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Major Bowel Surgery
The conditionThe large bowel (intestine) is made up of the colon and rectum (back passage). This part of the digestive tract carries the remains of digested food from the small bowel and evacuate it as waste through the opening to the back passage (anus). Cells that line the colon and rectum may begin to grow out of control, forming a tumour (a growth which can be benign or malignant [cancer]). The bowel has four sections: the ascending colon, the transverse colon, the descending colon and the sigmoid colon. Tumours can start in any of these areas or in the back passage. Tumours start in the innermost layer and can grow through some or all of the other layers. The operation Surgery is the main treatment for tumours of the bowel. Usually, the tumour and a length of normal bowel on either side of the tumour (as well as nearby lymph nodes) are removed. The healthy parts of the bowel are then stitched or stapled together – anastomosis). If it is not possible to join the bowel back together, an opening (stoma; colostomy or ileostomy) will be made on the outside of the body for waste to pass out of the body into a disposable appliance (bag) which fits securely on the skin. Sometimes, a temporary stoma (colostomy or ileostomy) is needed until the joined bowel has healed, and then it can be put back. This is done by further surgery. However, in some cases, the stoma is permanent, which means it can never be put back, and there will always be an opening on the skin for bowel waste. Similar operations may be required for other non-tumour conditions such as diverticulitis, colitis and volvulus (twisting of the bowel). Types of operation A number of different surgical procedures are used depending on the site of the tumour. These include:
Preparation for surgeryBefore surgery (exception is the right hemicolectomy), you will be given a medicated drink to help clean the large bowel. The medicated drink will completely empty your bowel. You will then fast for at least 6-8 hours before your surgery. If you are having a stoma, the surgeon and a stoma nurse will discuss with you the best site for the stoma and will mark the area with a marker pen. It is usually placed below your belt line, away from any other scars you may have and away from your wound. You will be visited by an anaesthetist to discuss the best form of anaesthetic and postoperative pain control. Most patients will also be seen by a consultant physician for a general check of vital functions eg: cardiac and lung status. Benefits of having your surgeryRemoval of the diseased bowel is the first and possibly the only treatment for a tumour of the bowel. The goal of the surgery is to give you the best chance of cure through total removal of the tumour. However, your recovery depends how far the disease has spread. At the time of your operation surgery can also be used as a measure to ease any symptoms. Most benign conditions are completely cured by the surgery. Risks of not having the surgerySymptoms including pain and bleeding may become worse and your bowel may completely block or burst. Without surgery, if the condition is malignant it may spread to other areas of your body. Additional treatmentsRadiation (adjuvant) therapy has been used for some people as an additional treatment for rectal tumours but is not normally used in colon tumours. Radiation therapy by itself is not as effective as surgery for malignant disease. Chemotherapy (use of drugs to treat tumour) is often used together with surgical removal. Sometimes it might be offered as the only treatment. It is unusual to require any such additional treatment after surgery for benign conditions. General risks of having an operation There are risks with any operation including:
Specific preventative measures are taken to minimise risks. Recovering from your surgery After the operation the nursing staff will closely watch you until you have recovered from the anaesthetic. You may be cared for in a high dependency unit (HDU) or intensive care unit (ICU) immediately following your surgery. The recovery period after colon surgery varies. It usually involves a stay in the hospital from 5 to 10 days in uncomplicated cases. On return from your surgery you will have a catheter (latex tube) in the bladder to measure and drain urine. After surgery you will be given intravenous fluids (a drip) through which antibiotics may be given. The drip will remain in place until you are able to drink enough fluids. Diet During the first few days of recovery, you will not be able to eat until the bowel has begun to work again. You know the bowel has started to work again when you pass wind and/or have a bowel movement. You will then begin to take liquids by mouth and then solid food. Wound Your wound will have stitches and/or staples and is usually covered with a dressing, which may be adhesive plaster or a spray-on plastic covering. If You Have A Stoma (colostomy or ileostomy) The stoma drains bowel waste from the bowel into the appliance bag. Most stoma waste is softer and more liquid than normally passed bowel waste. The thickness of the bowel waste depends on where the stoma is. You will be taught how to clean around the stoma and change the bag. The stoma bag sticks to the skin around the stoma with special glue, and can be thrown away when dirty. This bag does not show under clothing, and almost all people learn to take care of these bags themselves with an excellent quality of life. Drain You may also have a small tube that drains into a bag or a bottle from near your wound. The drain removes fluid from within the abdomen and helps the healing process. It is taken out when the drainage is minimal. The Lungs It is very important after surgery that you start moving as soon as possible. This helps to prevent blood clots forming in your legs and possibly going into your lungs. You will also most likely have blood thinning medication. Also, you need to do your deep breathing exercises. Take ten deep breaths every hour to prevent secretions in the lungs from collecting. If this happens, you may develop a chest infection. At all costs, avoid smoking after surgery as this increases your risk of chest infection. Exercise Expect to feel tired for some time after surgery. You need to take things easy and gradually return to normal duties, as you feel able. You should not drive during the first 2-3 weeks. Do not lift any heavy items for at least six weeks after surgery. This is to prevent a rupture where the cuts were made and allow healing to take place inside. It may take up to 3 months or more to feel completely recovered. When to contact the office ADVISE DR BRAUN IF YOU HAVE:
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