Anterior resection of the rectum

The bowel is a tube of intestine which runs from the stomach to the back passage. The lower half of the bowel is called the colon. This runs up to the right ribs and loops across the upper part of the belly. Then it passes down the left side to run backwards into the pelvis towards the back passage. This is called the rectum.

In your case, the problem lies in the left side of the colon or upper rectum. The left side of the colon and upper rectum is taken out, and the ends are joined up whenever possible. Although this operation is often performed using the traditional 'open' method with a cut across the abdomen, the laparoscopic (key-hole) method has the advantage of causing less post-operative pain and patients are able to return to full activity in a shorter time

The operation (Open)

• you will have a general anaesthetic, and will be asleep for the whole operation
• a cut is made in the skin to the left of the tummy button about 10cm long
• the left side of the colon loop and the upper rectum are freed from the inside of the tummy
• the diseased part is cut out and usually the ends are joined together

Laparoscopic (Key-hole)

• you will have a general anaesthetic, and will be asleep for the whole operation
• three or four small cuts made into the skin to allow camera and operating instruments
• the left side of the colon loop and the upper rectum are freed from the inside of the tummy
• the diseased part is cut out and usually the ends are joined together
• Sometimes it is safer if the ends are not joined together. Then the bowel waste is channelled through the bowel, which opens on the front of your tummy (a stoma). You will then need to wear a bag. Usually the ends are joined up at a later date.
• Sometimes the ends are joined up at the first operation, but a short term stoma is made as well.
• This keeps the bowel waste away from the join while it is healing.
• If the problem area is in the lower part of the rectum, the back passage may need to be removed as well. This is very rare. You would be warned about this before the operation.
• You should plan to be in hospital for about 5-7 days for 'open' operation and 3-5 days for laparoscopic operation.

Are there any alternatives?

• Simply waiting and seeing is not a good plan
• The trouble you are having with your bowel will get worse and may well lead to serious problems
• Tablets and medicines will not help, neither will x-ray and laser treatment

Before - at home

• stop smoking
• get your weight down if you are overweight
• if you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check these

if you are taking any of the following, check the hospital's advice about taking them:

• the pill
• hormone replacement therapy (HRT)
• aspirin, or
• warfarin

arrange for a relative or friend to:

• come with you to hospital
• take you home, and
• to look after you for the first week after you leave hospital

bring all your tablets and medicines with you to hospital

We usually recommend that five days before your operation you eat a light diet that is low in fibre. For example fish, chicken, rice and mashed potato. Try to avoid vegetables, fruit, cereals and wholemeal bread. You can drink as much as you like.

Sweet drinks will help to keep up your strength and calorie intake.

You will meet with the stoma nurse, who will see you in clinic. She will talk to you about your operation and stoma.

• When you attend the clinic you may be checked for past illnesses. You may have special tests to make sure you are well prepared and that you can have the operation as safely as possible.
• An anaesthetist will also come to see you, to discuss the type of anaesthetic you will be given. He or she will ask you about chest problems, dental treatment and any anaesthetics you have had in the past.
• The anaesthetist will also discuss different types of pain relief with you.

You will have a drip to give you fluids while you are not allowed to drink. This is a plastic tube attached to either your arm or neck. The doctors listen to your bowel through your tummy with a stethoscope. When they can hear sounds from your bowel or you have passed wind they start to give you oral fluids. This can take a few days. This is gradually increased until you are able to drink as much as you want.

• Once you are drinking normally the drip will come out and you will be able to eat a light diet.
• you will have a dressing on your wound
• you may have a stoma
• if the wound is painful, you will be given painkillers to control this
• ask for more if the pain is still unpleasant. By the end of four days you should have little pain you will probably have a fine drainage tube (catheter) going into your bladder to drain the urine. This will be taken out once you are able to get out of bed easily
• The wound has a dressing, which may show some staining with old blood in the first 24 hours. There may be stitches or clips in the skin. Stitches and clips are removed after about 10 days.
• If you have a stoma, the ward nurses will show you how to manage it and the stoma nurse will oversee.
• You will be given an appointment for a check-up at the outpatient department about six to eight weeks after you leave hospital. You will know the results of the examination of the bowel by then.
• The nurses will tell you about things like sick notes and certificates.

After a general anaesthetic

The anaesthetic drugs will make you slow, clumsy and forgetful for about 24 hours. Do not make important decisions during that time.

You are likely to feel very tired and need rests two or three times a day for a month or more. You will gradually improve so that after three months you will be able to return to your usual level of activity.

You can drive as soon as you can make an emergency stop without discomfort in the wound. This should be after about six to eight weeks.

You can restart sexual relations within two or three weeks when the wound is comfortable enough. There may be some damage to the sex nerves after this operation. The surgeon can talk to you about this.

You should be able to return to a light job after about six weeks and any heavy job within 12 weeks.

If you have a stoma, you will get help and advice from the stoma nurses.

The recovery time is much quicker than with the open surgery, but caution still should be taken when heavy lifting or driving.

Complications are unusual but are quickly recognised and dealt with by the nursing and surgical staff. If you think that all is not well, ask the nurses or doctors.

You may get a chest infection, particularly if you smoke. It is important not to smoke and to co-operate with the physiotherapists to clear the air passages to prevent this.

The bowel can be slow to start working again. You will continue to have food and water through your vein tubing until your bowel works.

There can be some discharge from the drain by the wound, but this stops given time.

Sometimes the join in the bowel can leak.

Wound infection happens more often in any bowel operation compared to other 'clean' operations such as taking out your gallbladder. The reason is that the bowel has many bugs that can cause an infection. This settles down with antibiotics in a week of two.

You may have aches and twinges in the wound for up to six months. There can be numb patches in the skin around the wound. These will get better after two to three months.

General advice

Some patients are surprised how slowly they get back their normal stamina. Nearly all patients are back to normal within three months. We hope these notes will help you through your operation. They are a general guide, they do not cover everything.

• If you have any questions or problems, please ask the doctors or nurses.
• Are there any long term effects of the operation?
• To start with your bowel actions are likely to be very loose, unpredictable and quite urgent. It can take several months for this to settle and for you to develop a predictable pattern. Your bowel function is unlikely to be exactly the same as before your operation.
• The expectation of what is "normal" for you might need to be adjusted. If loose bowels become a persistent problem, discuss this with your doctor. There are medicines that can help to firm the stool up.
• Some people have sexual difficulties after major abdominal surgery. It is normal to feel wary and anxious at first.
• If difficulties last, please discuss this with your doctor or nurse as help is available.