Specialty guide · Colorectal surgery
Colorectal surgery, the whole specialty in one place.
A patient-first map of colorectal surgery — cancer, IBD, benign anorectal, diverticular, functional and emergency work — and the pathway each one follows, from referral to recovery.
Why patients choose us
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Fellowship-trained colorectal consultants
Named colorectal surgeons on the ACPGBI register — not general surgeons dabbling. Sub-specialty expertise in cancer, IBD, pelvic floor and benign anorectal work.
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MDT-driven, not surgeon-driven
Every cancer and complex IBD case reviewed at a multidisciplinary meeting with radiology, pathology, oncology and specialist nurses before a plan is agreed.
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Independent, and free
We’re paid by no clinic, so the recommendation is impartial and costs you nothing.
Key facts
What colorectal surgery is, at a glance.
The specialty covers the colon, rectum, anus and pelvic floor — from a single haemorrhoid to a full pouch reconstruction.
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Specialty
Coloproctology (colon, rectum, anus, pelvic floor)
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Approach
Laparoscopic, robotic, open and transanal
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Recovery
Enhanced Recovery (ERAS) is standard
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Governance
MDT-led for cancer, IBD and complex work
The problem
The right sub-specialist, the right approach, the right MDT.
Colorectal is broad. A cancer resection, a Crohn’s stricturoplasty and a pilonidal excision aren’t interchangeable — and neither are the surgeons who do them best.
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Cancer or IBD?
You need a sub-specialised colorectal consultant, active in an MDT, with the right imaging and pathology behind them.
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Benign anorectal?
A day-case pathway with someone who does these operations weekly — not a general surgeon doing one a month.
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Functional or pelvic floor?
A specific pelvic-floor pathway with defecating MRI, manometry and a surgeon who treats prolapse and incontinence regularly.
The pathway
From referral to recovery — what happens, in order.
A single consultant-led thread through workup, MDT, surgery and follow-up.
Phase 1 · Before surgery
Referral, workup, MDT
Phase 2 · Admission and theatre
A planned inpatient stay
Phase 3 · After
Follow-up and surveillance
- 01
Before
Referral and triage
A short confidential form or GP letter. Symptoms, imaging, endoscopy and any prior histology are gathered in one place.
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Before
Consultant clinic and workup
A colorectal consultant reviews you, orders the right staging (CT, MRI rectum, endoanal ultrasound) and requests any missing endoscopy.
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Before
MDT discussion
Complex, cancer and IBD cases go to a multidisciplinary meeting — radiology, pathology, oncology, colorectal — and a written plan comes back.
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Admission
Admission and prehab
Enhanced recovery from the outset: carbohydrate loading where allowed, no long fasts, anaesthetic optimised, stoma marked if needed.
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Admission
Surgery — laparoscopic, robotic or open
Minimally invasive by default. Robotic or transanal approaches for the right rectal cases; open kept for genuinely complex or emergency work.
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Admission
Enhanced recovery on the ward
Early mobilisation, early feeding, opioid-sparing analgesia. Most laparoscopic patients are home in three to five days.
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After
Follow-up and surveillance
Wound and stoma review, histology discussion, oncology handover if needed, and a written surveillance plan for cancer or IBD.
Typical elective end-to-end: 4–8 weeks from referral to surgery. Recovery: 4–6 weeks for most laparoscopic resections.
Sub-specialties
The major areas of colorectal surgery.
Six sub-areas the specialty covers, plus the emergency red flag that means A&E — not a clinic.
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Colorectal cancer
Colon and rectal cancer surgery — laparoscopic, robotic and transanal approaches, with sphincter preservation where oncologically safe.
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Inflammatory bowel disease
Surgery for ulcerative colitis and Crohn’s — subtotal colectomy, ileoanal pouch (IPAA), stricturoplasty and bowel-sparing resections.
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Benign anorectal
Haemorrhoids, anal fissure, fistula-in-ano, pilonidal disease and rectal prolapse — day-case where possible, definitive when needed.
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Diverticular disease
Elective sigmoid resection for recurrent or complicated diverticulitis, and management of fistulating and stricturing disease.
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Functional and pelvic floor
Rectal prolapse, obstructed defecation and faecal incontinence — investigated with defecating MRI and manometry, treated with tailored surgery.
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Emergency general surgery
Obstruction, perforation, ischaemia and complicated diverticulitis — same-consultant continuity from emergency admission through recovery.
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Stoma formation and reversal
Loop and end ileostomy, colostomy, siting with a specialist stoma nurse, and later reversal on a planned pathway.
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Red flag: obstruction or perforation
Sudden severe abdominal pain, vomiting with distension, or peritonitis signs are surgical emergencies — A&E the same hour, not a clinic booking.
Surgical approaches
Keyhole, robotic, open or transanal — matched to the case.
Approach is chosen by the operation, not the surgeon’s preference — with enhanced recovery and MDT working around every step.
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Laparoscopic (keyhole)
The default for most elective colorectal resections. Small ports, faster recovery, less pain and shorter hospital stay than open surgery.
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Robotic
Robot-assisted platforms for pelvic work — particularly low rectal cancer, complex redo pelvic surgery and ventral mesh rectopexy.
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Open
Reserved for genuinely complex, adhesion-heavy or emergency cases where laparoscopic access is unsafe or would compromise the operation.
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Transanal (TaTME, TAMIS, TEMS)
Through-the-anus approaches for selected early rectal cancers, large polyps and low rectal disease — avoiding an abdominal incision entirely.
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Enhanced recovery (ERAS)
Standardised prehab, opioid-sparing anaesthesia, early feeding and mobilisation — the single biggest driver of shorter, safer stays.
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Day-case anorectal surgery
Haemorrhoids, fissures, fistulas and pilonidal disease done as day cases under LA, spinal or GA — home the same day.
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Endoscopic resection
ESD, EMR and full-thickness resection for large or complex polyps — often avoiding formal bowel resection altogether.
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Multidisciplinary care
Every complex case anchored around an MDT: colorectal, radiology, histopathology, oncology, stoma nurse and clinical nurse specialist.
Our vetted London network
A small panel of colorectal consultants, we picked them.
Fellowship-trained colorectal surgeons across central, north, west and south London — introductions made privately once we understand the case.
Selection criteria
How we choose every colorectal consultant in our network.
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Fellowship-trained colorectal consultants on the ACPGBI specialist register
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Active in a cancer MDT with weekly attendance and audited outcomes
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Laparoscopic and robotic proficiency, with open reserved for the right cases
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Full pathway support: specialist stoma nurses, IBD nurses and ERAS protocols
Safety and recovery
What to expect — honestly.
Modern colorectal surgery is safer than it has ever been. The things worth planning are enhanced recovery, stoma decisions, and the red flags that mean same-day help.
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Enhanced recovery is standard
Carbohydrate loading, opioid-sparing anaesthesia and early feeding and mobilisation — the evidence-based route to shorter, safer stays.
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Anastomotic leak is the main risk
A join between two ends of bowel can leak in 3–8% of colorectal resections. It’s the risk the whole pathway is designed to catch early.
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A stoma may be temporary or permanent
Some operations need a stoma — sometimes temporary (a loop to protect a low join), sometimes permanent. It’s discussed and sited before surgery.
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Wound and chest complications
Wound infection, chest infection and DVT are all reduced by keyhole surgery, early mobilisation and standard prophylaxis.
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Bowel habit changes after resection
After rectal or low anterior surgery, urgency, frequency and fragmentation (LARS) are common early on and usually improve over months.
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Cancer surveillance is planned
After cancer surgery you get a written surveillance schedule — CEA, CT and colonoscopy at defined intervals, coordinated with oncology.
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IBD surgery is not a failure
For UC and Crohn’s, surgery is a planned tool alongside medical therapy — timing matters more than “last resort” framing.
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Emergency vs elective outcomes differ
Elective resections have far better outcomes than emergency ones. Where safe, we push to convert emergencies into planned surgery.
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Red flags
PR bleeding with weight loss, obstruction, peritonitis, sepsis, post-op fever with abdominal pain or stoma failure — all reasons to seek same-day help.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever operation was performed, the note the colorectal team sends you keeps to the same shape.
A quiet reminder
Surgical and pathology language is precise and can read coldly — we translate it for you.
If you’d like us to talk you through the note or histology before your review, just ask.
- 01 Header
Indication and operation performed
Why the operation was done — cancer, IBD, diverticular, functional — and exactly what was resected or repaired.
- 02 Technique
Approach and anastomosis
Laparoscopic, robotic, transanal or open; the anastomosis technique; whether a stoma was formed and why.
- 03 Findings
Intra-operative findings and histology
What was found at operation, and the histopathology once it returns — staging, margins, node yield for cancer resections.
- 04 Impression
Recovery, surveillance and next steps
Read this first: expected recovery, stoma plan, oncology handover if needed, and the written surveillance schedule.
Recognised by major UK insurers
Most colorectal surgery is covered when medically indicated. We confirm cover, exclusions and any excess before booking.
Frequently asked
Everything we get asked about colorectal surgery.
Straight answers on scope, approaches, stomas, cancer, IBD and recovery.
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What does a colorectal surgeon actually treat?
Diseases of the colon, rectum, anus and pelvic floor. That covers colorectal cancer, inflammatory bowel disease (UC and Crohn’s), diverticular disease, haemorrhoids, fissures, fistulas, pilonidal disease, rectal prolapse, obstructed defecation, faecal incontinence and colorectal emergencies like obstruction and perforation.
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Is colorectal surgery always keyhole now?
Most elective resections are — laparoscopic or robotic. Open surgery is reserved for genuinely complex, heavily scarred, or emergency cases where keyhole access would be unsafe or compromise the operation. The approach is chosen for the case, not the surgeon’s preference.
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What is enhanced recovery (ERAS)?
A standardised bundle of pre-, intra- and post-op steps — carbohydrate loading, opioid-sparing anaesthesia, no routine drains or NG tubes, early feeding, early mobilisation. It cuts hospital stay and complications for colorectal resections.
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Will I need a stoma?
Sometimes. It depends on the operation. Low rectal cancer resections often need a temporary loop ileostomy to protect the join; some operations for cancer or Crohn’s need a permanent stoma. It’s always discussed and sited by a specialist nurse before surgery.
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How is a colorectal cancer plan decided?
By the multidisciplinary team — colorectal surgeons, oncologists, radiologists and pathologists — using staging CT, MRI of the rectum and histology. You then have a consultant appointment to walk through the recommended plan and the alternatives.
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When is surgery the right step for IBD?
For ulcerative colitis: severe acute flares failing medical therapy, dysplasia, or long-standing disease with poor quality of life. For Crohn’s: strictures causing obstruction, fistulas, abscesses, or disease failing medical therapy. Timing is a joint decision with gastroenterology.
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Can haemorrhoids and fissures really be day-case?
Yes — most benign anorectal surgery is done as a day case under LA, spinal or GA. Home the same day, back to office work within a week for most people.
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What are the red flags I should not sit on?
Rectal bleeding with weight loss or change in bowel habit, sudden severe abdominal pain, vomiting with distension, blood and mucus with fever, or peritonitis signs. Post-op: fever with abdominal pain, PR bleeding, stoma failure or wound breakdown — all same-day contact.
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How long is the recovery from a bowel resection?
Most laparoscopic colorectal resections mean three to five days in hospital and four to six weeks before you’re back to normal activity. Rectal cancer surgery and open operations can be longer.
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When should I get an urgent opinion?
Rectal bleeding with weight loss or altered bowel habit for more than three weeks, iron-deficiency anaemia, a palpable mass or an IBD flare not responding to medical therapy all warrant an urgent colorectal opinion — not a wait-and-see.
Sources and further reading
Guidance behind this page.
Last reviewed 2026-07-30. Next review 2027-07-30. Reading time ~7 min.
- Association of Coloproctology of Great Britain and Ireland (ACPGBI). Position statements and guidelines.
https://www.acpgbi.org.uk
- American Society of Colon and Rectal Surgeons (ASCRS). Clinical practice guidelines.
https://fascrs.org
- European Society of Coloproctology (ESCP). Clinical guidelines and consensus statements.
https://www.escp.eu.com
- National Institute for Health and Care Excellence (NICE). Colorectal cancer, IBD and diverticular disease guidelines.
https://www.nice.org.uk
Related pathways
Looking for a specific procedure?
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Colectomy
Elective and emergency removal of part or all of the colon.
Learn more -
Colon cancer surgery
Curative resection for colon cancer — laparoscopic or robotic.
Learn more -
Colon polypectomy
Endoscopic removal of colonic polyps, sometimes avoiding surgery.
Learn more -
All tests & procedures
Every test, procedure and treatment we arrange.
Learn more -
Acid Reflux
Related condition guide.
Learn more -
Crohns Disease
Related condition guide.
Learn more -
Gastroscopy
Related diagnostic test.
Learn more -
Colonoscopy
Related diagnostic test.
Learn more
In practice, in London
Where colorectal surgery sits in a private London pathway
For colorectal surgery, the private London route is mostly about consultant fit and hospital choice rather than raw waiting time. On the NHS, colorectal surgery typically sits behind a triage step and a wait that can stretch from a few weeks into months. In London’s private sector, the same appointment often lands within days. That speed matters when symptoms are disrupting work, sleep, or a plan you’d already committed to — and it’s the single most common reason people call us in the first place.
A private colorectal surgery pathway in London usually looks like this: an initial consultation, any diagnostics booked at a nearby facility (most within Zone 1 or 2), and a written report sent to you and your GP within a few days. The consultants we work with hold NHS posts alongside their private lists, which keeps the standards consistent across both settings. For colorectal surgery in particular, we bias towards consultants who do this every week rather than every month.
We’re careful about what a private pathway for colorectal surgery can and can’t promise. It can compress a wait, put you in front of a subspecialist quickly, and get a proper report in your hands within a week. It can’t rewrite what the imaging or the bloods say. Setting that expectation up front tends to make the whole experience less stressful.