Dr. Bauer is a pioneer in the field of colorectal surgery. He specializes in treating the following diseases thorough surgical specialties and procedures:

+ Crohn's Disease

Crohn’s disease is a chronic inflammatory disease that primarily impacts the gastrointestinal tract. First described in 1932 at Mount Sinai Hospital, Crohn’s disease affects patients in several different ways. The cause of Crohn’s disease is unknown but may involve genetic and environmental factors. There is no cure for Crohn’s disease.

Crohn’s disease carries various clinical manifestations, including stricture and fistula formation. It can sometimes cause life-threatening complications. Crohn’s disease can involve any portion of the digestive tract from the mouth to the anus.

Patients often come to need medical attention due to the following symptoms:

• Chronic abdominal pain
• Sudden weight loss
• Diarrhea
• Anemia
• Fatigue
• Vomiting
• Unexplained pain without a change in bowel habits
• Continued or chronic symptoms despite medication

Patients may have a form of Crohn's disease that causes strictures (narrowing) of the intestine. Strictures may lead to abdominal pain, as well as obstruction (blockage of the intestine). Intestinal obstruction may lead to the symptoms of abdominal pain, nausea, and vomiting. Alternatively, fistulizing disease causes the wall of the bowel to breakdown leading to abnormal communications (fistulas) to other parts of the bowel or other intra-abdominal structures. These can also cause intra-abdominal abscesses.

Patients with Crohn's disease also may have symptoms around their anus, including infected fluid collections (abscess) or communication between the anus or rectum and the skin (fistula). Crohn's disease may involve genetic and environmental factors in some cases. The management of the disease can include both medical and surgical therapy.

Dr. Bauer’s primary goal to is to help patients, with or without a surgical procedure, who suffer from chronic symptoms associated with Crohn’s disease. He understands the debilitation connected to lifelong gastrointestinal complications and strives to help you live your life without painful, constant flare-ups.

He authorized one of the first publications about laparoscopic resection for Crohn's and has followed up with additional publications for laparoscopic resections in Crohn's disease.

He has performed over 400 laparoscopic resections for Crohn's disease. Minimally invasive surgery for Crohn's Disease is advantageous because the smaller incision enables patients to have a shorter stay in the hospital with less pain and an early return to normal function.

+ Colon Cancer

Cancers of the colon (large intestine) are commonly diagnosed among Americans. In fact, there are an estimated 200,000 new cases reported annually. Many may begin as non-cancerous polyps. Frequently, early cases of colon cancer are asymptomatic (no symptoms). We therefore suggest routine colon cancer screening beginning at age 50 for all individuals and earlier screening for high-risk patients.

Symptoms are not specific to this disease and may include:

• Rectal bleeding
• Abdominal pain
• Colon obstruction
• Stool inconsistency
• Bowel movement inconsistency
• Sudden, unexplainable weight loss

The cause of colon cancer is unknown, but most cancers arise from polyps (growths) of the lining of the colon. Once diagnosed, treatment includes surgical resection (removal) of the involved colon. Following surgery, chemotherapy may be recommended. If you think you may be at-risk for colon cancer, or if you are experiencing a sudden, uncomfortable symptom that could be indicative of a greater health issue, contact Dr. Bauer to arrange a consultation.

It is our primary goal to help colon cancer patients increase their chances of survival using the most surgical minimal invasive approach to resect the involved portion of large intestine. Contact Dr. Bauer to request a one-on-one consultation.

The majority of these procedures are now being performed using minimally invasive techniques. This technique affords the patient smaller and fewer incisions, shorter hospital stay, and a more rapid recovery.

+ Ulcerative colitis

Ulcerative colitis is an inflammatory disease of the large intestine (also known as the colon). It is clinically distinguished from Crohn's disease as it only affects the large intestine, and thus can be cured by surgical removal in most cases. Management of the disease includes medication, often administered by a Manhattan gastroenterologist, and surgery.

The first step in the diagnosis of ulcerative colitis includes a history and physical examination. The disease is often then diagnosed definitively with a colonoscopy and biopsy, during which a small amount of tissue from the lining of the large intestine is removed and sent for pathologic examination. The disease can often be diagnosed from the resulting pathology.

Additionally, a colonoscopy is used for the surveillance of precancerous and cancerous lesions in patients with ulcerative colitis. Other studies that may be used include plain abdominal X-rays and a CT scan of the abdomen and pelvis. Radiologic studies are often used to evaluate for the complications of ulcerative colitis, including large intestine dilation and perforation.

A few of the most common symptoms of ulcerative colitis include:

• Bloody diarrhea
• Abdominal pain
• Pale skin
• Fatigue
• Weight loss and poor appetite

TREATMENT OF ULCERATIVE COLITIS

In many cases, the initial treatment of ulcerative colitis includes medication, which is administered by a gastroenterologist. The medications commonly used include 5-ASA compounds (such as mesalamine), steroids, 6-MP/azathioprine, Cyclosporine, and Remicade. Surgery may be recommended in patients who are unresponsive to medical management, those who have intolerable side-effects of the medication, or those who have developed precancerous or cancerous lesions of the large intestine. The surgery may be performed in one to three different procedures, depending on the reason for surgery and the clinical appearance of the patient.

In some situations, most of the colon is removed (subtotal colectomy) and a temporary ileostomy is performed. Following recovery from this surgery, the remaining colon and rectum are removed. Following removal of the colon and rectum, a permanent ileostomy is an option. However, most people are candidates for a restorative proctocolectomy (ileal J-pouch).

A restorative proctocolectomy involves creating a pouch out of the end of the small intestine and connecting it to the anus, therefore removing the diseased large intestine with maintenance of the normal route of defecation. Our practice has performed more than 1700 restorative proctocolectomies.

The majority of these procedures are now being performed using minimally invasive techniques. This technique affords the patient smaller and fewer incisions, shorter hospital stay, and a more rapid recovery.

+ Rectal Cancer

Rectal cancer is a very common form of cancer for both men and women. The rectum is continuous with the colon (large intestine) and is approximately 15 centimeters in length, ending with the anus.

Most cases of rectal cancer are asymptomatic and diagnosed by screening colonoscopy, however since symptoms are not always specific to this disease, thorough testing is very important. The exact cause is unknown, but most cases arise from polyps (growths) of the lining of the colon.

DIAGNOSIS & SYMPTOMS OF RECTAL CANCER

Rectal cancer is diagnosed using a combination of patient history, physical examination, endoscopy, radiology, and pathology. The diagnosis is often made using colonoscopy with biopsies. When patients have endoscopy or surgery for the disease, tissue is often submitted to the pathologist for an evaluation, where they look at the tissue under a microscope and makes the diagnosis of rectal cancer. Colonoscopy is also important in patients with a history of rectal cancer for surveillance of the colon for development of tumor recurrence.

Radiology tests that may be ordered include plain X-ray and CT scan of the chest, abdomen, and pelvis. These studies are often utilized in the evaluation for evidence of metastatic disease (tumor spread beyond the primary site in the colon).

Patients may also have an endorectal ultrasound, where a slender ultrasound probe is inserted through the anus into the rectum to evaluate the stage of the tumor. Once diagnosed, treatment includes surgical resection (removal) of the involved colon. Depending on the stage, preoperative chemotherapy and radiation and/or postoperative chemotherapy and radiation may be recommended.

Common symptoms of this disease may include:

• Rectal bleeding
• Pain
• Obstruction
• Weight loss

BOARD-CERTIFIED SURGEONS PROVIDING TREATMENT OPTIONS

The treatment of rectal cancer varies based upon the local and distant extent of tumor spread. Based upon the preoperative endorectal ultrasound staging, preoperative chemotherapy and radiation may be offered. This is done to shrink the tumor, decrease the rate of local recurrence after surgery, and increase the chances of the surgery being done without a colostomy. If there is no spread beyond the primary site in the colon, the treatment is often removal of the involved colon.

Following removal of the colon, the pathologist will evaluate the tumor under the microscope and give it a stage based upon the depth of penetration of tumor in the wall of the colon, as well as the presence of tumor in the lymph nodes surrounding the tumor. Based upon the stage of the tumor, postoperative chemotherapy may be recommended, which is administered by a medical oncologist.

In selected patients with limited spread in the liver or lungs, removal of the involved colon along with the tumor in the liver or lungs may be feasible. The recommendation for this treatment strategy is individualized based upon the extent of disease and overall clinical presentation of the patient. If this approach is chosen, it is common for postoperative chemotherapy to be administered. In the case that the tumor spreads beyond the primary tumor and it is not amenable to removal, surgery may not be recommended, in which case chemotherapy is often administered.

In most cases, the surgical procedure can be done using minimally invasive techniques with small incisions leading to less pain, shorter hospitalization and more rapid recovery

+ Diverticulitis

Colonic diverticuli are small outpouching of the colonic wall that most commonly occur on the left side of the abdomen in the sigmoid colon. Diverticulitis is the inflammation of the colon resulting from blockage of a colonic diverticuli. Any conditions relating to diverticulosis of the colon can be addressed by Dr. Bauer.

He is extremely professional, friendly, and prepared to provide you with answers to your questions. He can address any concerns that you may have about the diagnosis or treatment of your condition.

Patients with diverticulitis may have symptoms of:

• Sudden or unusual changes in bowel habits
• Persistent and extreme fevers
• Left-sided abdominal pain
• Rectal bleeding

CAREFUL DIAGNOSIS & TREATMENT OF DIVERTICULITIS
The first step in diagnosing diverticulitis is to get a full medical history and complete a physical examination. Other studies that may be done include blood tests and plain abdominal X-rays. A CT scan of the abdomen and pelvis often is used to make the diagnosis, as well as identify complications of diverticulitis, such as abscess, obstruction, or fistula. Following recovery from an attack of diverticulitis, a colonoscopy is often performed to evaluate the large intestine for other lesions, such as colon cancer.

SURGERY IN NEW YORK FOR DIVERTICULITIS
The treatment of diverticulitis varies based upon the severity of the attack. For mild attacks, oral antibiotics, consumption of a liquid diet, and rest at home may be all that is required. For more severe attacks hospitalization with intravenous antibiotics may be recommended. If there is an associated abscess, drainage using CT scan guidance may be included in the treatment. For severe cases, immediate surgery may be undertaken. In patients who recover from an attack, surgery on an elective basis following recovery may be recommended. The recommendation for elective surgery is based upon the age and clinical appearance of the patient, as well as the severity of the attack (or attacks) of diverticulitis.

Surgical procedures for diverticulitis, whether they are done acutely or electively, and almost always be performed using minimally invasive surgical techniques. This technique affords the patient smaller and fewer incisions, shorter hospital stay, and a more rapid recovery.

+ Colon Polyps

A polyp is a type of abnormal growth which shows up in the lining of the colon or large intestine. They can develop either on a stalk or as a flat mass, and are one of the most common types of conditions which develop in the colon, which occur in about 15-20% of adults. It can be difficult to diagnose polyps on your own without being examined by a doctor, as polyps are often asymptomatic.

Although many polyps never turn into cancer, some of them may develop cancer as they grow. It is very important that you are seen and treated by a surgeon as soon as possible. .

There are a few different types of polyps we may offer treatment for, including:

• Vukkiys Adebina: 40% Risk
• Tubulo-Villous Adenoma: 20% Risk
• Tubular Adenoma: 5% Risk

DIAGNOSIS MALIGNANT & BENIGN POLYPS

Most cases of colon cancer have developed from a polyp, which is why it is imperative that all colonic polyps are examined right away. Because a majority of colon polyps are without symptoms, it can be difficult to determine if one has developed before you have received an examination.

A few examples of symptoms you may experience include:

• Changes in bowel habits, such as constipation or diarrhea
• Rectal bleeding
• Bloody stools
• Abdominal pain

There are a few factors which are considered when determining the risk of cancer, including the type and size of the polyp. The larger the polyp grows, the higher the risk of cancer gets. The diagnosis process for polyps usually involves a colonoscopy, during which the doctor looks for changes or anything with a suspicious appearance. If there is anything which looks suspicious, it may be removed for further testing.

In some cases after the polyp is removed endoscopically, surgical resection may be required and this can be performed using minimally invasive surgical techniques. This affords the patient smaller and fewer incisions, shorter hospital stay, and a more rapid recovery.

+ Incisional Hernia

A hernia occurs when a bowel or section of fatty tissue is allowed to push through the wall of the abdomen due to a weakness in the abdominal wall. This can lead to a misshapen swelling due to the contents sliding around in and out of the pouch. In some cases, the contents can be carefully pushed back, which is called a reducible hernia, whereas if they cannot be pushed back in, it is called an irreducible hernia.

Hernias can occur in different areas of the abdomen and can be caused by a variety of different factors. Dr. Bauer treats patients throughout the area for hernias of all varying degrees.

TYPES & CAUSES OF HERNIAS

Each different hernia is determined by where it is in the body. The basic problem behind a hernia is a weakness in the muscle, which can be caused by a variety of factors. One common cause of hernias is congenital, such as a baby who is born with a hernia, while many others are developed later in life as a result to the over straining of muscles. Whether you have been diagnosed with a hernia or have been experiencing the common signs, it is imperative that you have it treated as soon as possible.

There are many different types of hernias we treat, which may include:

• Femoral hernia
• Inguinal hernia
• Incisional hernia
• Umbilical hernia

SURGICAL OPTIONS FOR TREATMENT OF HERNIAS

Depending on the severity of the hernia and where it is located, there are a variety of surgical options available to you. While we most commonly repair hernias with open surgery, you may be a candidate for laparoscopic repair, which is much less invasive. Dr. Bauer will determine your eligibility during your initial consultation with him. The operation will be completed with either general or local anesthesia, which will be determined by Dr. Bauer in consult with your primary care physician and our anesthesiologists.

Large incisional hernias often require open surgery and mesh placement for repair. Dr. Bauer has been a participant in many studies regarding abdominal wall reconstruction with a variety of meshes and has lectured extensively on this topic, nationally and internationally.

+ Minimally Invasive Surgery

After you have been diagnosed with a colorectal disease, such as colon cancer, your doctor may determine that surgery is the most appropriate option for you. Dr. Bauer has mastered, and in some cases, pioneered the most advanced surgical techniques available.

Once you have undergone all of the necessary testing, he may recommend a minimally invasive surgery technique instead of open surgery. He is interested in tailoring the surgical approach to your particular situation. The technique is “tailored” specifically to you, your disease, general health and lifestyle.

COLORECTAL SURGERY OPTIONS

There are many different approaches available other than traditional open surgery, including those which use tiny incisions and a laparoscope. There are numerous benefits associated with a minimally invasive approach, including smaller incisions, less blood loss, less pain, a shorter hospital stay, and a faster return to normal activities. Minimally invasive surgery also helps to reduce the risks of infection and hernias.

There are a number of different forms of minimally invasive survery, including:

• Laparoscopic Surgery
• Hand Assisted Laparoscopic Surgery (HALS)
• Single Incision Laparoscopic Surgery (SILS)
• Transanal Endoscopic Microsurgery (TEMS)
• Transanal Minimally Invasive Surgery (TAMIS)

Minimally invasive surgery may be used as a treatment option for a variety of conditions, including:

• Rectal cancer
• Colon cancer
• Crohn’s disease
• Ulcerative colitis
• Colon polyps
• Rectal polyps
• Diverticulitis

+ Sphincter Preservation Surgery

If you have been diagnosed with rectal cancer, you have likely been told that surgery is the only or most effective form of treatment available to you. However, the surgical treatment for rectal cancer is much more complex than that of anal cancer - it requires extensive knowledge and technical skills.

The reason this is so important is that tumors which develop in the rectum are often very close to the sexual organs and the sphincter muscle and must be removed with great caution. Dr. Bauer has extensive experience and has published widely in this area He has also trained many residents to employ sphincter preservation surgery.

A few of the possible techniques for sphincter preservation surgery include:

• Laparoscopic Surgery
• Neoadjuvant therapy
• Transanal Minimally Invasive Surgery (TAMIS)
• Coloanal J-Pouch
• Local excision

CREATING AN EFFECTIVE TREATMENT PLAN

By scheduling a consultation with Dr. Bauer, you will have an opportunity to discuss your condition and the surgical options which are available to you.

Each surgical treatment is intended to fix a specific problem and it is important that you have undergone a full examination and testing before any decision is made. For example, if you have a very large or advanced tumor, neoadjuvant therapy may be most appropriate for you to shrink the tumor as much as possible before it is removed. If your tumor is not as large, there are other less-invasive forms of treatment available to you.

EXPERIENCED & KNOWLEDGEABLE SURGEONS

Our goal is to offer you the treatment option which is as minimally invasive and effective as possible. We know that you may have a variety of questions and concerns, all of which we can address in your initial consultation.

+ Gastrointestinal Surgery

The gastrointestinal (GI) tract starts at the mouth and ends at the anus. It includes the esophagus, stomach, small intestine, large intestine (colon), rectum, and anus, and is afflicted by multiple disease processes.

As a board certified general surgeon, he is experienced and well-trained to deal with a myriad of conditions that affect the GI tract. Dr. Bauer treats a wide range of colorectal and gastrointestinal diseases and conditions. He understands that surgery is not the first answer or solution you turn to, but it may be the only way to treat your condition.

Symptoms of gastrointestinal disease are wide-ranging and variable, and may include:

• Pain
• Bleeding
• Nausea
• Vomiting
• Diarrhea
• Constipation
• Weight loss

In some cases, diseases of the GI tract produce no symptoms and you may not even be aware that you have problems. Other times, you may have visited the doctor numerous times complaining of your symptoms.

In order to determine whether surgery is appropriate, he will need to gather certain pieces of information, especially what type of treatments you have already attempted, if any. The first step in getting an accurate diagnosis is to complete a full history and physical examination. Other aspects of the examination that may be employed include endoscopy, ultrasound, and imaging, such as plain X-rays, CT scan, and MRI.

Completing an Effective Treatment Plan

After we have completed a thorough evaluation, the treatment plan will be tailored by Dr. Bauer, in consultation with your or our gastroenterologist. Although there are many types of treatment available which may include medication, we specialize in providing surgical procedures which will provide you with long-term relief. Most of these procedures can be done using a minimally invasive approach.

+ Colorectal Surgery

The colon (large intestine) begins in the right lower abdomen at the junction of the ileum (small intestine) and cecum, and it is afflicted by multiple disease processes. This includes the cecum, ascending (right) colon, transverse colon, descending (left) colon, and sigmoid colon. The rectum is a continuation of the sigmoid colon within the pelvis, and it is continuous with the anus, the last portion of the gastrointestinal tract. Dr. Bauer is experienced and well trained to deal with a myriad of conditions that affect the colon and rectum.

A few of the colorectal disease which may be treated with colorectal surgery include:

• Anorectal disease
• Colorectal cancer
• Bowel incontinence
• Diverticular disease

COLORECTAL CANCER TREATMENT.

Colorectal cancer is one of the most common conditions and can be found and treated in a number of different stages. In most cases, colorectal cancer will require some type of surgery to reach a complete cure. Other forms of treatment may also be appropriate in addition to surgery, such as chemotherapy or radiation.

If the cancer is detected in an earlier stage, there is a high percentage to completely cure and get rid of the cancer. However, the cure rate is much lower if it is diagnosed later on.

COMMON SYMPTOMS OF COLORECTAL DISEASE.

Symptoms of colorectal disease are wide-ranging and variable, and include pain, bleeding, nausea, vomiting, diarrhea, constipation, and weight loss. Sometimes, diseases of the colon may produce no symptoms.

The first step in diagnosis is a history and physical examination. Other aspects of the examination that may be employed include endoscopy, ultrasound, and imaging (such as plain X-rays, CT scan and MRI).

Currently many of these cancers can be dealt with using minimally invasive approaches.

+ Complex Colorectal and Anorectal Surgery

Conditions which affect the colon, also known as the intestine, can be extremely stressful on the body and lead to a need for surgery. In some cases, complicated conditions may require complex surgery that should only be trusted to a board-certified surgeon.

Dr. Bauer is experienced to deal with a wide range of conditions which affect the colon. He is highly trained and prepared to offer you the most up to date treatment.

DIAGNOSING CONDITIONS & DISEASE OF THE COLON

The colon starts in the right lower side of your abdomen at the junction of the ileum (small intestine) and cecum. It can be afflicted by multiple disease processes. The colon includes the cecum, as well as the transverse colon, ascending (right) colon, sigmoid colon, and descending (left) colon.

Your rectum is a continuation of the sigmoid colon within the pelvis and is continuous with the anus, which is the last section of the gastrointestinal tract. Depending on the type of disease which you have been diagnosed with and other issues which you are facing, colorectal and anorectal surgery may become complex.

The symptoms of colorectal disease are wide-ranging and quite variable, which can include:

• Weight loss
• Pain and bleeding
• Nausea
• Diarrhea
• Constipation
• Vomiting

HOW ARE COLORECTAL & ANORECTAL DISEASE DIAGNOSED.

Often times, diseases which affect the colon produce no noticeable symptoms. The first step in making a diagnosis is making an appointment with Dr. Bauer for a medical history consultation and physical examination.

Depending on your condition, he may determine that you need imaging such as a CT scan, MRI, or X-Rays, an ultrasound, or an endoscopy. There is no set treatment which applies to every person - you need to meet with a doctor who can accurately diagnose your situation and tailor a treatment plan for you.

If surgical treatment is required, most often, a minimally invasive approach can be used.

+ Abdominal Wall Reconstruction and Abdominal Wall Hernias

Dr. Bauer specializes in the surgical treatment of disease, including colorectal and anorectal procedures. He has experience handling the surgical management of these diseases. However, no matter how trained or experienced your surgeon is, during the course of surgery for disease, a defect may develop in the abdominal wall, which is known as a hernia.

COMMON SYMPTOMS OF ABDOMINAL WALL HERNIAS

Abdominal wall hernias may often be asymptomatic, however many patients experience symptoms. One of these symptoms, incarceration, occurs when intestine gets stuck in the hernia. This can lead to intestinal blockage or necrosis of the intestine and will need to be treated as quickly as possible.

Reconstruction surgery by an abdominal wall reconstruction surgeon is often recommended to treat these type of hernias.

A few examples of post-surgery symptoms you may experience after developing a hernia include:

• Abdominal bulge
• Pain
• Incarceration

Diagnosis & Treatment of Post-Surgical Hernias

Abdominal wall hernias are often diagnosed after a thorough physical examination by Dr. Bauer. Abdominal x-rays and a CT scan may be recommended to better evaluate your abdominal wall for the presence of a hernia, depending on what is discovered during the examination. He feels that the hernia has to be completely evaluated before making a treatment plan and determining whether surgery is necessary, and if so, what surgical procedure should be performed.

Once an abdominal wall hernia is diagnosed, he may recommend surgical repair of the defect. Occasionally, suture closure of the defect alone may be recommended, however in most cases, the defectsare is too large to be adequately treated with suture closure alone.

If that is the case, he may recommend placement of some form of mesh to repair the hernia defect in your abdominal wall. Mesh is a sterile material that repairs the hernia defect, and there are many different types of mesh available; he will suggest a specific mesh product based on your clinical needs. Dr. Bauer has participated in many national and international trials studying abdominal wall reconstruction focusing on a variety or meshes, techniques and safety issues.

+ Abdominal Procedures

When you are facing an abdominal procedure, Dr. Bauer is up-to-date on the latest procedures. Based upon your age and medical history, you may be asked to have blood tests, an electrocardiogram, and a chest X-ray prior to your procedure. In addition, a physical examination by your primary care physician or a specialist, such as a cardiologist, may be requested. The need for this pre-testing will be determined by your surgeon and is individualized for each of our patients.

PREPARATION

In preparation for your adbominal procedure, you will be asked to avoid eating or drinking after midnight the evening prior to the procedure. Ask your doctor whether or not to take your prescription medications the morning of the procedure. The need to take these medications is individualized for each patient. In addition, you may be asked to take a bowel preparation the day prior to your surgery. The need for a bowel preparation and the specific type of preparation used will be individualized for each patient.

Procedures Dr. Bauer Performs:

• Ileocolic Resection
• Small Bowel Resection
• Total colon and rectal removal with standard Brooke Ileostomy or J-Pouch with Ileoanal Anastomosis (Restorative Proctocolectomy)
• Total Proctocolectomy with Primary Kock Pouch (Continent Ileostomy)
• Conversion of standard Brooke Ileostomy to Kock Pouch (Continent Ileostomy)
• Colon Resection for Diverticulities
• Rectal Resection for Cancer or certain Polyps
• Colon Resection for Cancer or certain Polyps

+ Laparoscopic Procedures

Laparoscopic procedures are technologically advanced medical treatments that can help with a variety of abdominal and colorectal disorders. At Manhattan Surgical Associates, our skilled surgeons are dedicated to performing the latest procedures and guiding you through the entire process.

TYPICAL DIAGNOSES & TREATMENTS

Based upon your age and medical history, you may be asked to have blood tests, an electrocardiogram, and a chest X-ray prior to your procedure. In addition, a physical examination by your primary care physician or a specialist, such as a cardiologist, may be requested. The need for this pre-testing will be determined by your surgeon and is individualized for each of our patients.

In preparation for your anorectal procedure, you will be asked to avoid eating or drinking after midnight the evening prior to the procedure. Ask your doctor whether or not to take your prescription medications the morning of the procedure. The need to take these medications is individualized for each patient. In addition, you may be asked to take a bowel preparation the day prior to your surgery. The need for a bowel preparation and the specific type of preparation used will be individualized for each patient.

Dr. Bauer is proficient in all of the following procedures:

• Laparoscopic colon resection for cancer
• Laparoscopic rectal resection for cancer
• Laparoscopic colon resection for diverticulitis
• Laparoscopic total proctocolectomy with either standard brooke ileostomy, kock pouch ileostomy, or J-Pouch (Restorative Proctocolectomy)

+ Procedures For Rectal Prolapse

Rectal prolapse is protrusion of the rectum through the anus. Symptoms include incontinence, fecal and mucus soiling, and a sensation of fullness and tissue protruding from the anus. Surgery is often recommended as a treatment, and may involve an abdominal operation or surgery through the anus.

DIAGNOSIS

Rectal prolapse is diagnosed using a history and physical examination. In certain cases, other studies such as colonoscopy and endorectal ultrasound may be recommended.

Based upon your age and medical history, you may be asked to have the following before an operation:

• Blood tests
• An electrocardiogram
• Chest X-ray
• Physical examination by a specialist

TREATMENT OPTIONS

The treatment of rectal prolapsed often involves surgery. In properly selected patients, a colon resection and rectopexy is recommended. In this procedure the redundant colon is remove and the two ends reconnected. The rectum is then suture to the bony sacrum to prevent recurrent prolapse. A colon resection and rectopexy is an abdominal surgery. In select patients, it may be performed laparoscopically.

Dr. Bauer performs the follow procedures:

• Perineal Rectosigmoidectomy (Altemeier Procedure)
• Laparoscopic Sigmoid Colon Resection and Rectopexy For Rectal Prolapse

In some cases an abdominal surgery is not recommended. For these patients, the surgery is performed through the anus. A commonly performed procedure is call a perineal rectosigmoidectomy, also known as an Altemeier procedure. In this surgery, the prolapsed rectum is surgically excised through the anus. After removal of the prolapsed segment, the two ends are sutured together.