Different diseases can make colonic surgery necessary. The most common causes are colonic inflammation (ulcerative colitis, Morbus Crohn), diverticulitis, colorectal polyps or colon cancer. Depending on the disease, a large or small part of the colon must be removed. Sometimes a colonic stoma needs to be attached.
Colon cancer and colitis the most common diseases which make colonic surgery necessary. Depending on where and how much of the colon needs to be removed, the surgeon talks of total coloproctectomy, hemicolectomy, partial resection or sigmoidectomy.
Sometimes inflamed diverticula (diverticulitis) must be treated surgically if antibiotic treatment is not sufficient. In such cases, the affected part of the colon is also removed.
On the other hand, colorectal polyps can often be removed during a colonoscopy. The removal of polyps is known as a polypectomy.
Surgery on the lowest part of the colon, the rectum, is described in the chapter entitled rectal surgery.
What preparations are carried out before the procedure?
Different examinations are carried out to identify colonic diseases. They usually include a colonoscopy and an ultrasound examination. Sometimes, an x-ray with contrast agent is required.
All the usual pre-operative assessments are required, such as a blood test, blood pressure measurement and an ECG. All blood-thinning medication must be discontinued before the procedure takes place. Colonic surgery is conducted under general anaesthetic. Patients must have an empty stomach for the procedure.
How is the operation performed?
Nowadays, colonic surgery is usually carried out with the minimally invasive laparoscopic technique (keyhole surgery). During this gentle procedure, a camera with a light and different surgical instruments are inserted into the abdomen via several small skin incisions. The abdomen is then inflated continuously with air to gain a better view and more space for the procedure. The part of the colon affected by the disease is then exposed, isolated and finally removed. After the removal, the remaining ends of the colon are connected with each other (anastomosis) with a suture. In certain cases, the anastomosis must be temporarily rested with a stoma until it is fully functional. Sometimes no further anastomosis is possible and the colostomy is permanently attached.
A colostomy is required if there is not enough of the colon remaining after the surgery to bind it to the rectum. Or also if the anal sphincter had to be removed during the surgery.
To attach the stoma, the end of the colon is pulled outside through the abdominal wall and the abdominal skin, usually in the left middle abdomen. Then it is sutured with the skin in such a way that the mouth of the stoma does not protrude from the skin. A bag is attached to the mouth, and has to be changed regularly.
What is the success rate of this procedure?
The prognosis after colonic surgery depends on the underlying disease. The recovery rate for patients with localised tumours which have not yet metastasised is good once the tumour has been removed. Ulcerative colitis can be healed by removing the entire colon and rectum (total coloproctectomy). Polyps or diverticula are usually remedied with surgery.
What are the possible complications and risks of this procedure?
As with all surgery, the operation may occasionally lead to post-operative bleeding, nerve damage or infections. In rare cases, the intestinal suture can leak, which sometimes makes further surgery necessary.
Sometimes growths appear after the surgery which can lead to complaints many years later.
What happens after the operation?
After the surgery, the patient wakes up in the recovery room. The drainage tubes are usually removed in two or three days. You can usually stand up on the same day and eat again the following day. Patients who undergo this operation must usually stay in hospital for four to five days. They should avoid major physical exertion for six to eight weeks after the operation.
After colonic surgery, your bowel motions can change. Flatulence, increased bowel movements and liquid stool are common. As long as the stool is not too watery, the loss of fluid should be balanced with sufficient fluid intake.
A stoma must be regularly cared for. If you take proper and regular care of yourself, you can have a relatively normal life. After an initial adjustment period, you can eat and drink normally again. You can take up your normal daily activities, sporting and leisure activities once more. Approx. 300 ml pulpy stool is excreted over the stoma per day. However, excretion can vary and sometimes not occur at all, just like in the case of normal stool regulation. However, if the excretion stops for several days, you should talk to your doctor.
Bowel Cancer Centre Klinik St. AnnaAvailable by telephone from Monday to Friday 09.00 - 11.30 h and 13.30 - 16.00 h
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Swiss SurgeryProf. Dr. med. Jan Schmidt
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