Being a tertiary referral centre, the Division manages a high percentage of patients with advanced or recurrent diseases and low rectal cancer. The specialists of the Division are capable of different approaches in the management of rectal cancer, with the objectives of sphincter preservation and a low recurrence rate. Total mesorectal resection for mid- and low-rectal cancer has been adopted as the standard surgical technique in the treatment of mid and distal rectal cancer since 1993. Currently, total mesorectal excision is regularly performed with either robotic-assisted approach or laparoscopic approach. Transanal total mesorectal excision was first performed in 2014 and is now mainly used for ultra-low rectal cancers. The sphincter-saving rate is over 90% for all mid and distal rectal cancers. The local recurrence rate for patients with low anterior resection has been maintained at around 7%.

A protocol for enhanced recovery after surgery (ERAS) has been developed for our patients with elective colorectal resection. The aim is to standardize the treatments for postoperative patients so that more efficient and systematic patient care can be provided and hopefully the length of hospital stay can be shortened. This, together with the minimally invasive approach, has improved the postoperative outcome and shortened the hospital stay.

The incidence of inflammatory bowel disease (IBD) is lower in Hong Kong compared with Western countries. The Division works closely with gastroenterologists in the management of these patients. A joint clinic with the gastroenterologist is being held weekly to see patients with IBD. Complex procedures for Crohn’s disease and ulcerative colitis are regularly performed. With the skills in minimally invasive surgery, most of these procedures are performed with laparoscopy.

Anorectal diseases, such as haemorrhoids and fistulas, are common in patients presenting to our Clinic. With preoperative imaging, such as endoanal ultrasound or MRI, the Division has experience in performing sphincter-sparing procedures for complicated or recurrent anal fistulas, such as the Ligation of Intersphincteric Tract Ligation (LIFT) procedure or fistuloscope.

Rectal prolapse is one of the pelvic floor disorders where there is protrusion of the rectum through the anus. Multiple approaches have been used to treat this condition, e.g. the Delorme’s operation, suture rectopexy, etc. Robotic ventral mesh rectopexy has been used in this centre with favourable outcomes.

Pseuodmyxoma peritonei is a clinical syndrome with diffuse mucinous peritoneal involvement. The Division has over 15 years of experience in adopting the aggressive approach of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) to treat this condition. This technique is used to treat patients with peritoneal metastasis from colorectal cancer as well.

The Division performs over 3000 colonoscopies each year. In addition to the diagnostic procedures, therapeutic procedures such as colonoscopic polypectomies and insertion of metallic stents are regularly performed. Advanced endoscopic techniques, such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), are regularly performed. 

The anorectal physiology laboratory was established in 1995 to provide objective investigations (such as colonic transit study, 3D endorectal/endoanal ultrasound and high-resolution anorectal manometry) for patients with functional bowel disorders. Endorectal ultrasound helps in the accurate staging of patients with rectal tumour, and endoanal ultrasound could help in managing the complicated anal fistulas or sphincter injury. These then allow the most appropriate treatment to be offered. Anorectal manometry could assess the sphincter function after rectal resection and bowel training can be considered accordingly.