Which type of large bowel operation?
Large bowel operations are usually carried out for a cancer or polyp in the large bowel (or intestine), or for a condition called diverticular disease. The unhealthy part of the large intestine that is affected is removed and the remaining section, either side of this are usually reconnected with a stapling device or sutures. These types of large bowel operations can be performed as a traditional open operation, a laparoscopic or what is sometimes known as keyhole operation, and in this hospital, we are also now able to offer a robotic assisted operation.
Colorectal Laparoscopic Assisted Surgery (LAS)
Laparoscopic assisted surgery involves the surgeon operating using smaller incisions (cuts) with cameras and instruments. This allows them to see on high definition monitors which enables the surgeon to operate without the need for larger incisions, that can result in a longer postoperative recovery period and stay in hospital.
Colorectal Robotic Assisted Surgery (RAS)
Robotic assisted surgery involves the surgeon operating using a console that allows them to see in 3-D, high definition, and control small instruments within the body that have an additional range of motion. This enables the surgeon to operate in a precise, controlled manner with a better range of movement.
Open Surgery (OS)
In some instances it may still be more appropriate to perform open surgery using a larger incision, for example when there has been previous surgeries that could have caused more internal scarring or where there are large or multiple internal areas that require attention.
Before your operation
You will usually be required to prepare for your surgery before admission by taking some medication as well as having some dietary restrictions and supplements before your operation. You will be advised regarding the details of these at your preoperative assessment visit by your Colorectal Specialist Nurse. This may include medicine or enemas the day before surgery to clear out your bowel.
During your operation
During these operations you will have a general anaesthetic during which you will be asleep. The operation itself usually takes anything up to seven hours but usually lasts around four hours.
After your operation
When you wake up after the operation you will have a number of tubes attached to you, all of which will be temporary. As you recover the ward nurses will remove these tubes within a few days of the operation. These may include:
- A drip in your arm which allows fluid to be given to you continuously as well as sometimes monitor your blood pressure
- Sometimes a drip is placed into a vein in your neck. This makes it easier to give you fluids and drugs after your operation
- Pain relief given either through a drip in your arm, neck or through a small tube into your back called an epidural
- A temporary flexible tube called a catheter which will drain your urine away into a bag
- A drainage tube may be placed in your abdomen near your operation wound. This sometimes enables wounds to heal quickly and cleanly
Stoma (colostomy or ileostomy)
During the operation, if your surgeon thinks that you are at a high risk of ‘leaking’ then they may form a stoma (an opening in the surface of the abdomen). This is to divert the bowel contents away from the two ends of bowel that have been sewn together. This is usually temporary but may be permanent. The Colorectal Specialist Nurse will provide information about a stoma and will see all patients who are planned to undergo a bowel operation.
Potential Complications of Surgery
For all patients undergoing bowel surgery, there is a chance that the internal wound that joins your bowel together will not heal satisfactorily. There is a risk of developing a pelvic collection (collection of infected fluid, or an abscess). Sometimes this will heal by itself without further treatment. If it does not heal by itself a second operation may sometimes be needed to correct the leak. You can speak to your Colorectal Specialist Nurse about any concerns that you may have.
The anterior resection operation carries a risk of damage to a nerve that is in your pelvic area. If this nerve is damaged it can affect both urinary and sexual function. You can speak to your Colorectal Specialist Nurse about any concerns that you may have.
After any major operation there is a risk of chest infection, wound infection and thrombosis. Whilst you are in hospital the ward staff will take steps to reduce the risk of these happening to you. You can help by practising deep breathing exercises and following the instructions of the Physiotherapist.
The risk of this is increased with bowel surgery. Antibiotics will be given to you through the drip to help prevent this.
Other wound issues
In the longer term some wounds can be associated with hernias. Hernias are formed by a weakness in the muscles of your abdominal (tummy) wall and following surgery this weakness can lead to a bulge or lump. This is relatively uncommon but occasionally may require surgery at a later stage.
This is due to changes in the circulation during and after surgery. A small dose of a blood thinning drug will be injected before your operation and afterwards usually for 28 days until you are walking around. You can help by moving around as much as you are able and by exercising your legs whilst in the chair or in bed. You will also be given some support stockings to wear for the duration of your stay in hospital and until you finish your Tinziparin blood thinning medication.
Diet and nutrition
Most people who have had bowel surgery are concerned about what they will be allowed or are able to eat after the operation. Your surgeon will tell you when you can start eating again. In most cases it will be quite soon after your operation. When you are able to eat, you can eat whatever you feel like and you will be encouraged to return to a normal diet. A light diet initially with foods that are easily digestible is recommended. It is important to try and put the weight back on that you may have lost during your illness. In order for healing on both the inside and outside of your body to happen the nutrients and vitamins from your food are needed. Whilst you are in hospital the ward staff can arrange for a dietitian to come and see you. If you would like this please ask. Please ask your Colorectal Specialist Nurse about your diet if you are concerned.
Bowel function: for patients without a temporary stoma
The first few days after your operation you probably won’t go to the toilet. Your bowel needs time to adjust after it has been handled during surgery. When your bowel is ready you will notice that you begin to pass wind. Usually, once this happens you will feel the need to go to the toilet. It is expected that for about two weeks, your bowel motion (faeces) will be soft and even watery and you will need to go to the toilet several times a day. This will improve in the following weeks and will start to become more formed and less frequent. Your Colorectal Specialist Nurse will answer any questions you may have about your bowel function. You can ring the Colorectal Specialist Nurse once you are home and she will advise you about what is the best way to manage your bowel function.
Bowel function: for patients with a temporary or permanent stoma
The Colorectal Specialist Nurse will teach patients with a temporary or permanent stoma how to look after the stoma. The nurse will begin teaching you when you are feeling able to concentrate which is usually within a few days of surgery. Whilst you are learning, the ward staff will also support and assist you on how to care for the stoma.
Conversion to the other alternative forms of surgery
In rare instances your surgeon may choose to use one of the forms of surgical access to complete your operation if during your surgery it became evident that this would achieve a better outcome. This may mean that you will have different wounds to what you initially expected.
For further information please contact your Colorectal Nurse Specialist who will return your call Colorectal Specialist Nurses Tel 0191 4453150
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