WHAT TO EXPECT WITH YOUR
Below is a detailed description of the colorectal surgery process. Please read the following to familiarize yourself with what you can expect from your treatment. If you have any questions, do not hesitate to contact us.
Colorectal surgery procedures are generally between two and three hours in length, but may take longer depending on the particular circumstance. The majority of colon resections performed by the doctors here at Colon Rectal Surgical Associates are laparoscopic (minimally invasive) surgeries. These procedures involve making a series of small incisions, ranging in size from a quarter of an inch to four inches, in the patient’s abdomen. A small video camera, or scope, is placed in one of the incisions, providing the surgeon with a magnified view of the patient’s internal organs on a monitor. Surgical instruments are placed in the other incisions, allowing the surgeon to work inside and remove the cancer or diseased portions of the colon.
Minimally invasive treatment has been shown to be as effective as open surgery, and offers many advantages over the open procedure. These benefits include:
- Quicker recovery time. Most patients report being back to work in about three weeks.
- Shorter hospital stays. Patients typically require no more than two to four days in the hospital after laparoscopic surgery.
- Less pain and scarring.
Some factors might preclude a patient from undergoing a minimally invasive procedure; these include obesity, prior abdominal surgery, dense scar tissue, bleeding problems during the procedure, large tumors, an inability to visualize the organs, or concerns for the patient’s safety.
Prior to your procedure, you’ll likely need to obtain a pre-operative clearance from your primary care physician. This clearance consists of a medical history and a physical examination, as well as additional tests and blood work. A by a cardiologist or pulmonologist might be required as well. Other tests and preoperative evaluations may be ordered to assist in planning the procedure.
You will probably be given a preparation to clean out your colon the day before your surgery; this helps to decrease the risk of infection. Please do not eat or drink anything after midnight the day before your surgery (except medications with a sip of water), unless specifically instructed otherwise. Aspirin, Motrin, or related products, or blood thinners such as Coumadin should not be taken within five days of your surgery; vitamins and herbal supplements should be stopped 10 days prior to the procedure.
On the day of your surgery, you will be required to arrive at the hospital one to two hours prior to your procedure. It is imperative that you arrive on time, as arriving late may result in the cancellation of your procedure.
You will be directed to a preparation area in your hospital, where a nurse will greet you, obtain a brief history, make sure that your pre-operative studies are available, and help you change into a hospital gown. You’ll also be seen by an anesthesiologist. In the case of non-laparoscopic surgeries, the anesthesiologist may place an epidural catheter to improve post-operative pain control. For those undergoing a laparoscopic procedure, post-operative pain is managed by a patient-controlled device known as PCA. Most patients having low colon or rectal surgery will have two ureteral catheters placed by a urologist. One of the ureteral catheters is removed immediately after surgery, while the second one is removed on the first day after surgery. The catheters are painless, and help to lower the risk of injury to the ureters (the tube leading from the kidney to the bladder), which is near or in the surgeon’s operating field.
Once your procedure is completed, you will be taken to a recovery area for one to two hours. Nurses will help you to wake up, and will monitor your vital signs. Your family might not be able to visit you during this time; they will be able to see you afterward, however, when you are transferred to your room. You will find a tube in your bladder – a Foley catheter, which allows us to monitor your hydration status. This will remain in place for one to two days following your procedure. In the case of open (non-laparoscopic) surgeries, a nasogastric tube may be put place to remove air and secretions from the stomach. This is typically removed on the first postoperative day.
In order to improve recovery, your doctor will recommend for you to be out of bed and sitting in a chair on the day of your surgery, and taking a few steps in your hospital hallway by the evening of the surgery.
Your doctor and nurses will teach you and deep-breathing exercises, which work to expand your lungs and protect against fever. Special devices will be placed on your legs to aid in circulation; you will also receive medication to prevent blood clots.
Patients undergoing minimally invasive surgery may start consuming clear liquids in the evening after the procedure. Over the next day or two, as bowel function returns, we will advance your diet so that you will be on solid food by the time you return home. Open surgery typically lags 24-36 hours behind this time frame.
You will be allowed to leave the hospital and return home once you are able to tolerate a solid food diet. There should be no signs of an infection. Prior to discharge from the hospital, you will receive prescriptions for pain medication and other appropriate medication, as well as specific instructions from your doctor, which should be followed for two to three weeks after your procedure. Arrangements for a visiting home nurse can be made, if needed.
Recovery from laparoscopic surgery typically takes about three to four weeks; open procedure recovery takes roughly four to six weeks. You should not lift anything heavier than 10 pounds or operate a car for two to three weeks. We recommend that you eat five to six small meals per day for the first week or two; cut back on dairy products and avoid fresh fruits or vegetables, as these foods my keep the stool loose. Additionally, you should add a probiotic to your diet for at least two weeks, to help get the bacteria in the gut back to normal. You should expect to experience fatigue and lack of energy for the first week or two, and you may sleep a fair amount during the day.
Contact our office to schedule a follow-up appointment for about four weeks after your return home. If you have any questions about the pre-op instructions, your procedure or recovery, please call us.