Endoscopic Microsurgery (TEM) is a minimally invasive procedure in which colorectal surgeons laparoscopically remove rectal tumors that are too high up in the rectum to be removed through other surgical approaches, and to remove rectal polyps that are suspected of being early-stage rectal cancer.

During TEM, the rectal tumor or polyps are removed through the anus, thus avoiding painful abdominal incisions and damage to the surrounding tissue. Mass General is one of the few U.S. hospitals offering this leading-edge procedure.

Colorectal surgery encompasses a range of open and minimally invasive surgical procedures to treat conditions of the intestinal tract, colon and rectum, anal canal, and perianal area. 

If you are diagnosed with a colorectal condition—such as colon or rectal cancer, colitis, anal fistulas, etc.—your primary care physician or gastroenterologist may refer you to a colorectal surgeon. If the condition requires surgery, the Mass General colorectal surgery team will work with your primary providers to coordinate your surgical care in alignment with your overall health and goals. 

Often, colorectal conditions not only impact the colon (large intestine), but also surrounding organs such as the small intestine, pelvic floor, and reproductive organs. Colorectal surgeons are trained in general surgery with a specialization in colorectal conditions, and they are equipped to treat other nearby organs that interact with the large intestine or have been affected by the colorectal disease. 

Many colorectal conditions can be treated through minimally invasive techniques such as laparoscopic surgery and robotic surgery. Whether or not these techniques are the safest, most effective approach depends on each patient’s condition and overall health. Your Mass General colorectal care team will determine the best options in partnership with you. 

Every case is unique depending on the patient’s history, condition, and overall health. All patients in need of a colorectal operation can expect to undergo an evaluation with our multidisciplinary care team. 

We have created a variety of materials to help you prepare for your procedure, ensure better recovery, and return to normal life as soon as possible. 

Click the links below to watch a series of short videos about how to prepare for surgery and improve your recovery. These videos are offered in several languages. 

• English 
• Spanish 
• Arabic 
• Mandarin 
• Portuguese 
• Russian