Large intestine surgery - Medical specialists

Colon surgery (surgical coloproctology) is a treatment field of visceral surgery (abdominal surgery). The treatment includes the therapy of general and special proctology diseases. It is also part of the interdisciplinary treatment of chronic inflammatory bowel diseases such as ulcerative colitis. A colonoscopy is often necessary before the operation in order to make an exact diagnosis. This enables the surgeon to decide which procedure is necessary.

Here you will find further information and selected colon surgery specialists and centers.

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Article overview

Large intestine surgery - Further information

What procedures are included in colon surgery?

Surgery of the colon includes the treatment of

Surgical interventions are either traditional (conventional) or minimally invasive.

In conventional methods, the abdominal cavity is opened (usually through a long incision in the midline, sometimes also in the form of a transverse incision) and the bowel is thus completely exposed. Minimally invasive techniques , on the other hand, only require small incisions through which instruments are inserted.

What are the reasons for colon surgery?

Surgery on the colon is necessary when

  • inflammatory diseases,
  • infections,
  • tumors,
  • foreign bodies or
  • malformations

the intestinal wall is so severely altered or damaged that normal function is impaired and no improvement can be achieved with medication. Urgent (within a few hours/days) or emergency (immediately/within a few hours) surgery is necessary if there is a threat of perforation (rupture) of the intestinal wall or if this has already occurred.

During surgical treatment, diseased parts of the intestine are removed and an attempt is made to restore functionality. This often requires the temporary (or sometimes permanent) creation of an artificial anus.

Die Anatomie des Darms
The anatomy of the bowel © Henrie | AdobeStock

Which operations are performed for which colon diseases?

A surgeon performs operations on the colon for the following diseases:

  • Colorectal tumors and tumors of the anus: In the case of tumors, the affected part of the intestine is removed with enough safety margin to the remaining tissue. If the cancer is detected early, the treatment is often curative, i.e. the patient is cured.
  • Appendicitis: If the appendix of the appendix is inflamed, simply called appendicitis, it is removed. You can live without an appendix without any problems. In the past, the appendix was surgically removed via an abdominal incision, nowadays it is usually removed laparoscopically (i.e. via laparoscopy). In both cases, however, a general anesthetic is necessary.
  • Chronic inflammatory bowel diseases: ulcerative colitis, Crohn's disease, enteritis and irritable bowel syndrome: chronic inflammation of the bowel can lead to bowel cancer . Surgical removal is indicated for chronic inflammatory bowel diseases that do not respond to drug treatment. Nowadays, surgery is not always associated with an artificial bowel outlet and the sphincter muscle can be spared or reconstructed. Laparoscopic resection is also possible.
  • Foreign bodies and injuries to the colon or anus: Surgical removal prevents perforation with subsequent peritonitis.
  • Chronic constipation: Constipation is a bowel movement disorder that is treated with surgical techniques in severe cases.
  • Diverticula: Protrusions of the intestinal wall. In cases of chronic complaints with severe inflammation, medically known as diverticulitis, removal of the affected section can be curative.
  • Intestinal polyps: Benign outgrowths of the intestinal mucosa that protrude into the intestinal canal. Removal during a colonoscopy is part of colon cancer prophylaxis.
  • Fecal incontinence: In the case of fecal incontinence, controlled defecation is not possible. Possible causes include inflammation, tumors, pelvic floor or nerve disorders. Surgical treatment depends on the cause.
  • Hemorrhoids: vascular structures that protrude into the anal canal. Inflamed and swollen, they interfere with bowel movements and can cause considerable pain. They are also often the cause of peranal (i.e. via the bowel movement) blood loss. The surgical treatment of haemorrhoid surgery focuses on stopping the bleeding or removing the haemorrhoids.
  • Anal fistulas: ducts or a network of ducts that lead from the anal canal to the outside and have formed due to inflammation. Treatment is surgical treatment in the form of splitting, excision or drainage.
  • Anal fissures: tears in the skin or mucous membrane of the anus. In the case of chronic disease, surgical removal by anal fissure surgery is indicated.
  • Rectal prolapse: Rectal prolapse is a prolapse of the rectum. The rectum is partially resected, repositioned and fixed surgically or laparoscopically.
  • Infected pilonidal sinus: Chronic inflammatory disease of the gluteal fold, which can become very large and painful. In addition, it is often accompanied by the discharge of purulent secretions and rarely resolves on its own. Consequently, the therapeutic solution of choice is surgical excision.
  • Anorectal malformations: Congenital malformation in the area of the colon and rectum, for example anal atresia. In this case, the rectum and anus are insufficiently developed or the anus is completely absent. The aim of the operation is to reconstruct the malformed bowel and create an anus. However, this reconstruction often does not correspond to the natural conditions and the anus is located at the front of the abdominal wall (so-called artificial anus or stoma).

What surgical methods are available for the treatment of colon diseases?

Colon surgery is performed conventionally or minimally invasively. The course of treatment depends on the type of procedure. General anesthesia is generally required.

The patient must not have eaten anything for several hours before the operation. A bowel cleansing is also necessary. A colonoscopy(colonoscopy) usually precedes the operation or takes place on the same day.

On average, colon operations take between 15 minutes and five hours.

Procedures used in colon surgery:

  • Appendectomy: Appendectomy is the removal of the appendix of the appendix. It is performed conventionally or laparoscopically.
  • Colectomy and proctocolectomy: A colectomy is the irreversible removal of the colon, while a proctocolectomy involves the resection of the colon and rectum. If the colon is completely removed, it is not always possible to preserve the sphincter muscle and the bowel outlet and an artificial bowel outlet must be placed.
  • Hemicolectomy: In a hemicolectomy, the surgeon only removes part (hemi = half) of the colon. Accordingly, there is a right-sided or left-sided hemicolectomy, depending on whether the ascending right part or the descending left part of the colon is resected.
  • Laparoscopic colectomy: The colon can also be removed using laparoscopic procedures. Whether these are used depends on the findings. The advantage of this technique is a lower risk of adhesions.
  • Colostomy: A colostomy is the creation of an artificial bowel opening. The surgeon passes the end of the bowel through the abdominal wall, connects it to the skin and thus diverts the flow of stool.

What needs to be considered after colon surgery?

After colon surgery, especially if large sections have been removed, you may experience mushy to runny stools and flatulence. A diet that is gentle on the bowel is therefore important postoperatively. Constipating foods such as oatmeal, psyllium, wheat bran, potatoes or bananas can help to solidify the consistency of the stool.

However, it can take up to a year for the stool frequency to return to normal, so flatulent foods should be avoided permanently.

It is also important to compensate for water loss. Drinking two to three liters of fluid per day in the form of herbal or black tea and still mineral water is one of the most important recommendations.

What complications can occur after colon surgery and what is the prognosis?

After colon surgery in which a resection has been performed, the damaged and possibly newly connected parts of the bowel must heal.

Leaks (also known medically as leakages ) occur in around 5 percent of cases. If intestinal contents enter the abdominal cavity as a result, peritonitis occurs. In this case, reoperation is necessary, otherwise blood poisoning occurs.

If there is already a high risk of poor healing of the bowel from the outset, an artificial bowel outlet should be created as a precautionary (protective) measure to protect the diseased parts of the bowel and the sutures. Nevertheless, the artificial bowel outlet (stoma) can also become infected and heal poorly or the sutures can tear. The stoma then has to be operated on again and, if necessary, reapplied.

A further complication may be damage to neighboring structures (e.g. ureter, small intestine or nerves).

Complications that can occur with any type of surgery are

  • Infections,
  • bleeding or
  • anesthetic incidents.

The removal of large parts of the colon can also lead to permanent disorders of the fluid and salt balance.

Although colon surgery can be curative (i.e. completely healing), the prognosis depends heavily on

  • the underlying disease,
  • the general state of health
  • the surgical method and
  • the course of the operation

course of the operation.

References

  • https://www.koloproktologie.org/
  • https://www.dgav.de/
  • https://www.swiss-surgery.de
  • https://www.deutsche-apotheker-zeitung.de
  • https://www.chirurgie-online.net
  • https://www.reizdarm.one/
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