The surgery of colon removal
Before a removal of the colon can take place, the intestine must first be flushed, and the patient must also be fasting. It is also very important to inform the patient about the operation and its complications. 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 with the patient in the supine position. At the beginning of the operation, the skin from the nipples to the pubic symphysis is disinfected and a sterile cover is applied.
The skin incision is made in the middle abdomen with incision of the navel. The muscles are now spread in depth, trying to ensure hemostasis. Abdominal cloths are then inserted around the edge of the wound, and an abdominal frame is also inserted.
In addition, a temporary bladder catheter must be placed over the pubic bone to drain urine. After all these steps, the surgeon exposes the colon, tying the colon with a tape above and below the incision. In addition, the affected vessels in the abdominal cavity are cut through.
Additional clamps are placed over the ligaments. The intestine is then cut through between the clamps by means of a so-called masticator. The cauteriser is an electrical loop with which tissue and vessels are cut through.
It is also often used for hemostasis. Now the affected colon section can be removed without any problems. The two sections of the colon are then joined together with a suture.
Here, the small intestine and the rectum are connected for a complete removal of the large intestine. Or, depending on the procedure, a small intestinal pocket is formed, which is then connected to the rectum. Alternatively, the rectum can be closed and an artificial bowel outlet made.
All connections of the vessels as well as the intestinal sections should be checked for tightness. In order to improve the drainage of wound secretions, a so-called drainage is usually applied.A drainage is a plastic tube which sucks up the wound fluid to the outside. At the end of the operation, the wound is closed by sutures of the different skin and muscle layers.
Finally, the surgical wound is dressed in a sterile dressing. The complications of the operation include
- Post-bleeding
- Insufficient tightness of the vessel and/or intestinal section connections
- Peritonitis
- Intestinal obstructions
- Damage to nerves, vessels, organs and surrounding structures,
- Wound healing disorders
The duration of the surgery for removal of the colon depends very much on the type of procedure and the underlying disease. For example, if only a small section of the colon is removed in the middle of the colon and the ends are sutured directly, the procedure takes about two hours.
In more complicated operations, for example, where several sections are affected or where an artificial rectum has to be formed from other sections, the operation can take up to several hours. After surgical removal of the colon, the natural connection between the small intestine and the anus is now missing. The food pulp can therefore not be passed on to be excreted.
There are several ways to remove and excrete the food slurry that is transported by the small intestine. On the one hand, an artificial bowel outlet can be created. For this purpose, the remaining part of the small intestine is led to the abdominal skin and sutured there.
Such an outlet is called anus praeter or stoma. A distinction is made between an ileostomy and a jejunostomy. The decisive factor in this differentiation is the small intestine section remaining after the removal of the colon.
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 a jejunostomy, in addition to the large intestine, the last part of the small intestine was also removed, so the remaining part of the small intestine is the jejunum. The remaining part of the small intestine is therefore the jejunum. On the other hand, when removing the large intestine, it is possible to create a direct connection between the small intestine and the anus, thus avoiding the creation of an artificial anus.
Such a procedure is called ileo-pouch-anal anastomosis (IPAA) or ileo-pouch. For the time after the operation, the patient should initially remain in bed. In addition, vital parameters are checked over several hours.
Furthermore, lifting heavy objects should be avoided for the time being. Nutrition must also be taken into account, especially at the beginning. A light diet should lead to avoidance of pain and unpleasant flatulence.
