Colorectal
surgery

Colorectal Surgery

The large bowel is divided in several sections. On the right side the small bowel opens into the cecum, which has the appendix attached at the blind end. The ascending colon reaches straight up to the liver and then the bowel crosses the abdomen (transverse colon) to the left side just underneath the spleen. The descending colon runs down on the left side and forms an S-shaped loop called the sigmoid and finally ends in the rectum.The large bowel is divided in several sections. On the right side the small bowel opens into the cecum, which has the appendix attached at the blind end. The ascending colon reaches straight up to the liver and then the bowel crosses the abdomen (transverse colon) to the left side just underneath the spleen. The descending colon runs down on the left side and forms an S-shaped loop called the sigmoid and finally ends in the rectum. see figure

 

 

The rectum is the highly specialized end of the large bowel. It is about 15 cm long and ends in the anal sphincter (anus). Reservoir function is only one of many complicated physiological processes dealing mainly with continence and emptying of the bowel. Colorectal surgery means operations on the large bowel and rectum. It includes the treatment of benign and malignant diseases.

 

1. Benign diseases:

  • Diverticular disease
  • Crohn’s disease
  • Ulcerative colitis
  • Rectal prolaps
  • Chronic constipation
  • Benign polyps

 

2. Malignant diseases:

  • Colon cancer (carcinoma)
  • Rectal cancer (carcinoma)

 

Surgery of the large bowel

 

More and more operations of the colon can be performed laparoscopically. This was made possible by the development of new instruments to make the procedure easier and more feasible. The segment of bowel that needs to be removed from the abdominal cavity is retrieved through a small incision. The ends of the bowel are reconnected by suture. A stoma is not necessary. Fast recovery time, little pain and the cosmetic result are very convincing facts.

 

Personally I favor a, what I call “hybrid technique”, combining the advantages of both minimal invasive and open techniques. It includes the small incision and the safety of a hand-sown anastomosis of the bowel. I use laparoscopic resection of the bowel mainly in benign diseases like diverticulitis, Crohn’s disease or for big polyps. In surgery of colorectal cancer one should be careful. The complete and radical removal of all tumor growth has top priority and no concessions to cosmetic aspects can be allowed. That does not mean that cancer excludes the use of minimal invasive technique. The decision has to be made for each individual case.