COLORECTAL & BOWEL CANCER SURGERY
Management and Investigation of:
Benign and Cancerous Polyps
Diverticular Disease (Diverticulosis)
The information here is a guide only and does not replace my discussions with you on the day of consultation.
BOWEL SURGERY (Colectomy)
What Conditions require bowel surgery?
This type of surgery removes part of the colon that is diseased. The conditions they may need this type of surgery include:
-Inflammation in the bowel that has not responded well to medications
-Polyps that are not suitable to be removed with colonoscopy
-Blockage of bowel
-Diverticulitis which has not been responding well to medications or other problems that’s caused by diverticulitis
What symptoms should I expect from above conditions?
The symptoms can vary from one person to another and depending on the condition.
Do I need bowel preparation material before surgery?
Generally yes. This will make Key hole surgery much safer to perform.
Do I need to see the stoma nurse before surgery?
If your bowel is removed from the left side of your tummy I will ask the stoma nurse to mark your tummy for possible formation of stoma. The stoma is created only when it’s not safe to join your bowel.
How do I remove the bowel?
You will be advised to fast prior to the procedure, and the updated details will be given to you from my rooms or nursing team depending on timing of procedure.
This is done under general anaesthesia by Key-hole surgery. Once you are fully sleep the instruments will be inserted through small holes in the tummy and carbon dioxide gas is pumped in the tummy. Then I use a fibreoptic telescope and few other long instruments to safely remove the bowel. Special suturing instruments will be used to join the bowel.
If it is not safe to reconnect the cut ends of the bowel you will have a hole in the skin of the tummy through which the faeces will pass into the bag.
Sometimes, If you had previous surgeries in tummy, key hole surgery might not be safe and I will do open surgery to remove the bowel.
In other instances, after operation starts as a key-hole surgery and in unanticipated events for your safety I will not proceed with key hole surgery and change to open operation. This is in the best interest of the patient and in not the failure of surgery.
What happens after surgery?
-Most patients who undergo bowel removal surgery will stay 3-6 nights.
-We will encourage you to start walking as soon as you feel able to do so.
-You will be given regular simple pain relief medications. Examples include Panadol. Sometimes you require stronger pain relief and this will be prescribed in your medication chart.
-You may be given small hand-held pump which allows you to control the dosage of pain relief medication. The pump has safeguards to prevent you from giving yourself too much medication.
Sometimes the Anaesthetist will put a small plastic tube into you back to help reduce the pain as well. Simply the medications will numb the spinal nerves with this procedure. This is done usually before the operations starts.
-Your wound will be checked by nursing staff and will be given medications to prevent clot formation in legs together with white stockings(this will also reduce the risk of clot formation).Your heart rate, breathing rate, Blood pressure and temperature and your blood oxygen levels will be checked regularly.
-You might notice there is a soft plastic drain tube in you tummy. This is usually removed depending on the amount of fluid drainage after few days.
-You might have a tube into your nose which goes down to your stomach.
-Also you may notice tube under your nose or face mask which gives you extra oxygen.
-You generally can have normal diet and there are no restrictions after anaesthesia if not feeling sick. You can choose what to have after the operation and should listen to you body.
-A Temporary urinary catheter will be used to check the amount of urine your body is producing to guide me how your body is coping with the stress of surgery and the amount of fluid that needs to be administered.
-You will be given a device to help with breathing after surgery if you have underlying lung problem or if having trouble breathing well.
- If you have a stoma bag you will see our stoma therapy nurse to help you learn how to manage your bag. The stoma bag can be permanent or temporary.
-Try to do light activity shortly after discharge.
-The dressing that we use is waterproof and you can have shower with them and you can remove them after a week.
-The sutures that are used for skin closure are absorbed and there is no need to remove sutures.
-You should not drive for a week after the operation and avoid lifting heavy items for at least 6 weeks after surgery. A medical certificate will be provided if required.
-Most patients feel a hard ridge under the wound and this generally will disappear after few months.
-There is small risk that the wound can become red and sore and discharge fluid. If you are worried please don’t hesitate to call my rooms for earlier review.
What are the risks of bowel surgery?
There are general and specific risks to surgery:
-Heart problems, clots in legs, stroke especially if there are pre-existing serious medical conditions before surgery. Allergic reaction to medications.
-Gas bubble into the blood, Wound infection, raised, irregular scar. Few people develops these since most cuts heal well.
- Injury to organs/nerves/blood vessels near the Colon. Rarely
-Bowel blockage due to scarring or hernia.
-Re-operation if there is the bleeding or bowel leakage and it may require stoma bag.
-Blood transfusion risk if there is a bleeding.
What costs to be incurred from this practice?
There will be an out of pocket charge for your procedure from my service. When you present to my rooms for consultation, this is not covered by your private health funds. You will get some of the money for outpatient consultations back from Medicare.
There may be an out pocket expenses for anaesthetic services depending on your level of cover.Please contact Downs anaesthetics for further details.You should ask them ahead of time about this cost. You will also have to pay any hospital excesses that your policy dictates. We will provide you with contact details after consultation so you could check ahead of time.