Large bowel resection

Overview

A bowel resection is a surgical surgery that involves the removal of a segment of your small or large intestine. The damaged part of your intestine is removed during surgery, and the two healthy ends are linked together.

Types of bowel resections

Bowel resections of many varieties are performed to remove various segments of the intestine. Each form of bowel resection is called by the organ or tissue that is removed.

• Right hemicolectomy

A right hemicolectomy removes:

• • Part of the ileum
  • The Cecum
  • The ascending colon (the first part of the colon)
  • The hepatic flexure (the bend in the colon near the liver)
  • The first part of the transverse colon (the middle of the colon)
  • The appendix

Tumors in the right colon, including the cecum and ascending colon, are removed by a right hemicolectomy. It can also be used to remove appendix tumors. The transverse colon is completely removed during an extended right hemicolectomy. It is used to remove tumors from the hepatic flexure or the transverse colon.

• Transverse colectomy

The transverse colon is removed during a transverse colectomy. When the cancer has not progressed to other areas of the colon, this procedure may be used to remove a tumor in the center of the transverse colon. An extended right hemicolectomy is sometimes performed instead.

• Left hemicolectomy

A left hemicolectomy removes:

• • Part of the transverse colon
  • The splenic flexure (the bend in the colon near the spleen)
  • The descending colon
  • Part of the sigmoid colon
    

• Sigmoid colectomy

The sigmoid colon is removed during a sigmoid colectomy. It is used to eliminate sigmoid colon tumors.

• Low anterior resection

A low anterior resection removes the sigmoid colon and part of the rectum. It is used to remove tumors in the middle or upper part of the rectum.

• Proctocolectomy with coloanal anastomosis

A proctocolectomy (also known as a proctectomy) involves the removal of the whole rectum as well as a portion of the sigmoid colon. The residual colon is joined to the anus via coloanal anastomosis. This procedure is performed to remove malignancies from the lower rectum. Instead, a low anterior resection or an abdominoperineal resection is frequently performed.

• Abdominoperineal resection

An abdominoperineal excision eliminates the rectum, anus, anal sphincter and muscles surrounding the anus. It is used to remove tumors around the anus or that have developed into the muscles surrounding the anus.

• Subtotal or total colectomy
  

A colectomy is a surgical procedure that removes part or all of the colon. A subtotal or partial colectomy is performed when the majority of the colon is removed. A whole colectomy occurs when the entire colon is removed, including the cecum and appendix.

A subtotal or total colectomy is done:

1. When there is cancer on both the right and left sides of the colon
2. As a way to prevent colorectal cancer (called a prophylactic colectomy) for some people with familial adenomatous polyposis (FAP) or Lynch syndrome (also called hereditary non-polyposis colon cancer or HNPCC)
3. To remove a colon that is damaged by an inflammatory bowel disease

Depending on the type of colectomy done, the surgeon may also need to do a colostomy or an ileostomy 

Preparing for a bowel resection

Before surgery, tests will be performed to assess your overall health. To assess the health of certain organs, blood tests, a chest x-ray, and an electrocardiogram (ECG) may be performed. You may also be subjected to blood testing to rule out malnutrition. If you are malnourished, your bowel resection may be delayed until you improve your nutrition. Learn more about these tests, surgeries, and nutrition for cancer patients.

If you need to follow a particular diet before surgery, your healthcare staff will advise you. They will also advise you on when you should cease eating and drinking before surgery.

You may need to empty your gut before surgery, depending on the kind of bowel resection. This generally entails taking a laxative one to two days before to surgery. Cleaning enemas may also be administered in the hospital.

If you require a colostomy or an ileostomy, your surgeon will normally label the abdomen to ensure that the stoma (opening) is in a handy and comfortable location. Your surgeon or healthcare team may also discuss the sort of pouch you will require following surgery. Antibiotics may be used before to surgery to assist avoid infection.

Ways to have surgery

There are two main ways you can have bowel surgery: keyhole (laparoscopic) and open surgery.

• Your surgeon inserts equipment and a tube-like telescopic camera via small wounds ('ports') in your belly during keyhole surgery. They then use a bigger incision to remove the appropriate piece of bowel. Images from the camera are shown on a monitor for your surgeon to observe.
• Your surgeon will make a single major cut into your abdomen to reach your colon and remove the problematic piece during open surgery.

Keyhole surgery allows people to heal faster, spend less time in the hospital, and experience less discomfort. However, not everyone is eligible for keyhole surgery; it is dependent on your circumstances. During the operation, your surgeon may need to move from keyhole to open surgery. Before your operation, they'll explain to you about the risk of this happening and what it means.

In certain facilities, a revolutionary style of surgery that employs robots is being employed for back passage surgery (rectum). Because this is a novel approach that is currently being researched, it is not yet available everywhere.

How a bowel resection is done?

A bowel resection is performed in a hospital under general anesthesia (you will be asleep). The surgeon removes the sick or damaged portion of the intestine during a bowel resection. In addition, some healthy tissue on each side of the sick or damaged segment of the intestine is removed by the surgeon.

• Anastomosis

Before attaching the ileum or colon to the anus, the surgeon may shape it into a pouch (called a J-pouch). When the rectum is removed, a J-pouch forms a holding area for stool (poop). It aids in reducing the amount of bowel motions and managing the inability to control bowel movements.

An anastomosis is not always performed. Instead, one or both ends of the intestine are linked to an aperture in the abdomen. Depending on which segment of the intestine is utilized, this surgery is known as a colostomy or an ileostomy.

• Lymph node dissection

If the surgeon is removing cancer from the bowel, he or she will also remove at least 12 nearby lymph nodes. Lymph node dissection is the surgical removal of lymph nodes.

TME is a form of lymph node dissection that removes the mesorectum, which is fat around the rectum that includes lymph nodes and blood arteries. A TME is typically performed as part of a bowel resection to remove malignancy from the rectum. Some of the tissue around the tumor is also removed.

• Colostomy or ileostomy

After a bowel resection, the surgeon may need to perform a colostomy or an ileostomy depending on which part of the intestine is damaged and how healthy the rest of the intestine is.

A colostomy is a hole in the abdominal wall that connects the colon to the outside world. An ileostomy is a surgical procedure that connects the ileum to the outside of the body via the abdominal wall.

An ileostomy or colostomy can be either temporary or permanent. To enable the intestine to rest and repair following surgery, the doctor may perform a temporary colostomy or ileostomy. If the bottom part of the rectum and the anal sphincter are removed during the bowel resection, the colostomy or ileostomy will be permanent.

What to expect after bowel surgery?

After your procedure, you'll spend the first few hours in a special recovery section before being moved to a ward or other unit. You may have some discomfort as the anesthesia wears off, but you will be given pain medication as needed. Patient-controlled analgesia and epidurals are the two most popular methods of pain reduction. Morphine is given directly through a cannula or drip during patient-controlled analgesia. An epidural is a pain-relieving injection into the area around your spinal cord (the epidural space).

Initially, a catheter will be used to empty urine from your bladder into a bag. Fine tubes (drains) may also emerge from your belly to drain fluid into another bag. Typically, they are removed within a few days. Fluids will be administered through a drip in your hand or arm. After a day or so, this is generally erased. You'll be encouraged to eat and drink whenever you're ready.

You will be given a daily injection of an anti-clotting drug and urged to continue wearing compression stockings to help avoid deep vein thrombosis (DVT). You'll also be urged to get out of bed and move as quickly as possible. You may also be shown activities that may be done while sitting or lying down, such as breathing exercises to cleanse your lungs.

You'll be able to go home a few days following surgery, although the precise time will vary. It will depend on the sort of surgery you underwent and how well you recuperate. Before you leave, your nurse will give you instructions on how to care for your healing wounds and, if you have one, your stoma. If you have a stoma, you will be given the contact information for a stoma nurse, whom you may contact after you return home if necessary.

Complications after Surgery

Complications are issues that might arise during or after surgery. Any procedure might have consequences such as an unanticipated response to the anesthesia or developing a chest infection afterwards. Excessive bleeding or the formation of a blood clot, commonly in a vein in your leg, are additional possible complications (deep vein thrombosis).

Specific complications of bowel surgery include the following.

• The new bowel junction is leaking (an anastomotic leak). This can cause severe stomach discomfort and make you feel quite ill, especially if you have a fever. If you have an anastomotic leak, you may need to be admitted to the hospital for additional treatment and surgery.
• A wound infection. Your wound may swell, turn red, and become painful to the touch. You can have a fever and feel ill as well. If you have any of these symptoms, please contact your local hospital.
• Bands of scar tissue (adhesions). These can occur following surgery and cause your tissues or organs to stay together. Adhesions can cause persistent abdominal discomfort and clog your bowel. You might be able to devise a method to separate them.
• Temporary paralysis of your bowel (ileus). It takes time for your bowel to resume normal function. You may feel bloated, nauseated, or have bowel movements issues. If you aren't improving after a few days, your medical staff will give you fluids to assist you recuperate.
• Nerve damage. If nerves in your pelvic area are damaged during surgery, this can lead to loss of sensation. This could affect your sex life or how well you can control your bladder. 

Recovering from bowel surgery

It normally takes at least six weeks following bowel surgery to feel like you're back to normal. However, you should avoid heavy lifting and hard exertion for an extended period of time.

You may have some pain and discomfort as a result of your procedure for some time. You may be given pain relievers to take home, but you can also use over-the-counter pain relievers such as paracetamol or ibuprofen if necessary. Always read the patient information that comes with your medication, and if you have any questions, get assistance from your pharmacist.

It may take some time for your bowel to settle following surgery. While your gut is healing, your doctor may advise you to make certain dietary modifications. 

It's normal to feel fatigued when healing and to require more sleep and rest than usual. It is critical to take time to rest. However, try to get up and walk around as much as possible, and continue with any exercises prescribed by your physiotherapist. This can help you feel better, regain your strength, and lower your risk of problems.

After surgery

You will need to stay in the hospital for many days following a bowel resection. To keep you comfortable, you will be given pain relievers. You will be given clear fluids for 1 to 2 days following surgery. Solid meals will be gradually introduced.

If the intestinal resection was done to remove malignancy, you may be sent to an oncologist. A WOC (wound, ostomy, and continence) nurse will educate you how to live with and care for your ostomy if you have one. Before you leave, the healthcare team or WOC nurse will discuss with you:

• Changing the bandages or dressing
• Showering and bathing
• How and when to take any medicines
• Eating and drinking
• Physical activity
• What to do if you have problems
• When to visit the surgeon for follow-up

Special considerations for children

Preparing children for a test or treatment can reduce anxiety, boost cooperation, and help them develop coping skills. This involves clarifying what will happen throughout the exam to children, such as what they will see, feel, and hear. Preparing a child for a colon resection is dependent on the child's age and experience.

Frequently asked questions

• Will I need to change what I eat after bowel surgery?

While recovering after surgery, it is common to be instructed to eat a low-fiber diet. This includes eating white bread, spaghetti, and plain crackers, as well as just well-cooked or peeled fruits and vegetables. Diarrhea is frequent following colon surgery, and this can help avoid it.

Bloating and extra wind are usual following bowel surgery, so avoid foods and beverages that may exacerbate this. Onions, garlic, beans, fizzy drinks, lager, and beer are examples. These symptoms may be alleviated by drinking peppermint and fennel tea.

To aid your body's healing, eat smaller, more frequent meals heavy in calories and protein, such as meat, fish, and eggs. To avoid getting wind, eat your meal slowly and properly. You may be able to reintroduce specific foods when your gut recovers and calms. It may be beneficial to keep a food diary in order to document how different meals impact you. If your bowel motions do not appear to be returning to normal, consult your doctor or a dietician.

• Will bowel surgery affect my sex life?

Surgery near your back channel (rectum) may disrupt your pelvic nerves, causing problems with sex. Men may have erection or ejaculation issues, while women may have decreased sensitivity and vaginal alterations that make sex difficult. If this is affecting you, speak with your doctor; they may be able to prescribe medications to assist. These issues can sometimes improve over time.

You may be self-conscious about having sex if you have huge scars or a colostomy (or ileostomy) bag as a result of a stoma. Discuss your concerns with your specialized stoma nurse, who will be able to assist you and give advice and support.

• How will a colostomy or ileostomy bag affect my life?

Having a colostomy or ileostomy bag should not prevent you from doing the activities you used to do. However, it may take some time to acclimatize to having one, and you may need to make minor tweaks and plan ahead more

A specialized stoma nurse will show you how to care for your stoma and colostomy or ileostomy bag before you leave the hospital. The bags are meant to be concealed behind typical apparel. They should not leak or stink (except while being changed, and you can buy products to reduce any odour). You may bathe or shower while wearing one.

Your stoma nurse may visit you at home to provide more guidance on daily chores. For example, you can acquire a device that prevents your seat belt from pushing against your stoma and bag while driving. There is no reason why you should not return to work, although you may need to make some modifications in some cases. For example, if your job requires heavy lifting or other actions that impose pressure on your abdominal muscles, you may need to wear a support garment or reconsider your duties.

A stoma does not normally necessitate a particular diet. However, you may need to make certain dietary modifications while recovering after surgery. 

Conclusion 

Bowel resection, also known as partial colectomy, is the surgical removal of a diseased or damaged piece of the colon or rectum. Many disorders that affect the colon, such as colorectal cancer, diverticulitis, and Crohn's disease, can be treated with bowel resection.