Colon Surgery - Medical Experts

Colon surgery involves the treatment of

• inflammation of the appendix (appendicitis)
• Diverticula (outpouchings of the intestinal wall) 
• Resections for tumors of the colon and the anal region (rectum, anus)
• Surgery for chronic inflammatory bowel diseases 
• Surgery for congenital conditions (e.g., anal atresia)

Surgical procedures are performed either using traditional (conventional) methods or minimally invasive techniques.

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

Surgery on the colon becomes necessary when

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

that have altered or damaged the intestinal wall to such an extent that normal function is impaired and no further improvement can be achieved with medication. Urgent (within a few hours or days) or emergency (immediate or within a few hours) surgery is necessary in cases of impending or actual perforation (rupture) of the intestinal wall.

During surgical treatment, diseased sections of the intestine are removed, and efforts are made to restore normal function. To do this, a colostomy is often required on a temporary (or, in some cases, permanent) basis.

For which colon diseases are which surgeries performed?

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

• Colorectal tumors and tumors of the anus: In cases of tumors, the affected portion of the bowel is removed along with a sufficient margin of healthy tissue. If the cancer is detected early, treatment is often curative, meaning the patient is cured.
• Appendicitis: In cases of inflammation of the appendix—commonly referred to as appendicitis—the appendix is removed. It is possible to live without an appendix without any problems. Surgical removal used to be performed through an abdominal incision; today, it is generally done laparoscopically (i.e., via laparoscopy). In both cases, however, general anesthesia is required.
• Chronic Inflammatory Bowel Diseases: Ulcerative colitis, Crohn’s disease, enteritis, and irritable bowel syndrome: Chronic inflammation of the bowel can lead to colorectal cancer. In cases of chronic inflammatory bowel diseases that do not respond to medication, surgical removal is indicated. Nowadays, the surgery does not always involve the creation of a colostomy, and the sphincter muscle can be preserved or reconstructed. Laparoscopic resection is also possible.
• Foreign bodies and injuries to the colon or anus: Surgical removal prevents perforation and subsequent peritonitis. 
• Chronic constipation: Constipation is a disorder of bowel movement that, in severe cases, is treated with surgical techniques.
• Diverticula: Protrusions of the intestinal wall. In cases of chronic symptoms with severe inflammation—medically known as diverticulitis—removal of the affected section can be curative.
• Colonic polyps: Benign growths of the intestinal mucosa that protrude into the intestinal lumen. Their removal during a colonoscopy is part of colorectal cancer screening.
• Fecal incontinence: Fecal incontinence is the inability to control bowel movements. Possible causes include inflammation, tumors, pelvic floor disorders, or neurological conditions. Surgical treatment depends on the underlying cause.
• Hemorrhoids: Vascular structures that protrude into the anal canal. When inflamed and swollen, they interfere with bowel movements and can cause significant pain. They are also a common cause of rectal bleeding (i.e., bleeding during a bowel movement). Surgical treatment for hemorrhoids focuses on stopping the bleeding or removing the hemorrhoids.
• Anal fistulas: Tunnels or a network of tunnels leading from the anal canal to the outside, formed as a result of inflammation. Treatment involves surgical intervention in the form of incision, excision, or drainage.
• Anal fissures: Tears in the skin or mucous membrane around the anus. In cases of chronic disease, surgical removal via anal fissure surgery is indicated.
• Rectal prolapse: Rectal prolapse is the protrusion of the rectum. The rectum is partially resected, repositioned, and fixed in place via open or laparoscopic surgery.
• Infected pilonidal sinus: A chronic inflammatory condition of the gluteal cleft that can become very large and painful. It is also often accompanied by the discharge of purulent secretions and rarely resolves on its own. Consequently, the treatment of choice is surgical excision.
• Anorectal malformations: Congenital malformations in the area of the large and small intestines, such as anal atresia. In these cases, the rectum and anus are underdeveloped or the anal opening is completely absent. The goal of the surgery is to reconstruct the malformed intestine and create an anal opening. However, this reconstruction often does not correspond to the natural anatomy, and the anal opening is located on the front of the abdominal wall (known as an artificial anal opening or stoma).

Colon surgery is performed using conventional or minimally invasive techniques. 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 surgery. A bowel preparation is also required. In most cases, a colonoscopy precedes the surgery or takes place on the same day.

Colon surgeries last an average of between 15 minutes and five hours.

Procedures used in colon surgery:

• Appendectomy: An appendectomy is the removal of the appendix. This is performed either conventionally or laparoscopically.
• Colectomy and proctocolectomy: A colectomy refers to the irreversible removal of the colon, while a proctocolectomy involves the resection of both the colon and the rectum. In the case of a complete removal of the large intestine, it is not always possible to preserve the sphincter and the anal opening, and a colostomy must be created.
• Hemicolectomy: In a hemicolectomy, the surgeon removes only a portion (hemi = half) of the colon. Accordingly, there is a right-sided or left-sided hemicolectomy, depending on whether the ascending right portion or the descending left portion of the colon is resected.
• Laparoscopic colectomy: Removal of the large intestine can also be performed using laparoscopic techniques. Whether these are used depends on the findings. An advantage of this technique is a lower risk of adhesions.
• Colostomy: A colostomy involves creating an artificial opening in the bowel. The surgeon brings the end of the bowel through the abdominal wall, connects it to the skin, and thus redirects the flow of stool.

After colon surgery, especially if large sections have been removed, stools may range from mushy to watery, and bloating may occur. Therefore, a diet that is gentle on the intestines is important after surgery. Bulking foods such as oatmeal, psyllium, wheat bran, potatoes, or bananas can help firm up stool consistency.

However, it can take up to a year for bowel movement frequency to return to normal. Foods that cause bloating should therefore be avoided long-term.

It is also important to replenish lost fluids. Drinking two to three liters of fluid per day in the form of herbal or black tea, as well as still mineral water, is one of the most important recommendations.

After colon surgery involving a resection, the damaged and possibly newly connected sections of the intestine must heal.

In approximately 5 percent of cases, leaks (medically referred to as “fistulas”) occur. If intestinal contents enter the abdominal cavity as a result, peritonitis develops. In this case, reoperation is necessary; otherwise, sepsis will result.

If there is a high risk of poor intestinal healing from the outset, a stoma should be created as a precautionary (protective) measure to spare the diseased sections of the intestine and the suture sites. However, the stoma can also become infected, fail to heal properly, or develop tears at the suture sites. In such cases, the stoma must be reoperated on and, if necessary, re-created.

Another possible complication is damage to adjacent structures (e.g., the ureter, small intestine, or nerves).

Complications that can occur with any type of surgery include

• infections,
• bleeding, or
• anesthesia-related incidents. 

The removal of large sections of the colon can also lead to permanent disturbances in fluid and electrolyte balance.

Although colon surgeries can be curative (i.e., result in a complete cure), the prognosis depends heavily on

• the underlying condition,
• the patient’s overall health,
• the surgical technique, and
• the course of the surgery

.