Colorectal surgery is a subspecialty of surgery. It focuses on the surgical treatment of benign and malignant conditions of the rectum and the colon.
Here you will find further information as well as a selection of specialists in colorectal surgery.
Colorectal surgery includes surgical procedures for bowel diseases such as colorectal cancer (colon cancer, rectal cancer), Diverticulitis, polyps, anal fistulas as well as chronic inflammatory diseases (Crohn's disease, ulcerative colitis). The goal is to improve patient care, preserve bowel function, and prevent complications. Modern minimally invasive surgery (e.g., laparoscopic, sometimes robot-assisted) involves small incisions in the abdomen and often allows for a faster recovery.
Colorectal surgery is a general term for surgeries on the colon and rectum.
Depending on the extent of the condition, treatment is performed as conventional colorectal surgery or laparoscopic colorectal surgery.
Medical professionals define conventional surgery as open surgery involving a large skin incision.
A laparoscopic procedure, on the other hand, requires only small incisions. Doctors do not need to open up the surgical site. This is a minimally invasive method, also known as the “keyhole” method.
As part of fast-track colorectal surgery, doctors aim to keep the surgery as minimal as possible and reduce the risk of postoperative complications. Fast-track colorectal surgery is characterized primarily by a shorter recovery period.
Benign conditions of the colon treated by colorectal surgery include, for example:
The large intestine (colon), which is approximately 1.5 m long, is part of the digestive system. It begins at the ileocecal valve, where the small intestine transitions into the large intestine. This point is located in the lower right abdomen.
After the ascending colon (Colon ascendens), the colon makes a bend. It then transitions into the transverse colon (Colon transversum). After another bend, the descending colon (Colon descendens) follows.
This is followed by the final, usually S-shaped section of the large intestine (sigmoid colon, sigmoid loop). It transitions into the rectum at the level of the upper end of the sacrum and ends at the anal canal (anus).
The anal canal is surrounded by an internal and an external sphincter muscle.
The Anatomy of the Intestine © bilderzwerg | AdobeStock
The primary function of the large intestine is to thicken the intestinal contents.
The intestinal contents consist of:
This thickening occurs through the reabsorption of water from the intestinal contents back into the bloodstream (water reabsorption).
The rectum stores the intestinal contents until they are excreted.
Diverticula are outpouchings of the intestinal wall through the muscular wall of the intestine. They are usually located near the entry points of small blood vessels.
Most diverticula are located in the area of the sigmoid loop in the left lower abdomen. This condition is also known as diverticulosis.
Intestinal contents can accumulate in these protrusions; after losing water, these contents thicken and form fecal stones. Mechanical irritation of the mucosa leads to microscopic injuries to the intestinal wall. In addition, bacteria from the intestinal lumen can penetrate the intestinal wall.
As a result, the intestinal wall in the area of the diverticula can become inflamed, leading to diverticulitis (inflammation of the diverticula).
If the inflammation progresses, the following symptoms may occur:
If these complications resolve, scarring may occur as part of the healing process. If the scars contract, the intestine may narrow (stenosis).
In chronic, recurrent diverticulitis, flare-ups of inflammation occur repeatedly, which can be very distressing for patients.
The intestine is susceptible to various diseases © bilderzwerg | AdobeStock
An indication for colon surgery as part of colorectal surgery exists in cases of:
The goal of colorectal surgery for diverticular disease is to remove the section of the intestine containing the diverticula (intestinal resection). The two ends of the intestine are then reconnected.
In the event of a bowel perforation, a temporary artificial bowel outlet (ileostomy, anus praeter) may be necessary. This allows the bowel to heal without further irritation from its contents.
An artificial bowel outlet also allows the suture connecting the two ends of the bowel to heal more effectively.
After about three to six months, doctors reposition the bowel opening back to its original location. Since an ileostomy is less commonly required for elective colon surgery, timely colon surgery is recommended.
In most cases, doctors can remove the section of the intestine containing diverticula in a single operation using the keyhole method.
In contrast, emergency colorectal surgery usually must be performed using conventional, open colon surgery (laparotomy, a large abdominal incision).
To ensure the fastest possible recovery after colorectal surgery, treatment is often carried out according to the fast-track protocol.
Although colorectal surgery is often performed laparoscopically, the Fast-Track technique can also be used in open colorectal surgery.
Under this approach, the patient begins eating again on the day of surgery. They should also get out of bed as soon as possible. As recovery progresses, the patient does not need to follow any special diet.
After colon resection, a suture rupture (anastomotic insufficiency) may occur at the site of the suture connecting the ends of the bowel. This causes intestinal contents to leak into the abdominal cavity, leading to peritonitis (inflammation of the peritoneum).
Anastomotic leakage (tearing or leakage at the connection site) occurs only in rare cases. If conservative treatment is unsuccessful, repeat colon surgery may be necessary. If acute peritonitis is already present, surgery is always required.
Anastomotic stricture, in particular, can occur as a potential late complication of fast-track colorectal surgery. It results from scarring and contraction of the scar tissue. In such cases, endoscopic dilation performed during a repeat colorectal surgery may help.
In addition, as with any surgery, the following general issues may arise with colon surgery:
Polyps are (usually pedunculated) protrusions of the intestinal mucosa. Polyps can generally be removed during a colonoscopy.
If they are located in a hard-to-reach area or are very large, colon surgery is required to remove them.
In many cases, a partial removal of the colon can be performed laparoscopically.
However, the surgeon cannot feel the colon with their fingers during this procedure to locate the polyps.
Therefore, doctors must mark the polyps beforehand or visualize them during the colorectal surgery using a colonoscopy.
The risks and complications are comparable to those of colon surgery for diverticular disease.
Removal of a colon polyp during a colonoscopy © phonlamaiphoto | AdobeStock
Chronic inflammatory bowel diseases are recurrent or persistent inflammatory conditions of the bowel. The most common examples are ulcerative colitis and Crohn’s disease.
Collagenous and lymphocytic colitis (collectively referred to as microscopic colitis) are also classified as chronic inflammatory bowel diseases.
However, these forms are very rare. Therefore, we will describe only Crohn’s disease and ulcerative colitis below.
Crohn’s disease, which usually progresses in flare-ups, is characterized by the following symptoms:
The entire gastrointestinal tract—from the mouth to the sphincter—can be affected. However, in most cases, only the terminal portion of the small intestine at the junction with the large intestine is involved.
If the large intestine is also affected, there is an increased risk of cancer if the disease persists for a long time. This risk is particularly high when the disease begins in early adolescence.
During surgery for Crohn’s disease, doctors should avoid removing part of the intestine (intestinal resection) whenever possible. If it is necessary, the extent of the resection should be kept to a minimum.
Therefore, doctors treat localized strictures, whenever possible, by making a longitudinal incision in the intestine and performing transverse suturing (stricturoplasty).
In elective colorectal surgery for Crohn’s disease, endoscopic, minimally invasive colorectal surgery is also frequently used.
However, the stricture can lead to acute intestinal obstruction, or abscesses may form.
In such cases, emergency colorectal surgery is usually performed using open surgical techniques (laparotomy).
Crohn’s disease is incurable and recurs in different parts of the digestive tract.
Therefore, even after successful treatment, medication and ongoing monitoring by an experienced gastroenterologist are necessary.
Ulcerative colitis is a chronic inflammation of the colon’s mucous membrane that typically occurs in flare-ups. It affects almost exclusively the rectum and colon, although symptoms may also occur outside the intestine (e.g., joint inflammation).
The intestinal inflammation is characterized by the following symptoms:
It usually begins in the rectum and then often spreads to the left side of the colon or the entire colon.
This can lead to the following symptoms:
Ulcerative colitis and Crohn’s disease © bilderzwerg | AdobeStock
In cases of prolonged disease duration, malignant transformation is more common than in Crohn’s disease.
The frequency of diarrhea depends directly on the extent to which the colon is affected by the disease. Diarrhea can occur up to 20 times a day, and in severe cases, even up to 30 times a day.
If only individual sections of the intestine are affected by ulcerative colitis, doctors remove them through colon surgery or rectal surgery.
If the entire rectum and colon are affected, the colorectal surgery is usually a proctocolectomy (continent proctomucocolectomy).
During this colorectal surgery, doctors first remove the large intestine and the rectum. They then use a section of the small intestine to create a kind of artificial rectum.
This section takes over the function of the removed rectum. In this way, the patient remains continent, thereby avoiding the need for a permanent stoma.
Familial adenomatous polyposis is a rare but serious intestinal disorder in which the large intestine—and often the rectum as well—is covered with numerous polyps. Even in young adulthood, there is a high risk that these polyps will develop into colorectal cancer. To prevent complications, surgical clinics and proctology specialists recommend early surgical intervention. A proctocolectomy is often performed—a surgical procedure in which the rectum and colon are removed to prevent the development of malignant tumors. Close preventive care and follow-up in colorectal surgery play a crucial role in this process.
Malignant tumors in the colon and rectum most commonly develop after the age of 50, usually from polyps. Although colorectal cancer can develop in any section of the colon and rectum, it most frequently occurs in the lower 30 to 40 centimeters of the colon.
The primary treatment for colorectal cancer is colorectal surgery. During this procedure, doctors remove the affected section of the colon as well as the associated lymphatic vessels and blood vessels.
Colorectal surgery for colorectal cancer aims, among other things, to achieve the following:
Curative (healing) colorectal surgery is performed when doctors remove all tumor tissue, including metastases in lymph nodes or other organs.
In this type of colorectal surgery, doctors remove not only the directly affected section of the intestine but also a generous amount of the surrounding healthy tissue.
This reduces the risk of the tumor returning (recurrence). Since individual cancer cells may already have spread to the regional lymph nodes, doctors remove these as well.
Palliative colorectal surgery offers no prospect of a cure. It is used in cases of advanced colorectal cancer (e.g., when doctors were unable to remove metastases). The goal in such cases is to alleviate tumor-related complications.
For example, if the tumor grows into the intestine, it can obstruct the passage of intestinal contents. This can lead to a life-threatening intestinal obstruction. In such cases, doctors attempt to reduce the size of the tumor enough to clear the blockage.
Palliative colorectal surgery for colorectal cancer also includes:
An artificial bowel opening directs waste into a pouch © Photozi | AdobeStock
In colorectal cancer surgery, the approach is guided by the tumor’s lymphatic drainage area:
The need to create a colostomy has become rare today for tumors of the colon. In individual cases, however, it cannot be avoided.
For rectal cancer in the upper third of the rectum, doctors remove the affected section of the rectum and the associated lymphatic drainage area.
Doctors treat a tumor in the lower two-thirds of the rectum somewhat differently:
If enlarged lymph nodes or infiltration of the intestinal wall muscles are detected, radiation therapy and chemotherapy are administered first
During rectal surgery, doctors remove the affected section of the rectum along with the entire rectal suspensory apparatus
Reconstruction is performed by bringing down a section of the large intestine and connecting it to the remaining rectal stump. Doctors often need to create a pouch (replacement reservoir).
Most rectal and colon surgeries for colorectal cancer can be performed endoscopically. This requires that the tumor be of an appropriate location and size.
Surgical images: From www.chirurgie-im-bild.de, courtesy of Prof. Dr. Thomas W. Kraus
1. What is colorectal surgery?
Colorectal surgery is a subspecialty of surgery that deals with the surgical treatment of diseases of the large intestine (colon), rectum, and anal canal. This includes both benign conditions such as diverticula or polyps and malignant tumors such as colorectal cancer.
2. What conditions are treated in colorectal surgery?
Typical conditions include colorectal cancer, rectal cancer, diverticulitis, chronic inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis, polyps, and familial polyposis. Complex proctological procedures are also part of the range of treatments.
3. What surgical procedures are used in colorectal surgery?
Depending on the condition, both open surgical procedures and minimally invasive techniques (e.g., laparoscopy or keyhole surgery) may be used. Modern approaches, such as fast-track surgery, aim to minimize complications and shorten the recovery time after surgery.
4. When should you consult a specialized clinic or a colorectal surgeon?
If you experience recurring symptoms in the colon, rectum, or anal canal, have been diagnosed with polyps, suffer from chronic intestinal inflammation, or have a suspected case of colorectal cancer, you should schedule a colorectal consultation as soon as possible. Specialists and specialized clinics can tailor the best treatment and preventive care plan to each individual’s needs.
Every physician listed in the Leading Medicine Guide has attained the highest level of training and certification within their respective medical specialty society. Furthermore, we contacted this physician based, among other factors, on their case volume (surgeries, treatments, and therapies), which we determined by cross-referencing various publicly available sources. Following discussions with the selected physicians and the directors of the medical facilities, as well as a subsequent internal review, they were admitted to the Leading Medicine Guide.
The quality assurance of the Leading Medicine Guide is further ensured by 8 admission criteria. Each member must meet at least 6 of them:
