Surgery Online

The removal of the colon

introduction

When removing the large intestine, the most important goal is that the patient can continue to be stool continent. There are two ways of ensuring intestinal passage.
The first method is to connect the small intestine to the rectum. By creating a pocket in the small intestine, an attempt is made to create a reservoir similar to that in the large intestine and to maintain the usual stool continence.
The other option is to create an artificial anus. The small intestine is connected to the outside of the abdominal wall. However, the stool is emptied involuntarily via the abdominal wall into a bag.

Reasons for a colon removal

The complete removal of the colon is generally attempted to avoid, as otherwise the quality of life may be impaired for the patient, but if the risk of colon cancer is very high, removal of the colon is advisable.

There are various diseases that play a role:

Familial Adenomatous Polyposis (FAP) is a disease in which one must reckon with colon cancer in 100% of cases. This is an autosomal dominant inheritance of the disease to the descendants. The disease is based on a germline mutation in the APC gene. The FAP is characterized by an extremely high incidence of colon polyps.
Ulcerative colitis is a chronic inflammation of the intestinal lining in the large intestine. After a long period of onset, ulcerative colitis has a significantly increased risk of colon cancer. If the entire colon is affected, there is a significantly high risk after 8-10 years, and if the left-sided infection occurs after 12-15 years.
Crohn's disease is also an inflammatory bowel disease which, however, is not mainly limited to the large intestine, as is the case with ulcerative colitis, but can affect the entire intestinal transit system.
A rectal rolapse describes a prolapse of the rectal lining from the anus. It is based on weak pelvic floor muscles. This clinical picture is more common in women, especially after multiple births.
Colon cancer is a malignant neoplasm of the large intestine. Over 90% of these neoplasms are adenocarcinomas, i.e. neoplasms that originate from glandular tissue. Colon cancer in the rectum and sigmoid colon has a 70% probability. With decreasing frequency, they form in the ascending colon and in the rest of the intestine.

Read more on the subject at:

Colon cancer therapy
Therapy of ulcerative colitis
Therapy of Crohn's disease

The operation of the colon removal

Before the operation

Before the colon can be removed, the intestine must first be flushed, and the patient must be sober. It is also very important to educate the patient about the operation and its complications.

Course of the operation

The operation is performed under general anesthesia. In addition, a pain catheter is inserted at the level of the thoracic vertebrae. The operation is performed in the supine position of the patient.

Read more on the topic: Risks of general anesthesia

At the beginning of the operation, the skin from the nipples to the pubic symphysis is disinfected and a sterile cover is attached. The skin incision is made in the mid-abdomen with a circumcision of the navel.
In the depths, the muscles are now spread, trying to stop the bleeding. This is followed by abdominal towels, which are placed around the edge of the wound, and an abdominal frame is also inserted.

In addition, a urinary catheter must be temporarily placed over the pubic bone to drain urine.

After all these steps, the surgeon exposes the large intestine, while the intestine is tied with a tape above and below the incision. In addition, the affected vessels in the abdomen are cut. Clamps are also placed over the straps. Using a so-called cautery, the intestine is now severed between the clamps.
The cautery is an electric loop with which tissue and vessels are cut. It is also often used for hemostasis.

The affected part of the colon can now be removed without any problems. This is followed by connecting the two intestinal sections created by a seam. Here, each small intestine and rectum are connected with a complete removal of the large intestine. Or, depending on the measure, a small intestinal pocket is formed, which is then connected to the rectum. Alternatively, you can close the rectum and make an artificial anus. Then all connections of both the vessels and the intestinal sections should be checked for leaks.

So-called drainage is usually created so that wound secretion can be removed better. A drainage is a plastic tube that sucks the wound fluid outwards. At the end of the operation, the wound is closed by suturing the various layers of skin and muscles. Finally, the surgical wound is bandaged in a sterile manner.

Surgery complications

The complications of the surgery include:

Secondary bleeding
Insufficient tightness of the vascular and / or intestinal segment connections
Peritonitis
Intestinal obstruction
Damage to nerves, vessels, organs and surrounding structures,
Wound healing disorders

How long is the duration of the operation?

The duration of the operation to remove the large intestine depends very much on the type of procedure and the underlying disease. If only a small section of the intestine is removed, for example in the middle of the large intestine, and the ends are sutured directly, the procedure takes about two hours.
For more complicated operations, in which, for example, several sections are affected or where an artificial rectum has to be formed from other sections, the operation can take up to a few hours.

After the operation

After the large intestine has been surgically removed, the natural connection between the small intestine and anus is now missing.
The food pulp can therefore not be passed on to be excreted. There are different ways of removing and excreting the food pulp carried by the small intestine.

On the one hand, an artificial anus can be created.
For this purpose, the remaining section of the small intestine is led to the skin of the abdomen and sewn there. Such an exit is called an anus praeter or stoma. In particular, a distinction is made between an ileostomy and a jejunostomy.
The decisive factor in making this distinction is the section of the small intestine remaining after the colon removal. The small intestine can be divided into 3 sections. The duodenum is closest to the stomach, followed by the jejunum and finally the ileum.
In an ileostomy, the remaining section of the small intestine is the ileum, i.e. the last section of the small intestine.
In the case of a jejunostomy, the last part of the small intestine was removed in addition to the large intestine, the remaining part of the small intestine is therefore the jejunum. On the other hand, there is the possibility of creating a direct connection between the small intestine and anus when removing from the large intestine, thus avoiding the creation of an artificial intestinal outlet. Such a procedure is known as ileo-pouch-anal anastomosis (IPAA) or also ileo-anal pouch.

For the time after the operation, the patient should first stay in bed. In addition, vital parameters are checked over several hours. In addition, lifting heavy objects should be avoided for the time being. Particular attention must also be paid to nutrition at the beginning. Bare food should lead to the avoidance of pain and unpleasant gas.

Read more on this topic at: Anus praeter

What pain can be expected after the operation?

After the operation, pain is fought with pain relievers. However, people respond differently to pain medication.
The pain and impairments after the operation are of course dependent on the size of the procedure and the individual constitution. The bowel may be irritated after an operation, causing abdominal pain and discomfort. In the first few weeks after the operation, it is important to listen to the dietary instructions from the doctors to help the intestine recover.

Read more on this topic at: Pain after surgery

How much can be removed from the colon?

Only small and large parts of the colon can be removed. Since the body is able to live completely without a large intestine, it is also possible to remove the entire large intestine.
A complete removal of the large intestine is of course a major procedure and usually takes place in two procedures. However, it is only indicated in a few cases, in ulcerative colitis (a chronic inflammatory bowel disease) or in familial adenomatous polyposis (a hereditary disease with many polyps in the intestine). However, once large sections of the colon have been removed, the stool will not thicken as much and a lot of water can be lost through the stool. If necessary, the eating behavior must be adjusted after the procedure.

The artificial anus

The artificial exit of the intestine is called anus praeter or stoma in Latin, which means opening in Greek.
In diseases such as colon cancer or chronic inflammatory bowel disease, especially ulcerative colitis, the rectum can also be affected. If this has to be removed, the associated sphincter is also removed.
Without this, a controlled bowel movement does not work. If it is not possible to build a new rectum from remaining intestinal sections, an artificial anus is created. Part of the intestine is connected to the abdominal wall and the open tube is covered from the outside with a bag. This is odor-tight and catches the intestinal contents. It is also possible to close the opening with a flap.
A colonic irrigation is carried out once a day to empty the bowel. After a while, most people get used to the situation and learn to live with it without any problems. An artificial anus does not have to be permanent in all cases. In the event of an emergency such as a ruptured bowel or if only part of the rectum is diseased and a suture must therefore be made on the sphincter, an artificial exit is often created for about six weeks. This allows the seam to heal in peace and is not irritated by the stool. With a second small operation, the normal exit is then reconnected with the rest of the intestine.

Read more on this topic at: Artificial anus

Consequences of a colon removal

After a large intestine has been removed, those affected often complain of a liquefaction of the stool up to diarrhea, since the function of the large intestine to thicken the stool no longer exists. In addition, the intestine is shortened, so that there is a shorter intestinal passage. Accordingly, those affected have to stop bowel movements more often, which means that some patients can no longer sleep through the night.

After a colon removal, you should make a certain diet change. Another problem can be inflammation around the anus.

However, the tasks of the large intestine can partly be compensated for by the small intestine. However, this can take some time until the small intestine has adapted to changed conditions. From the age of 40, however, it is hardly possible to change the small intestine.

Read more about this: Inflammation of the anus

Measures to avoid discomfort

It is particularly important to pay attention to hygiene after a bowel movement. Gentle cleaning agents after a bowel movement are sufficient. To protect the skin around the anus, it is enough to apply a lotion. You should also take care to take regular Sitz baths to help the affected areas of skin to regenerate.

In addition, regular blood counts should take place to prevent deficiency symptoms, because the body increasingly loses minerals and salts.

It is important for the patient to avoid carbonated drinks in order to avoid discomfort. For those without a large intestine, a good diet includes an adequate intake of fluids. Because the elimination of the large intestine means that the stool is less thickened and those affected lose much more fluid.
So the patients should approx. Drink 3 liters a day. When it comes to nutrition, make sure that the digestion of plants and starch that is difficult to split is now considerably more difficult. This is especially the case with raw vegetables, raw potatoes, grains and seeds.

At the beginning of the diet, the stools are still very fluid or soft. The normal stool form, however, is only after half a year to a year given. Then the stool is firmer and the stool frequency is at 3-5 times a day. In order to achieve a thick stool, it is helpful to consume bulky, constipating foods. These include rice, grated apples, boiled potatoes, rice gruel, gruel, oatmeal, but also bananas. Swelling foods are psyllium, wheat bran, oat bran, and pectins.

Basically, a light whole diet is recommended while reaching a normal weight. It is important to avoid foods that often lead to flatulence and intolerance, such as cabbage, legumes, mushrooms, cucumbers, acidic foods, carbonated drinks and also fresh fruit, salads, raw vegetables, peas, beans, tomatoes.

In addition, there are special tables that list common foods with various properties such as flatulence or gas-inhibiting effects, constipating or laxative effects, and odor-inhibiting or odor-promoting properties.
In this way, the person concerned can orientate himself well which foods are currently beneficial.

In order to avoid a vitamin deficiency, especially vitamin B12, the vitamin should be injected regularly. Because vitamin B12 is normally absorbed in the large intestine.

Read more on this topic at:

Colon Disease Diet
Vitamin B12 supplements

forecast

The prognosis after successful colon removal is highly dependent on the original disease.
Ulcerative colitis is healed after the entire colon and rectum have been removed. To date there is unfortunately no cure for Crohn's disease, but the symptoms can be minimized with well-adapted therapies. Both diseases allow a largely normal standard of living and do not limit life expectancy.

Long-term illness increases the likelihood of colon cancer, which is why an annual colonoscopy is advisable for clarification.

Read more on this topic at:

Can you cure ulcerative colitis?
Is Crohn's disease curable?

Life expectancy after colon removal

Life expectancy is generally not reduced by the removal of the colon, but it is strongly related to the underlying disease, i.e. the cause of the colon removal.
Life expectancy is hardly limited by chronic inflammatory bowel diseases, and if the affected sections of the intestine in ulcerative colitis are removed, complete healing can even occur. In the case of colon cancer, the prognosis and thus life expectancy is very much dependent on the growth of the tumor.
Here, too, healing can be achieved in the early stages by removing the colon.

You may also be interested in this topic: Colon Cancer Prognosis

Colon removal in various diseases

Colon removal due to ulcerative colitis

Ulcerative colitis is a relapsing, persistent inflammatory disease that affects the lining of the large intestine and occurs continuously.
This means that only a contiguous part of the intestine is affected. At first only the rectum is affected.
In half of the cases, the disease remains confined to this part of the intestine. In addition, the diseased area in ulcerative colitis only spreads to other areas of the colon. Generally, ulcerative colitis is first treated with medication. However, if the medication does not respond adequately or if there are serious complications of the disease, surgical removal of the affected colon sections is necessary.
Such complications can include, for example, sudden widening of the intestines or heavy bleeding. Since the part of the intestine affected by ulcerative colitis is connected, the affected sections can be easily removed by an operation and the disease is usually completely cured. During the operation, a kind of rectum is formed from the remaining large intestine sections or from the small intestine, which is now responsible for normal bowel movements as an anus in the same place as before. However, this increases stool frequency in some patients and can cause irritation in the anal area.

Read more on this topic at: Therapy of ulcerative colitis

Colon removal for Crohn's disease

Crohn's disease is a relapsing, persistent inflammatory disease affecting the entire intestinal wall.
In two thirds of the cases the posterior section of the small intestine is affected. However, it can affect all sections of the digestive tract and spreads to different places at the same time. It is therefore very difficult to remove the diseased sections of the intestine through surgery.Therapy is therefore mainly carried out with anti-inflammatory drugs. However, surgery becomes necessary in 80% of Crohn's disease patients as the disease progresses. Only a few very active areas of the intestine are removed in order to alleviate a serious attack of the disease.
Surgery may also be necessary in the event of complications such as fistulas, abscesses, constrictions or obstructions of the intestine. If this is planned long enough, it can be carried out by means of a colonoscopy and is therefore an easier procedure for the patient.
However, the removal of sections of the intestine is always associated with future risks such as obstructions of the intestine. In addition, surgery may not completely cure Crohn's disease because the disease can recur in other parts of the digestive tract.

Read more on this topic at: Therapy for Crohn's disease

Function of the colon

The gastrointestinal tract is the main part of the human digestive system, which extends from the esophagus to the anus. It is composed of several organs. The pulp first passes through the esophagus and stomach, is then passed through the small intestine and thus reaches the large intestine.
The large intestine itself can be divided into 3 parts: the cecum, the colon as the longest part of the large intestine and the rectum, also called the rectum.
Basically, the first question that arises is whether you can go on living without a colon at all. This is entirely possible because the colon does not have any vital functions.

The functions are: