Colorectal surgeries treat conditions that affect your colon (large intestines) and rectum. According to 2016 research, they’re the largest subspecialty of surgery performed on organs in your abdominal cavity.
Colorectal surgeries are also used to treat many other gastrointestinal conditions, such as:
- inflammatory bowel disease (IBD)
- traumatic injuries
- bowel blockages
In this article, we take a look at the primary surgeries used to treat these conditions.
A colectomy, also called a large bowel resection, is the complete or partial removal of your colon. It’s called a partial colectomy if only part of your bowel is removed, and a total colectomy if your entire colon is removed. The removal of your rectum is known as a proctectomy.
- Intestinal blockages. Surgery for intestinal blockages may be needed if other treatments, such as intravenous fluids and bowel rest, aren’t successful.
- Irreversible intussusception. An intussusception occurs when part of the intestine slides into a nearby part of the intestine. This can block the passage of food or fluid and cut off the blood supply to that area.
- Cecal volvulus. A cecal volvulus is an unusual twisting of the bowel which may need to be corrected with surgery.
- Diverticulitis. Diverticulitis is typically managed with antibiotics and bowel rest. A partial colectomy may be needed for cases that don’t respond to treatment. You might also get this surgery to remove scarring that happens after repeated bouts of inflammation.
- Precancerous polyps. Polyps can typically be removed endoscopically. There’s no need for bowel resection unless the polyps are large and complex.
- Gastrointestinal infections. A Clostridium difficile infection may progress to toxic megacolon, in which case surgery may be needed.
- Ulcerative colitis. Surgery may be used for ulcerative colitis if toxic megacolon develops, or if all other medical therapy is ineffective.
- Bleeding in your bowel. Surgery for bleeding in your bowel is rare and only used as a last resort if other therapies aren’t working.
A colectomy can be performed using two surgical techniques:
- Open colectomy. Your surgeon makes a large incision in your abdomen to remove your colon.
- Laparoscopic colectomy. Your surgeon makes smaller incisions and inserts a long tube with a camera called a laparoscope.
Both techniques have similar survival rates and effectiveness. But a 2020 study found that laparoscopic surgery is associated with better short-term recovery.
A colostomy is a surgical procedure that creates a passage for your colon through a hole in your abdomen, where stool is collected in a pouch. It’s performed when you can’t pass stool through your anus because of illness, injury, or a problem with your digestive tract. It’s often used if part of your colon has been removed and can’t be joined back together.
According to the National Health Service, conditions that may be treated with a colostomy include:
- colorectal cancer
- anal cancer
- vaginal or cervical cancer
- Crohn’s disease
- fecal incontinence, or leakage of feces
Hirschsprung’s disease, a congenital condition where nerves are missing from the large intestines
Colostomies can be permanent or temporary, depending on the condition they’re treating.
Anastomosis is a surgery that removes part of a tube-shaped structure, like your intestines or a blood vessel, and reattaches the ends. Bowel anastomosis specifically refers to removing part or all of your large intestines and reattaching the ends. Types of bowel anastomoses include:
- Intestinal anastomosis. A part of your colon is removed, and the two remaining ends are surgically connected.
- Ileocolic anastomosis. Part of your bowel is removed, and the end of your small intestines is attached to the remaining part of your bowel.
- Ileoanal anastomosis. Your colon is removed, and your small intestines are attached to your anus.
Three techniques are used to connect your small intestines to your anus. According to
- J-pouch. With the J-pouch, two loops of your small intestines are connected to your anus to hold stool.
- S-pouch. The S-pouch is similar to the J-pouch, but has a short spout at the end of the pouch.
- K-pouch. If the J- or S-pouch surgeries aren’t an option, a surgeon may perform the K-pouch. This technique involves diverting the ends of your small intestines into a pouch that sits outside your abdomen.
During this procedure, a long flexible tube with a camera called a colonoscope is inserted through your rectum and into your colon. Irregular growths are then removed using one of two primary methods.
- Polypectomy. In this procedure, a wire loop is passed through the colonoscope and used to cut a polyp away from your colon using electricity.
- Local excision. Tools are used through the colonoscope to remove cancerous growths and a small amount of healthy tissue from the inside of your colon.
These procedures avoid the need for your doctor to cut into your abdomen. If lab tests find the tumor may have spread, you may need a colectomy.
Surgery may be needed if less invasive treatments like topical creams or oral medications don’t work. Hemorrhoids require surgery in about
A gastrointestinal fistula is a hole in your gastrointestinal tract that allows its contents to leak out. Fistulas in your intestines are
- Crohn’s disease
- radiation exposure
- injuries or trauma from foreign objects
A 2017 review found that approximately 70 to 90 percent of fistulas close without surgery if managed properly.
Anal fistulas, or holes that form between your anus and the surrounding skin, are most often treated with a procedure called a fistulotomy. During this procedure, a surgeon cuts the length of the fistula to open it so that it will heal with a flat scar.
Surgical treatment for fistulas in your intestines depends on the underlying cause. It often includes removing the damaged part of your intestines and reconnecting the divided parts.
Rectal prolapse is when part of your rectum protrudes through your anus. Various surgical techniques are used to treat prolapse.
Abdominal rectopexy is one option. According to a
Surgeons may also repair the prolapse by going through your perineum, which is the area between your anus and genitals. According to a 2021 review, the main perineal procedure types are:
- Delorme procedure. The outer lining of the rectum is removed, and the inner muscular layer is folded and stitched into place before the lining is reattached. This procedure is often used for shorter prolapses.
- Altemeier procedure. The entire part of your rectum that’s prolapsed is removed and then reattached. It’s often used for longer prolapses.
- Perineal stapled prolapse resection (PSPR). PSPR is a newer technique. A
2015 studysuggests that it’s faster and easier, but it’s also associated with high rates of reoccurrence. The procedure involves using an anal dilator and sutures to pull the prolapse back into place.
Colorectal surgeries treat problems with your colon or rectum. They’re commonly used to treat cancer, IBD, and many other conditions.
No matter what condition you have, your doctor can help you figure out if you may benefit from surgery and what type of surgery or procedure is best. Your doctor can also advise you about potential surgical risks, as well as recovery.