Dear patient,
The purpose of this guidance is to provide you with information that will help you go through the hospitalization and recovery period in the best and safest way possible. Please note that this document does not replace the explanations provided by your doctor or the informed consent form for the surgery.
The Colectomy surgery to which you have been scheduled involves the complete or partial removal of the colon (large intestine). This guidance is suitable for most patients undergoing Colectomy surgeries, but different procedures may require different instructions. During the pre-surgery guidance session, you will receive specific instructions tailored to your surgery.
Background:
The Colon and Rectum
The colon is part of our digestive system and consists of two main parts: the small intestine and the large intestine (colon). The large intestine consists of the colon and the rectum, with a length of approximately 1.5 meters.
After eating, food moves from the small intestine to the large intestine, where most digestion and absorption of nutrients occur. Only the indigestible remnants of food continue to pass through the large intestine. As the content moves through the large intestine, more water and salts are absorbed by the intestinal walls, and the stool becomes more solid until it is expelled from the body through the anus by the movement of the intestines. Following the Colectomy surgery, the absorption of fluids from the intestine is significantly reduced, leading to more frequent and liquid bowel movements. Over time, the frequency of bowel movements decreases.
Reasons for Colectomy:
1. Cancerous and precancerous growths
2. Inflammatory bowel diseases and diverticular diseases
3. Emergency surgeries, such as bowel obstructions, trauma, and perforations.
Based on the medical indication for the surgery, your doctor will determine whether a complete or partial removal of the colon is necessary.
The Colectomy surgery can be performed using different methods:
• Open surgery (abdominal incision)
• Laparoscopic surgery (minimally invasive, involving several small incisions and using a camera-guided laparoscope).
Laparoscopic surgeries offer many advantages, such as reduced pain, faster recovery, and shorter hospitalization, in addition to the aesthetic advantage of smaller scars.
The specific type of surgery to be performed will be chosen by the operating surgeon based on the problem and its location. In most cases, the affected area will be removed, and the remaining ends will be connected. However, in some cases where it is not possible to connect the ends due to the nature of the problem or the location (such as when there is a growth near the anus), a "stoma" may be created – a surgical opening through which the remaining end of the intestine is brought to the surface of the abdomen. In such cases, the bowel movements will be expelled into a bag worn over the stoma.
After a few months of healing from the surgery, it may be possible in some cases to perform a second surgery to close the stoma. A patient who is discharged with a stoma will receive additional guidance.
Preparation for Surgery:
Before the surgery, various blood and urine tests, chest X-rays, and an ECG (electrocardiogram) may be performed, along with any other tests requested before the surgery.
On the day before the surgery, you should:
• Have breakfast until 9:00 AM, avoiding fruits, vegetables, whole grains, and fruit juices. After 9:00 AM, drink only clear fluids such as tea, clear soup, water, and jelly. Avoid milk, fruit, and vegetable juices.
• Admit yourself to the hospitalization unit at 1:00 PM, or as instructed by the pre-surgery unit (in case the surgery is scheduled for the next day). Go directly to the General Surgery Department on the 8th floor.
• The hospitalization unit staff will check your vital signs, complete any missing tests, and provide guidance.
• You will be given a laxative solution to clean your intestines (according to the doctor's instructions).
• It is recommended to bring personal items such as toiletries, an upper garment, and slippers.
• Avoid bringing valuables, money, and jewelry.
• To prevent the formation of blood clots, several actions will be taken:
- Wearing elastic stockings during the surgery
- Administration of blood-thinning medication via injections before and after the surgery (the duration may vary depending on your condition and the type of surgery).
- Early mobilization – it is recommended to move your feet and get out of bed according to the treating team's recommendation.
• At midnight, begin fasting completely (no food or drink).
Hospitalization and Pre-Surgery Department:
The admission process to the Pre-Surgery Department will take several hours, so please plan accordingly.
1. A nurse will measure your pulse, blood pressure, and weight, complete any missing tests, and provide guidance.
2. You will be examined by a surgical doctor who will explain the nature of the surgery and ask you to sign a consent form for the surgery.
3. An anesthesiologist will explain the purpose and type of anesthesia and ask you to sign an anesthesia consent form.
4. You will meet with a nurse from the department who will provide you with guidance for the surgery, including preparation, the course of the surgery, and recovery.
After completing the admission process, you will return home. The Pre-Surgery Department team will contact you to inform you of the surgery date.
Department Structure:
• The department has 52 beds. The patient's unit includes a bed, a call button for the nurse, a wardrobe, a night light, a bathroom, and a shower adjacent to the room.
• A family member can stay with you overnight after the surgery, with approval from the responsible nurse in the department. The stay will be on a chair only.
On the Day Before the Surgery:
• The preparation for the surgery begins in the morning at your home. Have breakfast until 9:00 AM, avoiding fruits, vegetables, whole grains, and fruit juices. After 9:00 AM, drink only clear fluids such as tea, clear soup, water, and jelly. Avoid milk, fruit, and vegetable juices.
• Admit yourself to the hospitalization unit at 1:00 PM, or as instructed by the pre-surgery unit (in case the surgery is scheduled for the next day). Go directly to the General Surgery Department on the 8th floor.
• The hospitalization unit staff will check your vital signs, complete any missing tests, and provide guidance.
• You will be given a laxative solution to clean your intestines (according to the doctor's instructions).
• It is recommended to bring personal items such as toiletries, an upper garment, and slippers.
• Avoid bringing valuables, money, and jewelry.
• To prevent the formation of blood clots, several actions will be taken:
- Wearing elastic stockings during the surgery
- Administration of blood-thinning medication via injections before and after the surgery (the duration may vary depending on your condition and the type of surgery).
- Early mobilization – it is recommended to move your feet and get out of bed according to the treating team's recommendation.
• At midnight, begin fasting completely (no food or drink).
In the Pre-Surgery Department:
The admission process to the Pre-Surgery Department will take several hours, so please plan accordingly.
1. A nurse will measure your pulse, blood pressure, and weight, complete any missing tests, and provide guidance.
2. You will be examined by a surgical doctor who will explain the nature of the surgery and ask you to sign a consent form for the surgery.
3. An anesthesiologist will explain the purpose and type of anesthesia and ask you to sign an anesthesia consent form.
4. You will meet with a nurse from the department who will provide you with guidance for the surgery, including preparation, the course of the surgery, and recovery.
After completing the admission process, you will return home. The Pre-Surgery Department team will contact you to inform you of the surgery date.
Department Structure:
• The department has 52 beds. The patient's unit includes a bed, a call bell for the nurse, a closet, a night lamp, and an attached bathroom and shower.
• A family member can stay with you overnight after the surgery, with approval from the responsible nurse in the department. The stay is on a chair only.
Day Before the Surgery:
• Preparations for the surgery begin one day before the procedure in the morning at your home. Until 9:00, you should have breakfast without fruits, vegetables, whole grains, and fruit juice. From 9:00, you should only drink clear fluids: tea, clear soup, water, and jelly. Prohibited: milk, fruit juices, and vegetable juices.
• You will be admitted to the hospital one day before the surgery at noon, at 13:00, or according to pre-operative unit instructions (if the surgery is scheduled for Day 1, special instructions will be given). You should go directly to the General Surgery Department on the 8th floor.
• The department team will receive you and complete the preparations for the surgery.
• Upon admission, you will receive intravenous fluids and have blood tests taken.
• Bowel preparation will be done in the department, including:
• Bowel preparation in the department also includes:
1. Taking antibiotics to sterilize the intestines.
2. Drinking a solution to clean the intestines (according to the doctor's instructions).
• It is recommended to bring personal items such as toiletries, an upper garment, and slippers.
• Avoid bringing valuables, money, and jewelry.
• To prevent the formation of blood clots, several actions are taken:
• The use of elastic stockings during the surgery.
• Blood-thinning medication is given to most patients in the form of injections before and after the surgery. The treatment duration may vary based on the patient's condition and the type of surgery.
• Early mobility is encouraged – moving your feet and getting out of bed according to the team's recommendation.
• Fasting will begin at midnight (no eating or drinking).
The morning of the Surgery:
• You will have a bowel cleanse.
• Thorough washing.
• Wear only a gown (remove undergarments).
• Medications and pre-medication will be administered by the nurse – these medications aim to reduce stress due to the surgery. (Do not take any medications independently).
• You will be taken to the operating room according to the schedule set by the surgical department, based on the list of surgeries determined by the surgeon.
• At the designated time, a representative will come to take you to the operating room. Before that, remove makeup and nail polish, as well as glasses, watch, jewelry, contact lenses, dental implants, and hearing aids.
• It is recommended to convey final messages to a family member. If no family member is present, messages will be left with security personnel before going to the operating room.
• Family members can wait in the waiting room adjacent to the operating room until the surgery is complete. After the surgery, the surgeon will update the family members.
After the Surgery:
You will be transferred to the recovery room, located adjacent to the operating room.
In the recovery room, a nurse will monitor your vital signs, such as blood pressure, pulse, and breathing. Your surgical wound dressings will be checked, and the output from catheters will be monitored.
If you experience pain or nausea, you can request pain relievers or anti-nausea medication.
Upon leaving the operating room, you will have:
• Catheters for draining fluids from the surgical area.
• A catheter for urinary drainage.
• A nasal gastric tube (NG tube) inserted through your nose to your stomach, used to drain fluids from the upper digestive system. This is only applicable to specific surgeries.
• You might also have a PCA (Patient Controlled Analgesia) pump to self-administer pain-relieving medication.
One family member will be allowed to enter the recovery room with the nurse's approval.
In the Department:
Once your condition allows, you will be discharged from the recovery room and return to the department.
The hospitalization period in the department after the surgery is at least 5 days.
You will be cared for by a nurse who will monitor your condition and continue to provide care. Blood tests may be taken as needed. In the first days after the surgery, you will receive fluids through an IV until you start to drink. The catheters will be removed gradually, following the surgeon's instructions.
If you experience gas or bowel movements through the rectum or the stoma (if you have one), please inform the nurse. Gas expulsion is a sign that your bowels are awakening after the surgery.
Pain Management:
Your pain level will be measured on a scale from 1 to 10. You will receive pain-relieving medications through an IV or orally when you start to eat and drink. The dosage of pain medication will be adjusted to ensure you are comfortable. If the pain relief is not sufficient, please inform the nurse.
You may also have the option to use Patient Controlled Analgesia (PCA) to self-administer pain-relieving medication. The PCA pump is connected to the IV or epidural space in your spine. The device is designed to deliver a continuous or on-demand dose of pain medication when you press a button during pain.
Mobility:
To prevent complications related to prolonged bed rest, it is essential to:
• Get out of bed
• Walk
• Spend time outside of the bed area
• Your first time getting out of bed after the surgery will be done with the nurse's assistance the day after the surgery.
• The day after the surgery, a physiotherapist will visit you to guide you in breathing exercises to maintain proper lung function.
Hygiene:
Each morning, a staff member from the department will assist you with personal hygiene.
Nutrition:
You will receive personalized guidance from a dietitian before discharge.
During the first weeks after the surgery, it is recommended to have small, frequent meals (4-6 times a day).
Chew your food slowly and thoroughly.
Avoid gas-producing foods such as cabbage, broccoli, beans, lentils, and carbonated drinks.
Avoid chewing gum and consuming fizzy drinks, as they can increase gas and discomfort.
If you experience constipation, drink plenty of fluids and add prune juice to your diet.
If you have diarrhea, consume binding foods such as boiled chicken, cooked carrots, bananas, rice, and apple sauce.
Bowel Activity:
In the first weeks after the surgery, bowel activity might not be regular. With time, it will return to normal.
If you experience severe abdominal pain, nausea, vomiting, abdominal swelling, or constipation lasting several hours, please contact the surgical department or visit the triage.
If you have any questions or issues, you can consult the General Surgery Department team at any time, any day of the week.
Phone: 02-6555769, 02-6555569.