Scott’s Colorectal Surgery Story | Holy Cross Health

For Scott, Driving 1,000 Miles for Colorectal Surgery Was Worth It

“At Holy Cross Hospital everyone worked diligently to make sure I was comfortable,” said Scott who no longer lives in fear of having another diverticulitis attack. 

When his third episode of diverticulitis in three months landed him in the hospital for five days in Palm Beach, FL, Scott Pollard knew surgery was probably in his future. Scott trusted the physician who cared for him in Maryland and reached back out to Faisal Bhinder, MD, the gastroenterologist who had managed his diverticulitis for six years when he was living in Rockville. After telehealth visits with Dr. Bhinder and Matthew Skancke, MD, colorectal surgeon, Scott was so impressed he made the extraordinary decision to drive 1,000 miles to be treated by Dr. Skancke because of his expertise in robotic colorectal surgery.

What is diverticulitis? Diverticula are small, bulging pouches that can form in the lining of your digestive system, are common especially after age 40, and seldom cause problems. When one or more of the pouches becomes inflamed or in some cases infected, that condition is called diverticulitis, symptoms of which can include abdominal pain and tenderness, low-grade fever, loose stools, and bleeding with bowel movements.

“I never knew when another flare-up was going to happen and I would have to put my life on hold. When diverticulitis is severe, it feels like being kicked in the belly by a mule,” said Scott. “Often my pain was so bad that I couldn’t take walks or do simple tasks like going to the grocery store.” 

When pouches become inflamed, they often can be treated with liquid or soft diets and antibiotics. But, as in Scott’s case when chronic inflammation occurs, there is a risk of perforation or abscess, and surgery to remove the affected part of the colon is indicated. “My job is to treat patients non-surgically, but then optimize their care when they need surgery,” said Dr. Bhinder.

“We refer our patients to colorectal surgeons based on their clinical outcomes, excellent patient interactions, and most importantly, for their expertise in robotic surgery. This is why we work closely with Dr. Skancke and his partners Bradley Bennett, MD, and Rami Makhoul, MD.” 

“Dr. Skancke took a lot of time with me, not only talking about what to expect before and after surgery but getting to know me,” said Scott. “I could tell that he was not just a surgeon. He’s a caring person, too. Dr. Skancke was the reason I decided to come back to Holy Cross for my surgery.” 

For someone like Scott who has multiple diverticulitis attacks, each episode can last a week or so, but the treatment and recovery can take up to two months for the inflammation to get better. “If you keep having frequent attacks, you can’t go to work or do things you want to do,” said Dr. Skancke. “If ignored, diverticulitis can lead to prolonged inflammation, which is destructive.”

“It’s better to choose surgery for diverticulitis at a time when it’s an elective procedure, rather than putting it off until it becomes an emergency,” added Dr. Bhinder. “After recovery from surgery, we recommend having a colonoscopy to exclude colon cancer, which can mimic diverticulitis symptoms. ” 

Right before his robotic colorectal surgery at Holy Cross Hospital, Scott recalled, “Dr. Skancke was very encouraging when he came in to talk to me. He was totally focused on making sure I knew what was going on and what my side effects might be — that meant a lot. In the operating room, as I was drifting off, a nurse held my hand and said, ‘Just relax. Everything is going to be okay.’ At Holy Cross Hospital everyone worked diligently to make sure I was comfortable.” (Presurgical screening at Holy Cross Health includes testing for COVID-19).

Dr. Skancke performed the operation using the da Vinci^® XI robotic surgical system, the most advanced robotic platform available for colorectal surgery. Robotic surgery is minimally invasive, which results in less pain and faster recovery time for patients. Scott had five incisions the size of a dime and one 3 to 4 cm incision. Dr. Skancke removed the thickened portions of the colon that were most symptomatic and then reattached the colon to the rectum, maintaining normal bowel functioning.  

Scott spent two days in the hospital and continued to stay in the area for a week to meet with Dr. Skancke for a post-surgery evaluation. Within a couple of days of surgery, Scott was able to eat regular food. “Previously after an attack, it would be weeks of not eating solid food,” said Scott. “Plus, I was living in fear, not knowing when another attack might come. I’ve been released from my fear, thanks to Dr. Skancke.”

Watch Holy Cross Health colorectal surgery experts, Bradley Bennett, MD, and Matthew Skancke, MD, discuss early screening, diagnosis, and treatment options for colorectal cancer.

Meeting the Healthcare Needs of Our Community

Holy Cross Health is proactively meeting the needs of our community by recruiting highly skilled surgeons like Dr. Matthew Skancke. Affiliated with Holy Cross Health Partners, Dr. Skancke is a fellowship-trained colon and rectal surgeon with special expertise in using the da Vinci^® XI robotic surgery system. He sees patients alongside our colorectal program director and the team at Metro Colon and Rectal Surgery in Bethesda. 

“I’m impressed with how progressive Holy Cross Health is, staying at the leading edge of surgical technology and expanding colorectal surgery care throughout our community,” said Dr. Skancke.

Ninety-five percent of colorectal surgery at Holy Cross is performed robotically, and together, Holy Cross Hospital and Holy Cross Germantown Hospital provide access to robotic surgery for individuals from Prince George’s County through Montgomery County and into Frederick County and are happy to serve anyone from the surrounding region.

“Patient care at both Holy Cross Germantown Hospital and Holy Cross Hospital is a true team effort,” said Dr. Skancke. “That makes a big difference in providing easier surgical experiences and quality outcomes for our patients. ” 

Through ongoing studies on community healthcare needs, Holy Cross Health identified a shortage of colorectal surgeons in Montgomery County. The addition of Dr. Skancke to our team is just one example of what Holy Cross is doing to make sure you have the care you need today — and in the future when we open our new Holy Cross Health Cancer Center in spring 2022.

Phil’s Story – Diverticular disease / diverticulitis

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Phil has a condition called diverticular disease, which is very common and most of the time, harmless. Phil’s bowel has developed small pouches throughout. Sometimes though (and we don’t completely understand why yet), an infection can develop in one of these pouches and it can become life-threatening if untreated.

Talk us through the symptoms you were experiencing with your diverticular disease:

I was referred for a colonoscopy by my doctor after I was getting digestive symptoms, one was a stitch- like pain on my left side. After the colonoscopy, I remember being told that I had diverticulosis, but I had just been sedated so I wasn’t fully focussed on what they had to say.

I was never given any information and I was told these pouches were really common, so I didn’t even think to look for information online.

Talk us through the symptoms you had when you had developed an infection (diverticulitis):

One day I started getting a really severe wave-like abdominal pain that would come and go. Then I started with fever, I was sweating and nauseous, but the pain was bothering me the most. It was all-encompassing.

I’ll try not to sound like the “hokey cokey”, but I was in and out of the hospital a fair bit!

I went to the hospital and was given antibiotics, as my diverticular disease had become infected (diverticulitis). I was told if I started feeling worse, to come back.

I returned home and started feeling worse. I was being sick too. I was rolling around in pain at 3am thinking “this can’t be right”. We decided it best to return to hospital. The team did another scan and found that my bowel had perforated (torn) due to the diverticulitis.

What happened in hospital?

I was monitored by a fantastic team for a few days until I was sent home, but I didn’t feel any wiser about diverticular disease or diverticulitis. In fact, I’d been told conflicting information at hospital, so I began doing my own research.

When did you find Guts UK?

I found Guts UK online. I’d been scrolling through the internet and I was becoming so frustrated, as I’d read something on one website, and then another would say the complete opposite! I read Guts UK’s information in full, then called for some clarity.

It was such a relief to find somewhere with evidence- based information that I could trust and follow. The guys at Guts UK really did put the power in me.

Since your diverticulitis, you have decided to fundraise for Guts UK with a collection tub in the sweetshop that you run.

What did your customers think?

The tub in the shop has been a conversation starter. I openly speak to people about my guts and the amount of people who have digestive diseases has really surprised me. I think it’s so important that we talk openly about these symptoms and diseases.

Please consider giving £3 a month to Guts UK, so they can continue helping people like me when I was lost and confused. How can we know so little about something that affects so many people? I’m getting to grips with guts – you can too!

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Diverticulitis of the colon – a history of treatment in the Ilyinsky hospital.

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Diverticulosis is a common condition: by the age of 50, half of the people in the colon form protrusions of the mucous membrane – diverticula. Their incidence increases with age.

Why are diverticula dangerous?

Some authors consider the formation of diverticula ( diverticulosis ) in the large intestine as a variant of the age norm. In most people, they do not manifest themselves in any way, but in a small part of people they can lead to inflammation of the intestine ( diverticulitis ) and other complications – intra-abdominal abscesses and peritonitis, fistulas, bleeding.

How is diverticulitis treated?

Simple diverticulitis is usually managed with antibiotics. When complicated, it is often impossible to do without urgent surgery, which is associated with the formation of a colostomy. Closing this stoma is possible only with a second operation after a few months.

Clinical case

A 72-year-old patient, a man who looks much younger than his years and leads an active lifestyle, came to the Ilyinsky hospital.

For two years he was worried about frequent (up to 3 times a year) exacerbations of diverticular disease of the colon – diverticulitis, which manifested itself as abdominal pain, fever. The patient required hospitalization for several days for intravenous administration of antibiotics, electrolyte solutions. Outside of exacerbations for preventive purposes, the patient had to follow a diet. All this had a bad effect on the quality of life, the threat of another sudden exacerbation prevented us from making active plans.

We suggested that the patient undergo elective surgery to reduce the risk of repeated attacks of diverticulitis, to which he agreed.

The operation (resection of the sigmoid colon) was performed laparoscopically, without large incisions. During the operation, the affected area of ​​the intestine was removed, and the ends of the intestine were sewn together – the continuity of the intestine was restored.

The postoperative period was uneventful. On the 3rd day, the patient fully served himself, could eat on his own, and was discharged home.

Prophylactic surgery

If the course of the disease dictates the course of the disease in complicated diverticulitis, then the patient and the doctor can choose the treatment tactics together without exacerbation. For example, with frequent exacerbations, a prophylactic operation to remove a section of the intestine with diverticula is justified. For such an operation, even more than for a medical one, safety is important, since the reduction of risks from the disease is achieved through a procedure that in itself carries certain risks. It is important to balance these risks and perform the operation as safely as possible so that the patient ultimately wins.

The work of a team of doctors allows reducing the trauma of the operation and facilitating recovery after it: a surgeon who can perform the operation laparoscopically without large painful incisions, an anesthesiologist who will prepare the patient for anesthesia and carry it out safely, general practitioners who will help take control chronic diseases and prevent their exacerbation. And, of course, attentive and competent nurses caring for the patient will help to recover after the operation.

Computed tomography of the abdomen. Arrows indicate diverticula – sac-like protrusions of the mucous membrane.

Author: Markushin Leonid Igorevich, Surgeon, oncologist disease (Diverticulitis) of the colon, treatment of diverticulosis of the colon in Krasnodar

Diverticular disease – a condition in which numerous protrusions appear in the intestines. They can become inflamed and serve as a source of development of pathogenic bacteria, as a result of which the patient has unpleasant symptoms. Among the causes of diverticulum disease, the most common is a diet that lacks enough fiber. A lack of fiber leads to difficulty emptying the intestines, which increases internal pressure, stretches the organ, and protrusions occur.

HOW CAN DIVERTICULUM DISEASE MANIFEST?

In the early stages, the disease is difficult to detect, since for a long time it develops asymptomatically. Often it manifests itself, like other pathologies of the gastrointestinal tract, so a timely examination helps to identify the nature of the disease and begin treatment. The most dangerous consequence of diverticular disease is the malignancy of protrusions and the development of oncological diseases of the gastrointestinal tract.

Pathology may present with the following symptoms:

• Abdominal cramps
• Nausea
• Constipation
• Bleeding during bowel movements
• Bowel obstruction
• Fever and general intoxication

DIAGNOSIS OF DIVERTICULUM DISEASE

The WMT clinic uses a set of examinations to diagnose the disease:

• Colonoscopy (FCS) is a method that allows the doctor to view the inside of the intestines using an endoscope with a built-in video camera. With the help of diagnostics, the doctor can detect all changes in the mucous membrane of the organ and, if necessary, immediately take the material for additional examination to exclude a malignant process. For this purpose, the WMT clinic uses Olympus endoscopes (Japan) – equipment with a diameter smaller than a ballpoint pen, which allows the doctor to see the smallest details of the mucosa and blood vessels, as well as to perform the procedure with maximum comfort for the patient.
• MRI is a safe diagnostic method with which a doctor can diagnose the localization of protrusions, detect malignant processes, and also identify the places of diverticulum rupture. The WMT clinic uses an expert-level device – the MAGNETOM Aera tomograph from Siemens (Germany), which is suitable for people with large body weight and claustrophobia.

TREATMENT OF DIVERTICULUM DISEASE

Diverticular disease is usually treated with conservative therapy, but in situations where drug treatment fails, the disease progression is advanced, or emergency care is required, surgery is used.

Indications for surgery:

• Peritonitis (purulent discharge into the abdominal cavity)
• Bowel obstruction
• Profuse bleeding
• Positive results of a histological examination for oncology
• Colon perforation
• Failure of conservative treatment
• Recurrent diverticulitis

In the surgical treatment of diverticulum disease, surgeons at the WMT Clinic prefer laparoscopic methods.