Rectal surgery usually involves removing part of the rectum. As the rectum is located near the sphincter, special care needs to be taken to preserve the sphincter during these procedures. After the surgery, a temporary colostomy is attached to rest the sphincter muscle.
The rectum is the lowest part of the colon and can also be affected by tumours and inflammation. Cancers (rectal cancer) and inflammations of the rectum (ulcerative colitis, Morbus Crohn) are therefore the most common reasons for rectal surgery.
Procedures for colon prolapse or sphincter malfunction are described in the chapter entitled surgery for faecal incontinence.
What preparations are carried out before the procedure?
Different examinations are carried out to identify rectal diseases. They usually also include a palpation examination and a duodenoscopy; in patients with cancer undergo a CT scan on top of this.
If there are larger tumours which have already grown into the surrounding tissue, radiotherapy or chemotherapy is sometimes carried out beforehand. In this way, the tumour can first be reduced in size.
As with all surgery, all the usual pre-operative assessments are required before rectal surgery, such as a blood test, blood pressure measurement and an ECG. All blood-thinning medication must be discontinued prior to surgery and the patient undergoes a colonic. Rectal surgery is carried out under general anaesthetic. Patients must have an empty stomach for the procedure.
How is the operation performed?
Nowadays, rectal surgery is usually carried out with the minimally invasive laparoscopic technique (keyhole surgery). During this tissue-friendly procedure, a camera with a light and different surgical instruments are inserted into the abdomen via several small skin incisions. The abdominal area is then inflated with CO2 to gain a better view and more space for the procedure. The diseased part of the rectum is carefully exposed, resected and then removed. Afterwards, the remaining colon ends are connected with the stoma. A temporary stoma must often be attached until the newly created colon connection works correctly. If the sphincter muscle had to be removed, a permanent stoma is unavoidable. Explanatory notes on the stoma can be found in the chapters entitled colonic surgery and small intestine surgery.
What is the success rate of this procedure?
The success rates after surgery on the rectum depend on the underlying disease. If the tumours have not metastasised, the prospects of recovery with rectal surgery are high. The same applies for ulcerative colitis if the entire colon, including the rectum, is removed. Surgery in patients with Morbus Crohn is used to treat symptoms and complications such as fistula formation. However, the underlying disease cannot be healed with this procedure.
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. You can usually stand up on the same day and start eating 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.
A temporarily attached stoma can usually be closed with a further small operation four to eight weeks later.