Overview
What Is It ?
The bowel is a tube of intestine which runs from the stomach to the back passage. The lower half of the bowel is called the colon. The colon runs from the right side of the waistline, up to the right ribs, loops across the upper part of the belly and passes down the left side. There it runs backwards into the pelvis (the lower part of your abdomen) as the back passage, where it is called the rectum. In your case, the problem lies in the left side of the colon or upper rectum. The left side of the colon is taken out, and the ends are joined up (anastomosed) whenever possible.
Before The Operation
Stop smoking and get your weight down if you are overweight. If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control.
Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation. Bring all your tablets and medicines with you to the hospital.
On the ward, you will be checked for past illnesses and will have special tests to make sure that you are well prepared and that you can have the operation as safely as possible You will have the operation explained to you and will be asked to fill in an operation consent form.
Before you sign the consent form, make sure that you fully understand all the information that was given to you regarding your health problems, the possible and proposed treatments and any potential risks. Feel free to ask more questions if things are not entirely clear.
Any tissues that are removed during the operation will be sent for tests to help plan the appropriate treatment. Any remaining tissue that is left over after the tests will be discarded.
Before the operation and as part of the consent process, you may be asked to give permission for any ’left over’ pieces of bowel to be used for medical research that has been approved by the hospital. It is entirely up to you to allow this or not.
Many hospitals now run special preadmission clinics, where you visit a week or so before the operation, where these checks will be made.
The Operation
You will have a general anaesthetic, and will be asleep for the whole operation. A cut is made in the skin in the middle lower part of your abdomen about 40cm (15 inches) long. The left side of the colon loop and the upper rectum are freed from the inside of the tummy. The diseased part is cut out and usually the ends are joined together. Sometimes it is safer if the ends are not joined together. Then the bowel waste is channelled through the bowel which opens in the front of your tummy (a colostomy), and you need to wear a bag. Usually the ends are joined up at a later date. Sometimes the ends are joined up at the first operation, but a short-term colostomy is made as well. This keeps the bowel waste away from the join while it is healing up. You should plan to leave the hospital two weeks or so after the operation. Very rarely, if the problem area is in the lower part of the rectum it may be necessary to remove the back passage as well. You will be warned about this before the operation.
After – In Hospital
You will most likely have a fine plastic tube coming out of your nose and connected to another plastic bag to drain your stomach. This is to decompress your stomach which, along with the bowel, may feel sluggish after an operation. Swallowing may be a little uncomfortable. You will have a dressing on your wound and a drainage tube nearby, connected to another plastic bag. This drains any residual blood from the area of the operation. You may have a colostomy. The wound is painful and you will be given injections and, later, tablets to control this. Ask for more if the pain is not controlled or gets worse.
Many hospitals are now using what is called PCA (patient controlled analgesia). By pressing a button on a device you can inject painkillers into your bloodstream through a very fine plastic tube that goes into one of the small blood vessels (veins) in your hand. A small computer controls the amount of painkiller that is released and prevents any accidental overdose.
Alternatively, you may have a fine tube in your back through which pain relief can be given to help control the pain.
You will most likely be able to get out of bed with the help of the nurse the day after operation despite some discomfort. You will not do the wound any harm, and the exercise is very helpful for you. The second day after the operation you should be able to spend an hour or two out of bed.
After – At Home
You are likely to feel very tired and need to rest two or three times a day for a month or more. You will gradually improve so that by the time three months have passed you will be able to return completely to your usual level of activity.
You can drive as soon as you can make an emergency stop without discomfort in the wound, ie after about three weeks.
You can restart sexual relations within two or three weeks when the wound is comfortable enough.
Sometimes the operation will upset the nerves which control sex in the male. This is more frequent (some studies show in up to 50 per cent of cases) if during the operation the surgeon believes that your back passage (rectum) has to be removed. The surgeon can discuss this with you.
Possible Complications
As with any operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs.
The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.
Complications are unusual but are rapidly recognised and dealt with by the surgical staff. If you think that all is not well, let the doctors or the nurses know.
Chest infections may arise, particularly in smokers or obese patients. Getting out of bed as quickly as possible, being as mobile as possible and co-operating with the physiotherapists to clear the air passages is important in preventing the condition. Do not smoke.
Occasionally the bowel is slow to start working again. This requires patience. Your food and water intake will continue through your vein tubing until you pass wind or open your bowels.
Sometimes there is some discharge from the drain by the wound. This stops given time.
Wound infection is sometimes seen. This happens relatively more frequently in any bowel operation compared to other 'clean' operations such as taking out your gallbladder and the reason is that the bowel has many bugs that can cause an infection. The infection should settle down with antibiotics in a week or two.
Very rarely, during the operation, another part of your bowel, your bladder or a blood vessel can be damaged and this may require another operation to deal with the problem.
One potential major complication is a leak from the area where the two parts of your bowel were put back together. The chance of a leak is up to 15 per cent and is more frequent in patients whose wounds may take longer to heal, such as elderly people, diabetics and patients suffering from cancer .
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