Overview

 

What Is a Sigmoid-Colectomy ?

A sigmoid-colectomy is a partial removal and reattachment of the colon.  This healthcare procedure is used to treat and excise cancerous, diseased, or enlarged bowels that cause discomfort, pain, or infection.  Once the sigmoid-colectomy is complete, your surgeon may opt to restore the bowel by stitching both ends or creating a colostomy bag.  General anesthesia is administered by a healthcare provider prior to the operation, and a ten day to two-week recuperation period is fairly standard.  Work and other general activities may resume after three months.


When Is a Sigmoid-Colectomy Needed ?

The most common indications for sigmoid-colectomy surgery include colon cancer, diverticulitis, diverticular disease of the large bowel, and inflammatory bowel disease.  The specific disease being treated determines whether the healthcare provider administers elective or emergency surgery

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 the 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. This looks like a big nipple of pink bowel stuck to the tummy skin. 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 hospital two weeks after the operation. Very rarely, if the problem area is in the lower part of the rectum, at operation, the back passage may need to be removed as well. You would be warned about this before the operation.

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 be asked to fill in an operation consent form. 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 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.

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 is to drain 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 is getting 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 nurses the day after the operation despite some discomfort. You will not do the wound any harm, and the exercise is very helpful for you. The second day after operation you should be able to spend an hour or two out of bed.

You may be given a blood-thinning injection in your skin once a day to prevent any blood clots in your legs. This can happen in the first few days after the operation until you can move around a bit more. Those clots can be very dangerous because they can ‘travel north’ through your blood stream to your heart and lungs and cause very serious problems and even death.

By the end of four days you should have little pain.
A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important decisions during this time.

You will probably have a fine drainage tube in the penis or front passage to drain the urine from the bladder until you are able to get out of bed easily. Make sure that you are able to pass water comfortably after the catheter is removed. If you can’t, and this can sometimes happen soon after an operation, let the doctor or nurses know. It may be that you need a catheter (fine plastic draining tube) put in your bladder for a few more days.

You should be eating and drinking normally after about four days.
The wound will have a dressing which may show some staining with old blood in the first 24 hours. There may be stitches or clips in the skin. Sometimes seven or eight stitches are put across the wound to add strength. Stitches and clips are removed after about 7 to 10 days.

The drain tube is removed after four days or so.
You can shower and bath as frequently as you want but try to keep the wound area dry until the stitches come out.

If you have a colostomy, special nurses will show you how to manage it.
You will be given an appointment to visit the outpatient department for a check-up about one month after you leave hospital. You will know the results of the examination of the bowel by then. The nurses will advise about sick notes, certificates etc.

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