Rectum

In recent years, there has been a fundamental change in surgical techniques for operations on the rectum. At our clinic, malignant tumours of the rectum are always operated on using the "TME technique" (total mesorectal excision). This surgical technique largely minimises the risk of local tumour recurrence and also spares the nerves responsible for bladder and sexual function, so that disorders after the operation occur only in exceptional cases. Before the operation, we perform a special ultrasound examination (endosonography) and an MRI scan of the pelvis in order to see the extent of the tumour. Depending on the extent, pre-treatment (combined radiotherapy and chemotherapy) may be necessary, which on the one hand further reduces the local risk of tumour recurrence and on the other hand may shrink the tumour. Such therapy is decided in an interdisciplinary conference within the framework of the Darmzentrum Freiburg e. V. For very low-lying tumours, where we operate very close to the sphincter muscle, we perform so-called "pouch procedures". In these, a reservoir is created that improves continence after the operation. A permanent stoma is only necessary for tumours that, from a serious oncological point of view, can no longer be operated on while preserving the sphincter muscle. Depending on the surgical findings and the reconstruction procedure, even when the sphincter muscle can be preserved we may create a temporary artificial outlet (stoma), which can be reversed within a few weeks. For very small tumours or unclear findings, we remove the tumour through the anus (transanal full-thickness resection; TEM).