Various conditions can require colon surgery. Depending on the disease, a larger or smaller piece of the colon must be removed (resected). Sometimes it is necessary to create an artificial bowel outlet (colon stoma).

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Anatomy of the large intestine: diameter approx. 7 cm, total length approx 1.5 meters

• Colon - Intestinum Crassum         

• Rectum - rectum 15 cm

• Anus - anus

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An artificial exit of the large intestine is necessary if, after the operation, there is no longer enough large intestine to connect it to the rectum. Or even if the anus sphincter had to be removed during the operation.

A stoma is a blindly blocked intestine.

A permanent stoma is a "permanent" stoma.

A temporary stoma is a "temporary" / "transient" stoma.

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Causes:

• Inflammation of the intestine due to e.g. chronic inflammatory bowel disease (more often: ulcerative colitis - precancerosis)

• Colon cancer

• Polyps

• Diverticulitis (perforation, penetration)

• Peritonitis

• Adenoma

• accidental abdominal injuries

Why is nutritional therapy important?

Nutritional therapy supports you in relieving diarrhea symptoms (constipating foods & foods with a laxative effect) , strengthening your immune system and counteracting symptoms such as gas , bloating, pressure in the abdomen and pain.

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In addition, you will learn which foods you should better avoid with an ostomy and how you can counteract odor-intensive stools and gas. After the operation, there is an increase in diet, which is gradually expanded to an adapted permanent diet.

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The aim is to supply all of the fatty acids, micronutrients (vitamins and minerals) that are important to you, energy and protein in the measure that your body is optimally supplied with. For this purpose, foods that promote inflammation are specifically avoided and plenty of anti-inflammatory foods are consumed. Weight reduction is recommended if you are overweight / obese. An anti-inflammatory diet can improve the state of health.

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Operation methods:

• Conventional (less common today)

• Minimally invasive (endoscopic / laparoscopic operation method / "keyhole" operation)

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1. Stoma / AP system / anus praeter naturalis (= artificial anus)

2. Ileocaecal resection: Resectate: terminal ileum, cecum, partly ascending colon

3. Right hemicolectomy: Resectate: ascending colon with cecum

4. Transverse resection: Resectate: transverse colon

5. Left hemicolectomy: Resection: descending colon

6. Sigmoid resection Resectate: Sigmoid colon (Sigma)

7. Colectomy, resected tissue: entire large intestine

8. Anterior rectal resection, resected material: upper rectum, sigma, continence organ remains, possibly temporary AP application

9. Rectal extinction (rectal amputation), resected material: entire rectum, colostomy is created

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Hartmann operation episode: stoma

• Rare

• with pathological changes in the left hemicolon and rectum (ileus, perforation, stenosis, abscess or peritonitis)

• Resection of the affected section of the intestine

• Blind closure of the remainder of the rectum

• Creation of a terminal anus praeter naturalis

• Relocation possible after approx. 3 months

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Proctocolectomy with ileum pouch

• Total removal of the entire colon

• terminal ileum serves as an artificial reservoir = pouch

• Stool frequency through the pouch reservoir approx. 6x / day

• temporary double-barreled ileostomy

• ileostomy can be relocated back after 2-3 months

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Most common form of stoma: colostomy

• Drainage of the large intestine (mostly descending colon or sigmoid colon)

• Physiological function of the colon is largely retained: water reabsorption, postoperative diarrhea

• Adaptation: After the adaptation phase, largely normal stool behavior as before the operation with a tendency to thinner or firmer stool

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Most complicated stoma: enterostomy / ileostomy / ileostomy

• entire colon and rectum were removed

• Physiological function of the colon is omitted: high fluid / mineral loss, energy / nutrient loss

• 4 -> 8 thin stools / day (voluminous, aggressive, strong smell)

• Stool behavior can no longer be trained

• Inflammation from thin stool on the mucous membrane

• Adaptation: not comparable with Colostoma

• conditional adaptation possible (3-4l stool / day)

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All other ostomy systems are to be viewed differently

• The closer it is to the end of the colon, the fewer complications

• low amount of excretion

• high stool consistency

• Disadvantage of the colon: right / left flexure (fixed)

• In principle, diversion is possible via any section of the colon

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Classification of your weight - definition and classification of weight in relation to height.

Special percentile curves apply to children and adolescents; the BMI cannot simply be used here.

BMI and interpretation: BMI: body mass index. Formula: Body weight in kg : (body height in m) 2

Underweight: <18.5

Normal weight: 18.5 - 24.9

Overweight = pre-obesity: 25-29.9

Obesity grade I: 30 - 34.9

Obesity grade II: 35-39.9

Obesity grade III:> 40 = per magna

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Nutritional therapy

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• Anti-inflammatory nutrition as a basis, individually tailored to you

• Holistic therapy - do you have any comorbidities that need to be taken into account during the consultation?

• Overall fat selection, how should it be designed

• How many animal foods (e.g. meat products, milk and dairy products, cheese, fish products, eggs) are recommended?

• What do I have to look out for when choosing animal foods?

• How can I counteract inflammatory processes through diet?

• Body weight: Weight reduction is recommended if you are overweight / obese.

• Avoid micronutrient deficiencies and mineral deficiencies & possibly counteract them with nutrient preparations

• Prevent protein deficiency

• Which nutrients do I need in which ratio?

• Get enough fiber (> 30 g / day) through natural foods, possibly fiber substitution

• Sufficient fluid: total fluid per day: 30 - 35 ml per kg body weight and day. Attention, this is not just a drinking liquid. The liquid from food (approx. 500 - 800 ml) must still be subtracted from this, so that an amount of approx. 1.3 - 2 l of drinking liquid is created.

• add valuable anti-carcinogenic (anti-cancer) secondary plant substances

• A selection of foods tailored to your needs with cooking and technical information (for breakfast, snacks, lunch, dinner)

• Do you like to eat your warm meal in the evening? I am happy to cater to your individual situation and we will create a plan on how you can implement your wholesome diet into your everyday life.

• which oils are good for me? What should I watch out for in relation to the anti-inflammatory diet?

• How much fat spread (butter / margarine / vegetable fat) can I use and which products are recommended?

• Get enough Omgea-3 fatty acids and essential fatty acids

• How can I boost and support my metabolism with natural foods?

• Coordinate sensible meal frequency for your individual case - meal allocation

• Define the desired weight stabilization / normalization & the estimated period for this

• what should be considered with beverages and alcoholic beverages?

• How does exercise affect your body and thus also your diet?

• Avoid blood sugar fluctuations

• Sweetening foods - sweeteners, glucose, fructose, sugar and sugar substitutes, what can I use and in what quantities? How high is the respective sweetness of the different products?

• what should be considered when baking and cooking?

• what are cheap snacks / main meals

• Eating out - what should you watch out for?

• Vacation, boat trip or hospital stay, what should be considered?

• Flatulence, bloating, diarrhea, constipation, vomiting, heartburn, loss of appetite, pain related to eating, what can I do about it?

• Daily plans as an example for practical implementation in everyday life

• Enjoyment training

• Optimizing your eating situation

• long-term maintenance of a jointly defined weight

• Strengthen the stomach and intestines with natural foods

• Additional therapy options

• Dietetic products in support of nutritional therapy

• Food supplements - under certain circumstances, a supplement can be useful

• and other topics

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Any questions? I look forward to your call or email. To contact form

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Assistance:

• KISS self-help groups

• Self-help network

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