Your Surgeon has advised you to undergo a Laparoscopic Left Hemicolectomy. The operation is designed to remove approximately half of your large intestine. It is necessary to remove so much bowel because of the way the blood supply looks after the bowel rather than because the disease is extensive. Most of the operation will be done through several very small cuts in your tummy (about 1 cm. or less each) but there will be one slightly larger cut (approximately 6 cms.) which will be made towards the end of the operation through which the excised bit of bowel will be removed.
After removal of the diseased portion the two free ends will be joined together. This is what doctors call an ANASTOMOSIS. Occasionally, if the surgeon is worried about the join healing you may need to have a STOMA to divert the bowel contents through a small hole in your tummy into a bag. If you did have a stoma it is likely that it would only be for a short period of time after which it could be closed so that the bowel would then work in a normal manner. You would not need a bag on your tummy after closure of the stoma.
BEFORE YOUR OPERATION
- You will probably be admitted to hospital 1-2 days prior to your surgery. You will probably be in hospital less than one week, but it may be a little longer.
- A number of routine tests will be carried out to ensure you are fit for surgery. (If you have a attended a pre-admission clinic
you may well have already had these tests)
- You may be given some medicine to clear your bowel and you will be encouraged to drink water. This makes your bowel as clean as possible for the surgeon.
- You will only be allowed to drink clear fluids and you will not be allowed to eat any solid food the day before your operation. Some people (particularly elderly patients) require a drip before the operation to put fluid into a vein.
- You will have nothing to eat for at least 6 hours prior to your surgery and will be asked to stop drinking shortly before going to theatre..
- An anaesthetist will visit you and discuss your anaesthetic and various methods of post-operative pain relief.
ON THE DAY OF YOUR OPERATION.
A nurse will take you to theatre and will also collect you following your operation. After your operation you will be taken into the recovery ward, where you will have your blood pressure and pulse checked. When you are properly awake you will be taken back to the ward.
On your return to the ward from theatre you will have:
- A WOUND on your tummy with stitches, sticky paper dressings or clips, covered with a dressing.
- A needle into a vein (a DRIP) to give you fluids and medicines. YOU WILL NOT BE ALLOWED TO DRINK OR EAT FOR A DAY OR TWO as your bowel has had a ‘shock’ during the operation and will not work properly at first.
- A CATHETER – a small tube to keep your bladder empty
- You may have a tube in your nose (A NASO-GASTRIC TUBE) that will keep your stomach empty to stop you from feeling sick.
- You may have a fine tube in your neck (A CENTRAL LINE) to help measure the amount of fluid being put into your body accurately.
- You may have a DRAIN, a small tube to clear away any oozing fluids around the operation site inside. This helps to prevent infection.
- You may have an EPIDURAL (a fine tube in your back) or PCA PUMP (a line into a vein in your arm) which gives you pain relieving medicines. PCA stands for Patient Controlled Analgesia which means you can control how much pain relief medicine is given to you through a vein using a little button switch which you can hold yourself. If you have decided not to have an epidural anaesthetic and to have PCA instead your anaesthetist will have explained how this system works before your operation.
- VERY RARELY you may have a stoma appliance (a bag) on your tummy.
On return to the ward the nurses will check your blood pressure/pulse and wounds on a regular basis. This is completely normal.
It will take up to a few days for all these things to be removed (except of course the stoma if you have one), during which time the nurses will help you to wash, clean your mouth and enable you to move both in and out of bed. In the unpredictable event that you have had to have a stoma the nurses will help you to learn how to manage the bag.
AFTER THE OPERATION:
For the first couple of days the nurses will help you with your hygiene needs. They may also change your dressings. As you begin to feel better and stronger they will encourage you to do more for yourself. When your bowel begins to work or the doctors can hear your tummy rumbling you will be able to take limited fluids, this will be built up gradually then you can return to a ‘normal’ diet. After a few days you may feel that you want to pass wind or have your bowels opened. Even if you have a stoma this is entirely NORMAL and you may pass a little old blood or mucus. Please keep the nurses informed
When you first pass stool again it will be liquid and sometimes it takes several weeks or even months to get used to your new ‘plumbing’ arrangement: please be patient with yourself and ask the nurse or doctors if you are worried about anything.
Occasionally some people have to adjust their dietary habits after this operation in order to keep their bowel habit regular. Please talk to one of the nurses or doctors about this if you are in doubt.
RISKS AND BENEFITS
- Risks of this operation are small and much less than the risk of doing nothing but nonetheless this is a major operation and some people (less than 5%) do not survive such surgery. There are specific risks to laparoscopic surgery (keyhole surgery) which include inadvertent accidental damage to structures inside the tummy such as blood vessels and bowel. This is very rare but if that did happen you may require an open operation with a bigger scar to put things right.
Assuming there are no such problems with your operation the benefits of laparoscopic (keyhole surgery) are such that you would have a much smaller scar on your tummy and you would make a much quicker recovery from your operation. Most people go home after this type of operation within a week.
- All operations carry a risk from anaesthetics but this is minimal due to modern techniques.
Your stoma care nurse or surgeon will discuss this procedure further with you when you sign the consent form for the operation.