Proctology

The Department of Proctology deals with the diagnosis and therapy of benign and malignant diseases of the colon and anus. Colorectal cancer is the second most common cancer type in Germany. It accounts for approximately 15% of cancer cases in both women and men. In year 2011, the Cancer Registry of Lower Saxony stated that approximately every 47 women and 75 men by 100,000 inhabitants of our county are newly infected with colorectal cancer. Early detection is therefore vital, since almost half of the patients die because the treatment starts too late.

Colorectal cancer can only be cured through surgery. Our department has extensive experience in the treatment of the disease and has achieved good results, as shown by our ongoing documentation on quality assurance. We conduct the treatment strictly in accordance with the urrent interdisciplinary guidelines (S3 guidelines) as a partner of the Emsland Colon Cancer Center Lingen. Our department is certified as a coloproctological competence center by the German Society for General and Visceral Surgery.

Our treatment focus

  • Tumors in the small intestine, colon, and rectum
  • Disorders of the anus such as hemorrhoids, perianal thrombosis, mucosal folds, fissures and encapsulated suppurations (abscess), prolapse diseases, fecal incontinence
  • Diverticulitis
  • Other inflammations
  • Emergency interventions with the removal of the intestines, e.g. in case of the intestinal obstruction (ileus)

Detailed information can be found here

Many patients still fear that an artificial anus is necessary after the operation. However, a permanent ileostomy is fortunately unavoidable only in very few cases; Namely, when the tumor has grown directly into the sphincter.

After the removal of the affected intestinal parts and the lymph nodes, the intestines are again sewn together (anastomosed), which is possible even close to the intestinal outlet with the help of special staplers. At certain early stages, it is also possible to remove the intestine within the sphincter (so-called intersphagnterous resection) or to cut out the tumor from the intestinal wall through the anus.

However, with the intestinal seams placed very closely to the sphincter, a stoma may be necessary in order to let the wound heal for a few weeks – just like after a bone fracture one must first walk with crutches until the bone can be loaded again.

For certain tumors in the rectum the result of the treatment can be improved by irradiation combined with chemotherapy before the operation, this procedure is standard today. Standard is also the chemotherapy after the surgery in case of lymph node involvement. In such cases, we work closely with our Oncology and a Radiation Therapy Departments. All these cases are discussed at the tumor conferences.

Immediately after the operation, the patients are usually allowed to drink and after a few days to eat again. The long fasting is no longer necessary (fast track) thanks to gentle surgery and anesthesia.

The removal of the intestines may also be necessary in benign diseases such as diverticulitis, but also for other inflammations. Emergency interventions with intestinal obstruction, e.g. (Ileus) are not quite rare.

Often we perform the described operations using laparoscopy (using abdominal endoscopy) in cases of both benign and malignant diseases, which further reduces recovery period after the operation. We are also particularly experienced in such „keyhole“ operations.

Disorders of the intestinal tract are usually unpleasant, often painful and, as you can see, very frequent. Because of shame, but also for fear of more pain, many patients with proctological diseases receive treatment only after a long period of suffering. Fortunately, such diseases are usually not dangerous, but a malignant tumor must be excluded in all cases.

A special focus of our department is the operative treatment of the anal diseases called surgical proctology.

Usually all complaints about the intestinal exit are reverted to haemorrhoids, especially all painful ones. Hemorrhoids, however, are usually painless, in that case we are talking about the sealing bolster of the bowel outlet going outside. Therefore, it becomes noticeable as nodes, the displacement of the mucous membrane leads to the known complaints such as itching and burning. In advanced hemorrhoids the only option is surgery. In most cases, we perform the operation inside the intestine, where the tissue is mostly insensible to pain. After the removal of the excess tissue, the prolapsed mucous membrane is fixed with clamps (so-called stapler haemorrhoidectomy). Advantages of this procedure are the significantly lower pain and the avoidance of any visible and perceptable wound. For less advanced haemorrhoids, we perform a double-controlled haemorrhoidal artery ligature, in which the blood vessels leading to the haemorrhoids are examined using an ultrasound probe and selectively suppressed.

Painful, suddenly occurring nodes can be blood clots (so-called perian thrombosis). These nodes can then be removed the same way as excess skin folds (anal folds) mostly outpatient and under local anesthesia.

Mucosal fissures and encapsulated suppurations (abscess) are particularly painful. An abscess is always an emergency. In most cases originates the inflammation in fistula, which must always be searched for. Often, such a fistula must first be fixed with a rubber band, the final remediation is safe only after the acute inflammation has decayed, since the sphincter shall not be injured in any case.

In elderly people, especially women, prolapse is very common. In case of internal prolapse the obstruction of the defecation occurs, the external prolapse often bothers the patient with the prolapsed bowel and leads inevitably to incontinence. For both prolapse forms, effective and gentle operations done through the anus are available, which can also be performed in senior patients. Sometimes the intestine can also be fixed from the inside via laparoscopy.

In the case of fecal incontinence, the reconstruction of the sphincter muscle, as well as the stimulation of the pelvic floor musculature, is available through a sort of pacemaker (sacral nerve stimulation), depending on the cause and severity.