Colectomy - total and ileostomy

The bowel is a tube of intestine that 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.

If most of the colon is diseased it can cause diarrhoea, bleeding or general illness, so it is better removed.  Sometimes the ends can be joined up inside your tummy.  More often, the back passage is not healthy enough to make a safe join.  Then the lowest part of the small bowel is brought out as a sort of spout (ileostomy) on the right side of the tummy.  The bowel waste runs into a special bag stuck over the ileostomy.

Open Surgery

• you will have a general anaesthetic, and will be asleep for the whole operation
• a cut about 15cm long is made in the skin
• the colon is freed inside your tummy and the diseased bowel is taken out
• the lower end of remaining bowel is stitched shut
• the upper end is made to open as an ileostomy
• the wound in the tummy is stitched up

You should plan to be in hospital for about a week

Keyhole Surgery

• you will have a general anaesthetic, and will be asleep for the whole operation
• 3 small cuts 2cm long are made in the skin and muscle in the central lower part of tummy wall
• the colon is freed inside your tummy and the diseased bowel is taken out
• the lower end of remaining bowel is stitched closed
• the upper end is made to open as an ileostomy
• the wound in the tummy is stitched up

You should plan to be in hospital for 3-5 days

Are there any alternatives?

Leaving things as they are is risky.  Bleeding or perforation means that an urgent operation is a must.

General ill health will not get better by carrying on with drug treatment alone.

A bigger operation to take out the back passage as well as the rest of the colon is not needed.

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  
  -  look after you for the first week after you leave hospital
• bring all your tablets and medicines with you to the hospital

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

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.

In Pre-Assessment

• you will be checked for past illnesses.
• you will have special tests to make sure that you are well prepared and that you can have the operation as safely as possible.
• an anaesthetist 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.
• if you are not sure about anything, please ask a doctor or nurse for more details.

After - in hospital

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 and a drainage tube nearby, connected to a plastic bag. This is to drain any blood left from the operation
• the wounds are painful for several days. You will be given painkillers to control this
• you will probably have a fine rubber tube (catheter) going into your bladder to drain the urine. This will be taken out when you are able to get out of bed easily
• the stoma may not work immediately. It is always runny.
• the nurses will help you with everything you need until you are able to do things for yourself
• you will get special advice and help from the stoma nurses

You should be eating and drinking normally after about four to six days.

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 7 to 10 days.  The drain tube is removed after about 2-4 days.

There may be some purple bruising around the wound.  This spreads downwards and will fade to a yellow colour after 2 to 3 days.  It is not important.

There may be some swelling of the surrounding skin, which also improves in 2 to 3 days.

You can wash as soon as the dressing has been removed.

You will be given an appointment for a check up at the outpatient department about six to eight weeks after you leave hospital.

The nurses will tell you about things like sick notes and certificates.

The stoma nurse will keep in contact with you at home.

After a general anaesthetic

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

After - at home

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 three to four weeks when the wound is comfortable enough.  There may be some damage to the sex nerves after the operation. The surgeon will talk to you about this.

You should be able to return to a light job within eight weeks and a heavy job within 12 weeks.

After keyhole surgery the recovery time is much quicker than with the open method of surgery but caution should still be paid to heavy lifting and driving

As with any operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs.

The tests that you will have before the operation will make sure that you can have the operation in the safest possible way.  This brings the risk for such complications very close to zero.

This is a major operation and complications can happen more often compared with other operations of the bowel.  When they do happen, they are quickly recognised and dealt with by the surgical staff.  If you think that all is not well, let the doctors or the nurses know.

You may get a chest infection, particularly if you smoke.  To prevent chest infections it is important to:

• get out of bed as soon as possible
• get as mobile as possible
• co-operate with the physiotherapists to clear the air passages
• do not smoke

The bowel can be slow to start working again.

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

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 or two.

Very rarely, during the operation, another part of the bowel, bladder or a blood vessel can be damaged.  Another operation may be needed to deal with this.

You may also have:

• aches and twinges in the wound for up to six months
• numb patches in the skin around the wound - these get better after two to three months
• slow healing of the lower wound
• trouble with the stoma

Some patients are surprised how slowly they get back their normal stamina.  Nearly all patients are back to normal within three months.

Your social life should not be affected by the operation.

The stoma nurses will keep in touch with you always.

We hope these notes will help you through your operation.  They are a general guide, and do not cover everything.

If you have any questions or problems, please ask the doctors or nurses.