COLON SURGERY may be necessary for a number of reasons; the most common are diverticulitis and cancer. Whatever the reason, preparation for the operation is basically done the same way. There are several kinds of operations on the colon, depending on where the problem is located. In most cases, the section of intestine that is diseased is removed, and the remaining ends of the colon are sewn or stapled together. Occasionally, this may not be possible, and a colostomy may be necessary.

GETTING READY for the operation is extremely important. Since the colon normally contains stool, which is full of bacteria, operating on it carries a risk of infection. This risk can be reduced by cleaning out the colon and taking antibiotics ahead of time. You will be given instructions to take a liquid diet and laxatives for two days ahead. The laxatives can cause dehydration. Therefore, it is important to drink lots of fluid, such as fruit juice or Gatorade, during this time. The doctor may also prescribe potassium pills to take along with the laxatives.

The operation is usually done through a vertical incision in the abdomen. In some cases, it may be possible to use laparoscopy. This procedure can reduce the size of the incision necessary to remove a portion of the colon, and thus make the recovery from the operation much faster and more comfortable. It does not change the nature of the operation which is done, and does not reduce the risk of complications from the operation.

 

The operation involves removing the diseased section of intestine and sewing the two ends of the remaining colon together: this may be done with stapling machines or with handsewn stitches, depending on which is safer and quicker.

The procedure takes about two hours. Afterward, you will wake up in the recovery room. You may have a catheter in your bladder and a small tube in your nose which goes down your throat to your stomach to keep it empty. The discomfort from the incision in your abdomen will be treated with pain medication, and should never be bad enough to keep you from resting. Most patients are concerned about the possibility of a colostomy. This is only necessary in two situations: if the operation is an emergency, and there is infection or blockage of the intestine; or if the rectum and anus must be removed because of cancer there. In some situations, a temporary colostomy may be needed to prevent infection from developing, or to prevent the connection between the two ends of the intestine from bursting apart. If the colostomy is temporary, it may be "taken down", or reversed, in about two or three months.

RECOVERING FROM THE OPERATION usually takes about four to seven days in the hospital. For the first three or four days, you will need intravenous fluids, and the tube may stay in your stomach to keep it empty and prevent you from vomiting. During this time, the intestines will begin working again. Once your intestines are growling and you are passing gas, you will be ready to have the tube removed and to start taking something by mouth. It then takes about two days before you are ready to eat solid food again. It may take several weeks for your appetite to return.

The first three days after the operation are the most important time. Most complications show up during this period. It is very important for you to take deep breaths, cough, and walk around when the nurses ask you to. This is the best way of avoiding pneumonia and phlebitis, which are two of the biggest problems after abdominal operations. Make sure you get enough pain medication to do what you need to do.

Once you are able to eat, are moving your bowels, and are able to walk around by yourself, you will be ready for discharge. When you go home, do not expect to feel normal for at least six weeks. You can expect to feel tired easily, and should take a nap when you need it. You will have a lack of appetite for a while, and this is normal -- just make sure you drink plenty of fluids and eat sensibly several times a day -- don't try to eat a full meal right away. Your bowels will be irregular for some time; you may have loose stools several times a day. This should improve with time, and is normal. If diarrhea becomes severe, you should call the doctor.

Like any operation, there are possible complications associated with colon surgery. Complications are rare (less than 10%), but can be serious. Infection is one of the most common. This occasionally appears as an abscess in the wound five to seven days after the operation, which needs to be drained. Sometimes, abscesses can develop inside the abdomen, which is a much more serious problem and can require needle drainage or operation. Sometimes, a leak can develop where the intestine is sewn back together; this can be a very bad problem, and usually requires operation and colostomy until the infection is cured. Pneumonia, phlebitis (blood clots in the leg veins), and heart attacks are other possible problems. Any major operation carries the risk of major complications and even death, although this risk is usually less than 1%.

After discharge, you will need to see the surgeon two or three times before recovery is complete. If the operation was done for cancer, you should have regular followups, with the surgeon, with your regular physician, and possibly by an oncologist (cancer specialist) as well. This is to watch for signs of development of new cancers, or spread of the first cancer.

If the operation was done for benign disease (not cancer), you will usually not need to see the surgeon again after you have fully recovered from the operation.
RETURN TO WORK: For any major abdominal operation, it is usually about six to eight weeks before you will be ready to return to work.

BEFORE THE OPERATION: Please follow these instructions exactly, and call the office if there is any problem (781) 331-4432.

1. On the day before colectomy, take only clear liquids; do not eat any solid food or dairy products. Juice, soda, water, gatorade, tea, and coffee, popsicles, and jello are all fine.
2. On the day before colectomy, in the morning, and again at noon, drink 1 1/2 oz. (3 tablespoons) of Fleet Phospho-Soda added to half a glass of cool water. You can buy this laxative at the pharmacy, and you will start having diarrhea after taking it. The diarrhea will stop after several hours.
3. Do not eat or drink anything after midnight before the operation. You may take your regular medications as directed in the morning before operation with just a sip of water.
4. Shower daily with Hibiclens soap (which you can buy at the pharmacy) for a tleast two days prior to the operation to reduce the risk of infection.
5. DO NOT take aspirin, Advil, Nuprin, or similar medications for ten days prior to the operation. Tylenol (acetaminophen) is OK.