Left hemi-colectomy

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.

Your problem lies in the left side of the colon or upper rectum. The left side of the colon is taken out, and the ends are joined up whenever possible.

The operation

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 in the middle lower part of your abdomen
• 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 and opens in the front of your tummy (a stoma)
• You may need to wear a bag and 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 a week.

Keyhole Surgery

• you will have a general anaesthetic, and will be asleep for the whole operation
• 3 cuts are made in the skin in the middle lower part of your abdomen
• 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 and opens in the front of your tummy (a stoma)
• You should plan to be in hospital for 3-5 days

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

• 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
• bring all your tablets and medicines with you to the hospital
• arrange for a relative or friend to:
  - come with you to the hospital
  - take you home, and
  - look after you for the first week after you leave 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.

• 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 will 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.

You maybe asked to see the stoma nurse. She will talk about the operation and the stoma

• 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.
• 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 another plastic bag.
• This is to drain any blood left from the operation the wound is painful for several days. You will be given painkillers to control this.
• Ask for more if the pain is not controlled or if it gets worse
• The nurses will help you with everything you need until you are able to do things for yourself
• You will probably have a fine drainage 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 ward nurse will show you how to manage your stoma if you have one and the stoma nurse will oversee
• The wound will have 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 2-4days.
• You can wash as soon as the dressing has been taken off.

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

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

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

You are likely to feel very tired and need to rest 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. Some studies suggest that it happens in up to 50% of cases. The surgeon can discuss this with you.

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 is much quicker than with open surgery but caution still should 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 and may take a week or more. You will continue to have food and water through your vein tubing until you pass wind or open your bowels.

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.

One possible major complication is a leak from the area where the two parts of your bowel were put back
together. The chance of a leak is up to 15%. It is more frequent in patients whose wounds may take longer to heal. For example elderly people, diabetics and patients suffering from cancer.

If you do have a leak you will stop eating and drinking for several days until the bowel heals completely. In the meantime you will be given all the food and water you need through a catheter in one of your veins. This often fixes the problem but another operation may be needed to control the leak.

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.

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, as help may be available.