COLORECTAL (BOWEL) RESECTION INFORMATION SHEET

The Operation

Under a general anaesthetic, a catheter is placed in the bladder, an intravenous infusion will be placed in the neck veins and the arm and possibly an epidural into the back (depending on your discussion with the anesthetist).  A cut is made in the abdominal wall.  The surgeon inspects the organs in the abdominal cavity and then frees the bowel section from its attachments.  The blood supply to the part of the bowel being removed is tied off and cut.  The diseased section of the bowel is removed and sent for microscopic examination which takes 1-2 weeks and will give more information in case further treatment and follow-up is needed after the operation.

When possible a telescope (laparoscope) may be used to do some or all of the operation which will reduce the size of the wound and the subsequent problems from the wound.  However, even when the operation starts using a telescope we sometimes have to go on to open the tummy to finish the operation safely.

If the bowel is clean, the surgeon will bring the two ends of the bowel together and sew or staple them together.  It may not be possible to join the bowel at this stage if the preparation is poor or there is a lot of infection present.  The surgeon may bring the bowel end out as a stoma (a bag on the tummy).  Bowel continuity may then be restored at a later operation when it is safer to do so.  This is then closed a few months later.

A plastic tube (drain) may be put near the operation site and brought out through the abdominal wall.  The abdominal wound is closed.

Complications are possible with all operations or treatments but specific complications may be predicted to be more likely with certain operations (eg rectal surgery may alter bladder and sexual function).

Normally you can expect to be in hospital for 2-8 days providing your recovery is uncomplicated and once the bowel starts working.  Your individual risk of problems depends on many factors including your age, weight, mobility and other health problems.  This may be estimated by your surgical team at your request and this should be considered by you (and perhaps your family and friends) prior to agreeing to the procedure.  However, the risk is only an estimate and needs to be balanced against the reason for the operation and the risks of not having it done.

There are risks associated with the anaesthetic. These include sore throat, nausea, skin rash, chest infection and infection of the intravenous site.  Rarely an epidural may cause spinal nerve problems that the anaesthetist should explain to you before you agree to have an epidural to reduce postoperative pain.

General risks of surgery include:

• blood clots in the leg veins (deep vein thrombosis)
• pulmonary embolus (blood clots in the lung blood vessels)
• Chest infection
• Heart attack
• Stroke

Any operation on the abdomen and bowel has specific risks and limitations:

• The bowel may take several days before bowel function returns (and may be softer than your usual bowel habit).  Until it does, you will not be able to eat normally and after some days you may have to have nutritious fluid through a neck vein (TPN) to supply you with energy and nutrition.  You may also have a tube into your stomach through the nose to reduce sickness.

• The join in the bowel may leak (approximately 5-10 % chance per join made), causing infection in the abdomen.  This may be treated with antibiotics in the first instance but if not improving another operation may be necessary.  Sometimes an abscess forms at the site of the surgery and if so this may be drained using a needle through the skin with the help of an ultrasound, or as a last resort another operation may be necessary.  A colostomy (bag) is sometimes needed to rest the joined ends of the bowel.  This is usually temporary and we will make sure you are confident to care for it before you go home.

• Uncommonly, you may bleed after the operation and this may require going back to theatre if this bleeding is excessive it may also mean that a blood transfusion is necessary so please indicate to the team if you are not willing for this before the operation.

• Rarely, other structures, such as the ureter (the tube joining the kidney to the bladder) or spleen may be damaged inadvertently during the operation.  This may require further treatment, usually during the same operation.

• Scar tissue following surgery almost always occurs but commonly may cause kinking or even obstruction of the bowel at a later date (‘adhesions’).  This may occur many years after the operation

Please remember:

Much of this information might sound frightening to you but these days patients and their families like to know about possible complications.  To us, identifying these and treating them is part of our day to day work and knowing what to expect helps if these things happen.  Helping the nurses to help you by getting out of bed as soon as possible, deep breathing and coughing and a positive approach helps us to help your recovery (please read about Fast Track / Enhanced recovery on this website).