The colon (or large intestine) and the rectum are the last parts of the digestive system, starting from the cecum and ending at the anus. The main function of the colon is water absorption.
In some cases, the entire colon is removed, and in others, only a part of it, due to various reasons, including colon cancer, pre-cancerous polyps (concern for familial polyposis development), inflammatory bowel diseases (such as Crohn's or ulcerative colitis), diverticulitis (inflammation of pouches formed from the colon wall), and diverticulosis of the colon.
Before the surgery, your doctor will perform a physical examination, blood tests, colonoscopy, and biopsy (sampling and removal of tissues using a flexible tube with a camera at its end) and various imaging tests (such as CT and MRI).
Before the surgery, you may need to stop taking certain medications, such as aspirin or other anti-inflammatory drugs (up to a week before surgery), and blood-thinning medications (like Coumadin or Plavix). You may also need to follow a special diet.
- Special diet if recommended by your doctor.
- Shower the night before the surgery using an antibacterial soap.
- Arrange transportation to and from the hospital, and plan for assistance at home after discharge.
- The day before the surgery, you should consume a light meal or clear fluids and avoid heavy meals.
- You should not eat or drink after midnight unless instructed otherwise by your doctor.
Anesthesia:
The surgery is performed under general anesthesia.
Surgical Procedure:
During the surgery, the affected part of the colon is removed, and the remaining ends of the colon are connected. The removed segment will be sent for examination at the pathology institute. In some cases, there may be a need to create a colostomy or ileostomy, which is an alternate pathway for waste disposal from the body. This involves creating a small opening in the front of the abdominal wall, called a "stoma," to which the colon is connected. The contents of the colon are collected in a bag.
A stoma can be temporary or permanent, and it may be used to allow the healing of a diseased colon.
At the end of the procedure, the surgical incision is closed with sutures or staples.
After the surgery, you will be taken to the recovery room to ensure a slow and safe awakening, and later, you will be transferred to the surgical ward for further monitoring and care.
There are two approaches to perform the surgery, and the choice will be made by the surgeon based on your specific case and consultation with you.
- Open approach: Performed through a central abdominal incision.
- Laparoscopic approach: In this approach, the surgeon makes small incisions in the abdomen, inflates the abdomen with gas, and then inserts tubes through the incisions. A tiny camera is inserted through one of the tubes, allowing the surgeon to view the surgical site on a screen. The surgical instruments are also inserted through these tubes, and the surgery is performed within the abdomen without the need for a large incision. The section of the colon that needs to be removed is done through a 4-7 cm incision. In some cases, the surgeon may need to switch to open surgery.
Duration of Surgery:
The surgery takes about 2-4 hours.
Expected Pain:
Despite pain management, some discomfort is expected after the surgery. Painkillers will be provided as needed and advised by the pain service.
Average Hospital Stay after Surgery:
After the surgery, the average stay in the hospital ward is 4-7 days, on average six days.
Post-Surgery Treatment:
- You will be given instructions regarding nutrition and activity tailored to your condition, and the department's dietitian will guide you during this period if needed. In the first few days after the surgery, you will follow a gradual diet that starts with clear fluids and then progresses to soft foods until returning to a "regular" diet.
- Special compression stockings will be used to prevent blood clots.
- The physiotherapy team will guide and assist you in performing appropriate breathing exercises.
- It is recommended to get out of bed several times a day. Walking accelerates the healing process and reduces the risk of complications, such as pneumonia.
After Discharge from the Hospital:
If you experience any of the following symptoms, you should contact your doctor:
- High fever above 38.5°C or chills.
- Redness, swelling, increased pain, discharge, or any other abnormality in the surgical area.
- Nausea and/or vomiting that cannot be controlled by the prescribed medications or continues for more than two days after discharge.
- Pain that cannot be controlled by the prescribed medications.
- Cough, shortness of breath, or chest pain.
- Weakness or dizziness.
- Swelling in the feet, ankles, or legs.
- Black or bloody stool.
- Diarrhea.