Colorectal surgery is a specialist area of surgery. It deals with the surgical treatment of benign and malignant diseases of the rectum and colon. Here you will find further information and selected specialists for colorectal surgery.
Colorectal surgery is a generic term for operations on the colon and rectum.
Depending on the disease, the procedure is performed as conventional colorectal surgery or as laparoscopic colorectal surgery.
Conventional surgery is open surgery with a large incision. Laparoscopic surgery, on the other hand, involves small incisions and the surgical area is not opened. This is a minimally invasive method, also known as the keyhole method.
The aim of fast-track colorectal surgery is to minimize the surgical intervention and reduce the risk of postoperative complications. Fast-track colorectal surgery is characterized above all by a shortened recovery phase.
Benign diseases of the colon that are treated in colorectal surgery include, for example
Malignant diseases that are treated as part of colorectal surgery are
The approximately 1.5 m long large intestine (colon) is part of the digestive system. It begins at the ileocecal valve, where the small intestine merges into the large intestine. This point is located in the right lower abdomen.
After the ascending branch(ascending colon), the large intestine makes a bend and merges into the transverse part(transverse colon). After another bend, the descending part of the colon(descending colon) follows.
This is followed by the last, usually S-shaped section of the colon(sigmoid colon, sigmoid loop). It merges into the rectum at about the level of the upper end of the sacrum and ends in 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 main function of the large intestine is to thicken the intestinal contents. The contents of the intestine consist of
Thickening takes place via the release of water from the intestinal contents back into the blood (water reabsorption).
The intestinal contents are stored in the rectum until excretion.
Diverticula are protrusions of the intestinal mucosa through the muscular wall of the intestine. They are usually located at the entry points of small vessels.
Most diverticula are located in the area of the sigmoid loop in the left lower abdomen. This clinical picture is known as diverticulosis.
Intestinal contents can accumulate in these protrusions, which thicken after dehydration and form fecal stones. Mechanical irritation of the mucous membrane causes microscopic injuries to the intestinal wall. Bacteria from the intestinal lumen can also penetrate the intestinal wall.
As a result, the intestinal wall in the area of the diverticula can become inflamed and diverticulitis (inflammation of the diverticula) develops. If the inflammation progresses, it can lead to intestinal bleeding and a rupture of the intestine.
If these complications heal, scars may form as part of the healing process. If the scars shrink, the bowel can narrow (stenosis). In chronic recurrent diverticulitis, there are repeated bouts of inflammation, which can be very stressful for patients.
The colon is susceptible to various diseases © bilderzwerg | AdobeStock
There is an indication for colon surgery as part of colorectal surgery in the case of
The aim of colorectal surgery for diverticular disease is to remove the section of bowel containing the diverticulum (bowel resection). The two ends of the bowel are then reconnected.
A temporary artificial anus (ileostomy, anus praeter) may be necessary in the event of an intestinal perforation. This allows the bowel to recover and is not further irritated by the bowel contents. An artificial anus also allows the suture that connects the two ends of the bowel to heal better.
After around three to six months, the anus is moved back again. As an ileostomy is rarely required for elective colon surgery, timely colon surgery is recommended.
In most cases, the part of the bowel containing the diverticula can be surgically removed using the keyhole method.
Emergency colorectal surgery, on the other hand, usually requires conventional open colorectal surgery (laparotomy, large abdominal incision).
In order to achieve the quickest possible recovery after colorectal surgery, treatment is often carried out according to the fast-track scheme. Although colorectal surgery is often performedusing laparoscopy, the fast-track technique can also be used for open colorectal surgery.
This means that the patient eats again on the day of the operation and should also get out of bed quickly. The patient does not have to adhere to any further diet in the further course of the operation.
After removal of the colon, the suture between the ends of the bowel may break (anastomotic insufficiency). This causes intestinal contents to leak into the abdominal cavity and peritonitis(inflammation of the peritoneum) develops.
Anastomotic insufficiency only occurs in rare cases. If conservative treatment is unsuccessful, a new colon operation may be necessary. If acute peritonitis is already present, treatment is always surgical.
Anastomotic stricture can occur as a possible late complication, particularly in the case of fast-track colorectal surgery. This is caused by shrinkage of the scar. This can be remedied by endoscopic dilation via a repeat colorectal operation.
As with any surgical procedure, the following general complications can also occur during colorectal surgery:
Polyps are (usually stalked) protrusions of the intestinal mucosa. Polyps can usually be removed as part of acolonoscopy.
However, if they are located in an area that is difficult to access or if they have a very broad base, colon surgery may be necessary to remove them.
In many cases, partial colon removal is possible using laparoscopy.
However, the surgeon cannot feel through the colon with his fingers to detect the polyps. The polyps must therefore be marked in advance or visualized during colorectal surgery using colonoscopy.
The risks and complications are comparable to those of colorectal surgery for diverticular disease.
Removal of a colon polyp during a colonoscopy © phonlamaiphoto | AdobeStock
Chronic inflammatory bowel diseases are recurring or persistent inflammatory diseases of the bowel. The most common types are ulcerative colitis and Crohn's disease.
Collagenous and lymphocytic colitis (collectively referred to as microscopic colitis) are also chronic inflammatory bowel diseases. However, these variants are very rare. For this reason, only Crohn's disease and ulcerative colitis are described below.
Crohn's disease, which usually progresses in episodes, is characterized by
characterized. The entire gastrointestinal tract, i.e. from the mouth to the sphincter muscle, can be affected. In most cases, however, only the end part of the small intestine at the transition to the large intestine is affected.
If the large intestine is also affected, there is an increased risk of degeneration if the disease persists for a long time. This risk is particularly high at the onset of the disease in early adolescence.
Removal of the bowel (bowel resection) should be avoided as far as possible during Crohn's disease surgery. If it is necessary, the extent of the resection should be kept to a minimum.
Therefore, spatially limited stenoses are treated by means of longitudinal opening of the bowel and transverse suturing (stricturoplasty) wherever possible.
Endoscopic, minimally invasive colorectal surgery is often used for elective colorectal surgery due to Crohn's disease. However, the stenosis can lead to an acute bowel obstruction, or foci of pus can form. In this case, emergency colorectal surgery is usually performed using the open surgical technique (laparotomy).
Crohn's disease cannot be cured and always recurs elsewhere in the digestive tract. Therefore, even after a successful operation, drug therapy and long-term monitoring by an experienced gastroenterologist are required.
Ulcerative colitis is a chronic inflammation of the colon mucosa that usually occurs in episodes. It almost exclusively affects the rectum and large intestine, although symptoms can also occur outside the intestine (e.g. joint inflammation).
Intestinal inflammation is characterized by
characterized. It usually begins in the rectum and then often spreads to the left side of the colon, but can also affect the entire colon.
It can lead to
can occur.
Ulcerative colitis and Crohn's disease © bilderzwerg | AdobeStock
Malignant degeneration is more common with prolonged disease than with Crohn's disease.
The amount of diarrhea depends directly on how severely 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 bowel are affected by ulcerative colitis, these are removed by means of colon or rectal surgery.
If the entire rectum and colon are affected, the colorectal operation is usually a proctocolectomy (continent proctomuco-colectomy).
During this colorectal operation, the colon and rectum are removed first. An artificial rectum is then formed from a piece of small intestine. It takes over the function of the removed rectum. In this way, the patient remains continent so that a permanent artificial anus can be avoided.
Familial polyposis is a serious disease in which the colon is covered with hundreds of polyps.
Even in young adulthood, these polyps develop into malignant tumors. For this reason, the removal of the rectum and colon during colorectal surgery (proctocolectomy) is recommended at an early stage.
Malignant tumors in the colon and rectum develop more frequently after the age of 50, usually from polyps. Colorectal cancer can develop in all sections of the colon and rectum. However, it occurs most frequently in the lower 30 to 40 centimeters.
The most important treatment for colorectal cancer is colorectal surgery. This involves removing the affected section of colon as well as the lymphatic and blood vessels supplying the area.
Colorectal surgery for colorectal cancer has the following aims, among others:
If the entire tumor tissue, including any metastases in lymph nodes or other organs, is removed during colorectal surgery, this is referred to as curative colorectal surgery.
In this colorectal surgery, in addition to the directly affected section of bowel, surrounding healthy tissue is also generously excised. This reduces the risk of the tumor recurring (recurrence). As individual cancer cells may have already spread to the regional lymph nodes, these are also removed.
With palliative colorectal surgery, there is no prospect of a cure. It is used for advanced colorectal cancer (e.g. metastases that cannot be removed). The aim is then to alleviate tumor-related complications.
For example, if the tumor grows into the bowel, it can obstruct the passage of bowel contents. This can lead to a life-threatening intestinal obstruction. An attempt is then made to reduce the size of the tumor so that the narrow passage is unobstructed again.
Palliative colorectal surgery for bowel cancer also includes
In the surgical treatment of colorectal cancer, colorectal surgery is based on the lymphatic drainage area of the tumor:
The need for an artificial anus has become rare in the case of colon tumors. However, it cannot be avoided in individual cases.
In the case of rectal cancer in the upper third of the rectum, the affected section of bowel and the lymphatic drainage area are removed. A tumor in the lower two thirds of the rectum is treated slightly differently:
Rectal surgery and colorectal surgery for colorectal cancer can usually be performed endoscopically. The prerequisites for this are the appropriate location and size of the tumor.
Surgical images: From www.chirurgie-im-bild.de with the kind permission of Prof. Dr. Thomas W. Kraus
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