This procedure is being performed mostly in „Crohn`s disease”, a chronic inflammation which can involve small and large bowel alike. This operation is mostly done laparoscopically and seldom if there is presence of extensive adhesions in open technique. The last last part of the small bowel and the first part of the colon including the valve of Bauhin is removed. Siûbsequently both bowel ends are connected.
Mostly there is chronic-recurrent inflammation of this part of the colon as an indication fort his procedure because here in the site where most diverticula develop. By means of minimal access surgery (rarely also open), the inflamed sigmoid colon is mobilized, the supplying vessels are divided and the diseased bowel portion is removed. Finally, an anastomosis is formed between the descending part of the colon and the upper rectum.
In ulcerative colitis and/or in familial polyposis coli (FAP) the entire colon from the beginningto the end must be removed. This is necessary because the underlying disease would manifest itself in the remaining portion of the colon or a malignant tumor would develop. After mobilisation of the entire colon the rectum all the way down to the anus will be dissected from ist tissue connection, the supplying vessels cut and finally the complete colon and rectum is removed. Subsequently, a reservoir is formed from small bowel (J-Pouch) and and connected to the anal sphincter muscle. This reconstruction must be protected for a few months by a deviation of the bowel passage which can be closed after verification of complete healing. Potential complications are bleeding, infection, failure of healing of the anastomosis between small bowel pouch and sphincter muscle, bladder or sexual problems (in men). Hospital duration is 10 to 12 days.