Small intestine receives food from the stomach and transfers it to the large intestine or colon, from which and its last portion the remnants of the food are carried out. At the point of transition between the small and large intestine locates the appendix. The small intestine has an important role in the absorption of the nutritional substances of the food, like proteins, fat and carbohydrates, while it contributes in many ways in the absorption of vitamins. On the other hand, colon is responsible for the absorption of the water from the food, while it concentrates and stores temporarily stool, until it is carried out by defecation.

Small intestine

Surgical diseases of the small intestine are proportionally much less frequent than those of the colon. The most frequent benign conditions involve inflammation of Meckel’s diverticulum (causing similar symptoms with acute appendicitis), cases of internal or abdominal wall hernias (causing obstruction), several benign tumors (very rare) and inflammatory bowel diseases, like Crohn’s disease.

Malignant conditions of the small intestine are relatively rare and involve rare forms of intestinal carcinomas. All of the above conditions are treated with laparoscopic and robotic techniques, offering very effective and minimally invasive surgical approach.

Large intestine

Surgical diseases of the large intestine are much more frequent than those of the small intestine. It is estimated that colon cancer in the western countries is the third most frequent cancer and is responsible for many deaths annually. Besides that, colon is affected by a series of benign diseases requiring surgical treatment like polyps, diverticula and inflammatory diseases. Valuable diagnostic tool for the diseases of the colon is colonoscopy, while important is the contribution of CT and MRI.

Factors relevant with the frequency of colon cancer are high consumption of meat and fats instead of fibres, family history, smoking, history of ovarian, uterus and breast cancer in women, inflammatory diseases like ulcerative colitis and the presence of one or more polyps. The treatment of colon cancer is surgical. For the excision of these tumors (colectomy), no matter in which portion of the colon, laparoscopic and robotic surgery are applied. The necessity for open surgery has been dramatically reduced and is reserved practically for selected advanced and metastatic tumors.

Frequent benign disease of the colon is the diverticular disease. Diverticula are small protrusions of the intestinal mucosa through the muscular layer of the colon, creating in that way sensitive spots which can at any time rupture. They appear more often in greater age and they are relevant with constipation and low fibre diet. They cause abdominal pain, mucous and bloody stool, and in acute inflammation rupture or peritonitis.

The same minimally invasive technique is applied for the treatment of the benign conditions of the colon, offering that way a complete modern treatment of the surgical conditions of the colon.

Appendix

Appendix is an embryonic remnant, locating at the beginning of the colon, just after the transition of the small intestine to it. At young age it is rich in lymphatic tissue, contributing to immune response. Acute appendicitis is the inflammation of the appendix, usually resulting by obstruction of its lumen. This may be a result of mechanic obstruction (stool, food), inflammation (virus infections, enterocolitis) and less frequent by tumors (carcinoid).

It is initially manifested with mild pain around the umbilicus and gastrointestinal disorders (vomiting, diarrhoea), fever, discomfort and anorexia. Later the pain relocates at the right lower quadrant of the abdomen and it can be worsened by cough and movements. The inflammation can cause oedema or even rupture of the appendix, resulting in stool spillage and life threatening peritonitis.

This is the reason for the immediate need for the patient to be operated and have appendectomy. Appendectomy is the most frequent surgical procedure at young age. Surgical treatment is almost exclusively done with laparoscopic and robotic techniques by experienced surgical teams.