Rectal Surgery – Surgical Treatment of the Rectum

Surgery on the rectum is always necessary when conservative treatments are insufficient or when a structural abnormality is present. Common reasons for rectal surgery include:

• Rectal carcinoma (rectal cancer)
  
  
• Rectal prolapse (prolapse of the rectum)
  
  
• Abscesses or fistulas in the rectal area
  
  
• Severe hemorrhoids
  
  
• Chronic inflammatory bowel diseases (e.g., Crohn’s disease, ulcerative colitis)
  
  
• Injuries or congenital malformations
  
  

Depending on the diagnosis, various surgical procedures are used, each tailored to the patient’s specific findings and overall health.

The choice of procedure depends on the type and location of the condition. A basic distinction is made between minimally invasive (laparoscopic) and open surgeries.

1. Rectal resection

In this procedure, a portion of the rectum is removed, e.g., in cases of rectal cancer. The healthy sections of the intestine are then reconnected. The goal is to completely remove the tumor while preserving continence.

2. Deep anterior rectal resection (TAR)

This procedure is used for tumors in the upper and middle rectum. The section of the rectum is removed through the abdominal cavity, and bowel function is subsequently restored.

3. Abdominoperineal rectal resection

If the sphincter muscle is affected, the entire rectum, including the anus, is removed. In this case, a colostomy (stoma) is created to divert stool.

4. Transanal endoscopic microsurgery (TEM)

A minimally invasive procedure used to remove smaller tumors or polyps through the anus without opening the abdominal cavity.

5. Fistula and abscess surgery

In cases of chronic fistulas or purulent inflammation, the affected tracts are opened, cleaned, and closed to allow for healing.

A thorough diagnostic evaluation is performed prior to rectal surgery:

• Colonoscopy and biopsy
  
  
• Imaging (CT or MRI) to assess the extent of the condition
  
  
• Blood tests and anesthesia consultation
  
  

On the day before surgery, the bowel is usually emptied using laxatives. Patients are given detailed information about the procedure, possible complications, and postoperative care.

The healing process depends on the type and extent of the procedure. Following major rectal surgery, the hospital stay usually lasts from several days to several weeks.

Key points of postoperative care:

• Early mobilization to prevent blood clots
  
  
• A bland diet and gradual reintroduction of solid foods
  
  
• Wound and drainage checks
  
  
• Training in the care of a stoma, if one has been created
  
  
• Physical therapy and pelvic floor exercises to restore continence
  
  

Complications such as postoperative bleeding, infections, suture leaks, or bowel dysfunction are possible but are significantly reduced by modern surgical techniques.

Thanks to modern procedures and interdisciplinary treatment, the prognosis for rectal surgery is very good today. Following the removal of benign lesions, a complete cure is usually possible. In cases of cancer, the prognosis depends on the stage, tumor type, and overall health.

Specialized follow-up programs, regular checkups, and a healthy lifestyle can significantly reduce the risk of recurrence.