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Chelsea and Westminster

Department of Colorectal Surgery at

West Middlesex University Hospital

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You and your bowel operation

You will have been seen by your surgeon prior to coming into hospital and discussed the intended surgery. This should have included a discussion of the benefits and risks so that you are fully informed. It is important that you realise that no operation is risk-free.

General risks of major surgery:

  • Chest infection ( particularly if you smoke)
  • Wound infection
  • Urinary infection
  • Bleeding and the need for a blood transfusion
  • Blood clot in the leg or lung
  • Heart attack
  • Stroke

Less common risks of surgery include:

  • Post operative bleeding (haemorrhage)
  • Incomplete removal of the cancer or none of the cancer being removable
  • Occasionally the bowel can be slow to start working again. This requires patience but usually resolves in time (this is known as an ileus)
  • Risk of internal join (anastomosis) leaking
  • Wound breakdown
  • Damage or bruising to the nerves, which control the bladder and sexual function
  • Formation of internal scarring (adhesions). These may occasionally need further treatment
  • Damage to the spleen, which may result in it being removed if it cannot be repaired
  • Damage to the ureters (the tubes which drain from the kidneys), bladder, small bowel, uterus or any other intra-abdominal organ.

If you have further questions about your operation to make sure you understand exactly what is going to happen then you should speak to your surgeon or specialist nurse. Frank discussions about surgery can be distressing but it is important to us that you understand about every aspect of your treatment.

Preparing for your operation

Depending on your operation you may require an enema to empty the bowel before surgery. The nurses on the ward will advise you of this.

You will be told by the ward nurses what you can eat and drink in the time leading up to your operation.

You may require a drip into a vein in your arm the night before your surgery to maintain hydration.

Who is involved in your care whilst in hospital?

There are a number of Healthcare professionals who are likely to be involved in your care whilst in hospital. These include :

  • Doctors
  • Nurses
  • Medical Students
  • Healthcare Assistants
  • Physiotherapists
  • Dietitians
  • Pain Control Nurse Specialist
  • Colorectal/Stoma Nurse Specialists
  • Pharmacists

We work hard to ensure each member of the team is fully informed of you condition. Feel free to ask to talk to specific members of the team if you have particular questions about your recovery.

Recovering after your operation

Recovering after any operation involves a partnership between you and the team of healthcare professionals involved in your care. Your co-operation will aid your recovery process and reduce time spent in hospital.

At the West Middlesex University Hospital we follow some research-based principles to enhance recovery after bowel surgery. These include:

  • Thorough pre-operative planning
  • Effective pain relief after surgery
  • Early Mobilisation after surgery
  • Early introduction of oral nutrition after surgery

Please see the Enhanced Recovery Information leaflet for further details on this programme.

After your operation it is possible that you will spend a short period of time in the Intensive Care or High Dependency Unit. This is to closely monitor and stabilise your condition before you are moved back to the ward. It is not necessary for all patients and the level of support is tailored to individual patients' needs.

To ensure you do not become dehydrated you will have a drip into a line in your neck or into a line in your hand, when you are drinking enough the nurses will stop your drip.

You may have a nasogastric tube in place when you wake up. This is a tube that passes through your nose and into your stomach. This tube allows fluid to be drained from your stomach until your bowel starts working again and will help to reduce sickness. This tube also allows us to feed a liquid feed slowly into your bowel to give you extra nutrition. The dietitian will assess your diet regularly and may also recommend high energy drinks for you to drink. Your body cannot heal itself without nutrition so we take steps to ensure you are getting enough calories. Everyone is different but you will normally be allowed to eat 1-2 days after surgery. Your team of doctors will assess you every day.

You will have a catheter in place, which is a small tube that passes into your bladder and drains your urine into a bag. This is to enable us to accurately monitor you level of hydration. The catheter will be removed as soon as possible after the operation. We do not leave unnecessary tubes in place as they are a potential source for infections and we remove all tubes that are in place at the earliest opportunity.

You may have a tube going into your abdomen which is a drainage tube to drain any fluid that can collect after surgery takes place. The colour and volumes of fluid will be monitored by the nurses and the tube will be removed as soon as possible after the operation.

You will have a dressing covering your wound. Your wound will be closed with stitches under the surface of the skin and clips which look like staples will be on the surface of the skin. These stay in for 7-10 days after your operation. The dressing will be checked regularly by the nurses. It is not uncommon for the wound to ooze requiring a new dressing which the nurses will see to.

You will be wearing specially measured surgical stockings during your stay in hospital. These are to help circulation and reduce the risk of blood clots forming. You will also have a daily injection of Clexane which is an anti-clotting medication.

After your operation you will be encouraged to move around as soon as possible. This is an essential part of your recovery and will minimise the risks of complications such as blood clots, chest infections and will also prevent muscles in your legs weakening. When you are in bed it is important to do regular leg movements. You should also sit upright and do regular deep breathing exercises. The nurses and physiotherapists will explain these to you. By complying with these exercises your recovery is likely to be faster.

Your blood pressure, pulse, temperature and breathing rate will be recorded regularly. The charts, including your medicine chart and other information is kept at the end of your bed. Feel free to read through these charts and discuss any concerns with the nurses.

Pain Control

Pain control will have already been discussed with you before your operation. The pain control specialist nurse and the ward nurses will do everything they can to make you recovery as pain free as possible and it is important that you let your nurse or doctor know if you have any pain or discomfort.

Bowel Movements

The bowel works by muscular contractions. After surgery to the bowel, an anaesthetic, and limited movement after surgery these contractions are slower or may stop for a short period. You should not be worried about this, bowel function after an operation differs from one person to another. Your doctors and nurses will ask you regularly if you have passed wind and if your bowels have opened.

Your bowel habits may become unpredictable, with a sense of urgency. The colour and consistency of your bowel motions may also vary. Your bowel habit should settle down, and your specialist nurse can talk to you further about this.

If you have concerns about any aspect of your care whilst in hospital discuss it with a member of the ward team so any anxieties can be promptly dealt with.

Infection Control

At the West Middlesex University Hospital the staff are dedicated to minimising the risk of hospital acquired infections. This includes measures such as hand washing and vigilant adherence to the hospital’s infection control policy. Should you require further information please ask a member of the ward team.

Results

A piece of your bowel will have been removed during your operation and sent to the laboratory for testing. The results of these tests will be available in approximately 10-14 days after your operation and you will almost certainly be discharged home before the results are available.

These results will be discussed with you at your follow up appointment and a plan for any other treatment discussed with you. Your specialist nurse will be able to discuss this further with you before you go home.

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