Robotics

Safe Surgery Guidelines From The ASCRS


Tips for Safer Surgery

What you should know. What you can do.
Courtesy of the Surgical Care Improvement Project Partnership

Millions of people have surgery each year. Every surgery has risks, but we know there are some that can be prevented. What does this mean to you as a patient? If your doctors and nurses follow some simple steps, you will have a shorter and safer hospital stay.

Questions to Ask Your Doctors and Nurses Before Surgery
One way you can help lower your risk for problems from your surgery is to talk with a member of your surgical care team before surgery about the type of care you should receive. Your care team includes your surgeon, your anesthesiologist and your nurses. Ask your doctor or nurse who you should discuss this tip sheet with and when. This tip sheet will help you know what to ask.

To avoid infection–

If I need antibiotics before surgery, when will I receive the antibiotic and for how long?
Antibiotics should given within 60 minutes before surgery and should be stopped within 24 hours in most cases. Given properly, antibiotics can greatly lower your chances of getting an infection after surgery.

If hair needs to be removed from the part of my body that is having surgery, what will you use?
Your doctor or nurse should use clippers to remove hair if needed at the site of your surgery. Using a
razor to remove hair before surgery can cause infections because of the risk of leaving small cuts on the skin.

To avoid blood clots–

What will you do to prevent blood clots?
Blood clots can lead to heart attacks and strokes. When you have surgery, you are at risk of getting blood clots because you do not move while under anesthesia. The more complicated your surgery, the higher your risk. Your doctor will know your risk for blood clots and steps that will help prevent them, such as giving you the right medicine before surgery.

To avoid heart attacks–

If I take medicine for heart disease, should I keep taking it?
Taking certain medicines together can cause problems. Tell your doctor about all the medicines you are taking, including over-the-counter things like aspirin and herbal remedies. Your doctor or nurse will tell you which medicines you should continue to take and which medicines you should stop taking before surgery.

Other Information
• Tell your doctor about other medical problems you may have, such as allergies or diabetes. These problems could affect your surgery and treatment.
• Patients who smoke get more infections. Talk to your doctor about how you can quit.
• If you do not see them do so, ask your care team members to wash their hands before examining you.
• Speak up if you have questions or concerns. If you don’t understand, ask again. It’s your body and you have a right to know.

Other Resources
• For information on preparing for surgery, please visit http://www.ahrq.gov/consumer/surgery/surgery.htm, which offers additional questions to ask your physician and surgeon about your surgery.
• For information on quality of hospital care, visit Hospital Compare at http://www. hospitalcompare.hhs.gov. It includes information on how often hospitals provide some of the recommended care to get the best results for most patients.
• For information on the Joint Commission’s Speak Up™ program, which includes safety tips for surgical patients and infection prevention, visit www.jointcommission.org/PatientSafety/SpeakUp.
• For patient information concerning anesthesia, please visit http://www.asahq.org/patientEducation.htm.
• For more information concerning surgery, visit the American College of Surgeons at http://www.facs.org/public_info/ppserv.html.
• If you have additional questions, please contact your doctor.

About SCIP
The Surgical Care Improvement Project (SCIP) is a large national partnership dedicated to reducing the number of preventable surgical complications. SCIP includes a number of steps that surgeons, anesthesiologists, nurses and patients can take to lower the number of surgical problems.

Project Coordinators:
Oklahoma Foundation for Medical Quality
14000 Quail Springs Parkway • Suite 400 Oklahoma City, Oklahoma 73134 405.840.2891 • SCIPpartnership@okqio.sdps.org

Colon Surgery General Information


Information for patients undergoing Colon Resection for Benign and Malignant Conditions

CHS Colorectal Surgery, Paul E. Savoca, MD, FACS, FASCRS, Saint Catherine of Siena Medical Center, Smithtown, N.Y., Saint Charles Hospital, Port Jefferson, N.Y.

PLEASE READ THIS SHEET BEFORE YOU CONSENT TO the large bowel (intestine) is made up of the colon and rectum (back passage). This part of the digestive tract carries the remains of digested food from the small bowel and gets rid of it as waste through the anus. Cells that line the colon and rectum may begin to grow out of control, forming a polyp or tumor (a growth of abnormal cells). The large intestine has four sections: the ascending colon, the transverse colon, the descending colon and the sigmoid colon. Tumors can start in any of these areas or in the back passage. Tumors start in the innermost layer and can grow through some or all of the other layers.

The Operation

Surgery is the main treatment for tumors of the bowel. Removal of the diseased bowel is the first treatment for a tumor of the bowel. The goal of the surgery is to give you the best chance of cure through total removal of the tumor. Usually, the tumor and a length of normal bowel on either side of the tumor (as well as nearby lymph nodes) are removed. The healthy parts of the bowel are then stitched or stapled together (anastomosis). If it is not possible to join the bowel back together, an opening (stoma) will be made on the outside of the body for waste to pass out of the body. This is called an ostomy and is made to allow waste to pass through an opening in the abdominal wall. Sometimes, a temporary ostomy is needed until the joined bowel has healed, and then it can be reversed. This is done by further surgery. However, in some cases, the colostomy is permanent, which means it can never be put back, and there will always be an opening on the skin for bowel waste to pass through. A number of different surgical procedures are used depending on where the tumor is. This will be reviewed in detail by your surgeon.

Preparation for Surgery
Before surgery, the bowel may need to be cleansed to facilitate the operation. You will be on a clear fluid diet and given a cleansing solution the day prior to the operation. This can cause diarrhea and cramps, and may be tiring. The solution will completely empty your bowel. You will then fast for at least 6-8 hours before your surgery.

General Risks of Surgery

  • Secretions may collect in the lungs causing collapse and pneumonia. This risk is increased in smokers.
  • Clotting may occur in the deep veins of the leg. Rarely part of this clot may break off and go to the lungs. This can be life threatening and its risk is increased in smoker and obese patients.
  • Circulation problems to the heart or brain may occur which could result in a heart attack or stroke. Smokers and obese individuals are at increased risk.
  • Death is possible during or after an operation due to severe complications.

Specific Risks of Surgery

Leakage of Bowel fluid inside the abdomen (anastomotic leak)
This situation occurs when there is infection at the where the two ends of bowel are joined. The risk is about 5%. If mild it is treated with antibiotic, moderate infection is treated with non-surgical drainage. If severe (1-2%), further surgery and a temporary colostomy may be required. The risk is increased in smokers, obese patients and those with weakened immune systems due to disease or medications.

Ileus (intestinal paralysis)
This occurs for 48-72 hours after all colon operations. In 2-5% of cases, it is prolonged and severe requiring bowel rest (nothing to eat or drink), insertion of a tube through the nose to empty the stomach and sometimes intravenous high calorie supplementation is needed. The vast majority of cases resolve on their own, further surgery is rarely required. Xrays and/or a CAT scan are used to diagnose this condition.

Wound Infection
The surgical incision may become infected. This is treated with antibiotics by mouth or by vein or the wound may need to be opened to drain. Although it takes longer, the wound will eventually heal as if it were closed with sutures. The risk is increased in smokers and obese patients.

Urinary Tract Infection
Bacteria enter the tube draining the bladder. The earlier, the catheter is removed, lower the infection rate. Generally, the tube is removed 2-4 days following surgery. If infection occurs, antibiotics are used to treat it. In some cases, prolonged catheter drainage is required because of pressure on the bladder required during the operation. This is more common in men, especially those with an enlarged prostate.

Damage to the Ureter (tube that leads form the kidney to the bladder)
The ureter is a delicate tube that carries urine from the kidney to the bladder. It lies directly in the operative field and therefore can be damaged during surgery if the bowel next to it is diseased. As a precaution, colon operations are commonly preceded by a procedure that inserts a guide into this tube to avoid this complication. If an injury occurs, it is usually corrected at the time of the operation. Rarely, procedures or further surgery may be required.

Postoperative Bleeding
Significant bleeding occurs in about 5% of patients and either requires no treatment or with blood transfusion. Rarely, further surgery to control the bleeding is required.

Bowel Blockage (Obstruction)
This occurs when scar tissue often referred to as adhesions, form internally as a part of the natural healing process. This can result in kinking or twisting of the small intestine. Patient then experience bowel movement stoppage, abdominal distention, nausea and vomiting. While the symptoms are identical, this is different thean “ileus” described above. Only your surgeon can distinguish the two and xrays or a CAT scan are required. Treatment is the same as for ileus. Obstruction may occur immediately after surgery or many years later. It is the most common abdominal complication of colon surgery long term. Precautions are taken at the time of surgery to reduce this problem but it cannot be eliminated.

Stoma Problems (for those with a colostomy or ileostomy)
Skin irritation: This happens to everyone with a stoma at some point. This usually occurs in response to irritation form the appliance or the glue that causes it ti adhere to the skin. Various medicines can be applied to relieve this or a change in the type of appliance may be required. The ostomy nurse will assist with this.
Prolapse: This is excessive protrusion of the stoma. Usually no treatment is required as it can be easily pushed back in in most cases by applying a warm moist washcloth and gentle pressure. If large, surgery may be required. For temporary stomas, reversal of the stoma corrects the problem.
Hernia: A bulge that occurs around the stoma due to weakening of the abdominal wall due to the presence of the stoma. Small hernias require no treatment, klarger hernia require a truss or support device to be worn. If large, symptomatic and unsightly, surgical repair may be required.
Loss of blood Supply: This occurs due to pressure around the stoma due to conditions in the abdomen at the time of construction, particularly obesity. The blood supply is choked off and the stoma can die. Most times this resolves when the swelling from surgery subsides however surgical correction may be required early after surgery or later when chronic lack of blood supply results in narrowing (stricture).

WHAT TO EXPECT AFTER YOUR SURGERY

In- Hospital Care
After the operation the nursing staff will closely watch you until you have recovered from the anesthetic. You may even be cared for in the intensive care unit immediately following your surgery.

The recovery period after colon surgery varies. It usually involves a stay in the hospital from 3-7 days in uncomplicated cases. On return from your surgery you will have a catheter (plastic tube) in the bladder to measure and drain your urine.

After surgery you will be given intravenous fluids (a drip) through which antibiotics may be given. The drip will remain in place until you are able to drink enough fluids. It general requires 3-4 days before the colon has healed well enough to tolerate anything by mouth. You know the bowel has started to work again when you pass gas and/or have a bowel movement. You will then begin to take liquids by mouth and then solid food. It is likely that on your return from surgery you will be wearing tight fitting stockings that are used to reduce the risk of blood clots forming in your legs. In addition, it is very important that you start moving as soon as possible. This helps to prevent blood clots forming in your legs and possibly going to your lungs. This can be fatal.

Also, you need to do your deep breathing exercises. Take ten deep breaths every hour to prevent secretions in the lungs from collecting. If this happens, you may develop pneumonia. At all costs, avoid smoking after surgery as this increases your risk of chest infection. Coughing is painful after abdominal surgery do not hesitate to use the pain medication provided.

Colostomy (“stoma” or “bag”)
Many patients undergoing colon surgery require a stoma. The colostomy or ileostomy drains bowel waste into an external bag attached to the abdomen. Most colostomy waste is softer and more liquid than normally passed bowel waste. The thickness of the bowel waste depends on where the stoma is. You will be taught how to clean around the colostomy and change the colostomy bag. The colostomy bag sticks to the skin around the stoma with special glue, and can be thrown away when dirty. This bag does not show under clothing, and most people learn to take care of these bags themselves. Stomas may be temporary or permanent, if reversible a second operation is always required.

Wound
Your wound will usually have no visible stitches or staples and is usually covered with a dressing. In certain cases staples or stitches are used to close the incision and will need to be removed at a later date.

Drains
You may also have a small tube that drains into a bag or a bottle from near your wound. This drain removes fluid from the surgical site and is usually removed within a few days after surgery at the bedside.

Pathology Report/Need for further treatment
Depending on the pathologist’s report, which is available 5- 7 days after the operation, further treatment may be required. These include: Surgery- in rare circumstance an additional operation is required.
Radiation Treatment- this been used for some people as the main treatment for rectal tumors but is not normally used in colon tumors. Radiation therapy is not as effective as surgery for patients who could normally be treated by bowel removal. Chemotherapy (use of drugs to treat tumor) is usually used together with surgical removal and may not be offered as the only treatment”.

Postoperative Instructions (after Discharge)

  1. Soft diet for first week. Try eating six (6) small frequent meals rather than 3 big meals. Excessive sweets tend to make the stools more liquid. Add one new food at a time in small mounts. Drink plenty of fluids.
  2. Fiber: Avoid raw vegetables and raw fruits for 1-2 weeks. Gradually increase the fiber in your diet, as this will thicken the stool. Lessen the doses of Metamucil, Konsyl or Citrucel if abdominal cramps or bloating occur.
  3. Activity: Avoid activity which causes pain. Walking and climbing stairs OK. No lifting more than 20 lbs and no vigorous sports for 4-6 weeks or as directed.
  4. Resume home medications except: Aspirin or NSAIDS unless otherwise directed by the Doctor.
  5. No driving until seen in the office, riding in the car as a passenger is permitted.
  6. Common problems
    • Wound problems: It is okay to shower and get the incision and staples wet. Some drainage from the incision is common; a light gauze pad over the incision can be helpful. If drainage is cloudy or associated with fever > 101 degrees, call the office.
    • Medication reactions: Reactions to medicines can occur. The most common symptoms are nausea, vomiting, or itching related to taking the medication. If this occurs stop the medication and contact the office.
      *Note: All Narcotics cause constipation*
    • Urinary difficulties: Urinary tract infections occasionally occur following abdominal surgery. Pains with urination and/or blood in the urine are symptoms of infection. Bring these symptoms to the doctor’s attention at your post-op visit.
    • Bowel obstructions: abdominal cramps, bloating, nausea, vomiting, and constipation. When these develop, call your physician for advice. If the symptoms are mild, you may restrict intake to liquids only and avoid solid food. If the symptoms are severe or if persist beyond 24 hrs, call your physician.
    • Irritation around anus from severe diarrhea: Use Destin ointment or Skin protective paste. Avoid vigorous wiping after a bowel movement. Instead use a shower nozzle attachment to clean the area. A warm tub bath or sitz bath is also helpful. Pat gently dry afterwards. Baby wipes can be used instead of toilet paper.
    • Steroid withdrawal: If you had been on prednisone for a long time and have now stopped the medication, you are at risk for steroid withdrawal if the weaning is too rapid or if you are in a stressful situation. The manifestations may be vague with sever fatigue, nausea, fever/chills and joint aches being the most common. If there is no improvement within 24 hours, call your physician.
    • Infection: If you experience fever above 101 degrees, shaking, chills, lower abdominal discomforts, difficulty in passing urine and sometimes drainage of pus from wound, call your physician.
  7. Call the office on the day of your discharge to make follow up appointment in 1 to weeks (as directed at time of discharge).

On-call physician: To reach the doctor on call, dial the office number anytime day or night 631-862-3600.

  • The following is a brief list of the most common issues for which you should contact the physician:
  • Large amounts of bloody leakage from the wound.
  • Blood in the stool.
  • Fever and chills.
  • Pain that is not relieved by prescribed pain killers.
  • Tender, swollen abdomen.
  • Swelling, tenderness, redness at or around the incision
References for further study
The Surgical Clinics of North America Murray, John, J. (Ed), W. B. Saunders Company, Philadelphia, Volume 73, Number 1, February 1993, Medical Oncology A Comprehensive Review, Pazdur, R. (Ed), Huntington, New York, 1993. Comparison of manually constructed and stapled anastomoses in colorectal surgery Docherty, J., McGregor, J., Arkyol, A., Murray, G. and Galloway, D Annals of Surgery, 221: 76-184, 1995. In-Hospital mortality and associated complications after bowel surgery Ansari, M., Collopy, B., Hart, W., Carson, N., and Chandraraj, E Australian and New Zealand Journal of Surgery, Vol. 70 pps 6-10, 2000. Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomized controlled trials, Song, F., and Glenny, A. British Journal of Surgery, Vol. 85, pps 1232 -1241, 1998. Risk Factors for Morbiditand Mortalit After Colectomy for Colon Cancer, Longo, W et.al. Dis Colon Rectum, Vol 43, No. 1., pps 83-91, January 2000 Post Colectomy Syndrome, World Journal of Surgery, Schoetz, D Vol. 15, pps 605 -608, 1991. Bladder and Sexual Dsfunction after Surgery for Rectal Cancer, Kinn, A. and Ohman, U, Dis Colon Rectum., January 1996. Effect of anterior resection on anal sphincter function, Horgan, P., O’Connell, P., Shankwii, C. and Kirwan, W., British Journal of Surgery, Vol. 76, pps 783-786, 1989.

Colon Surgery


CHS Colorectal Surgery

Paul E. Savoca, MD, FACS, FASCRS
Saint Catherine of Siena Medical Center
Smithtown, N.Y.
Saint Charles Hospital
Port Jefferson, N.Y.

Information for patients undergoing Colon Resection for Benign and Malignant Conditions

PLEASE READ THIS SHEET BEFORE YOU CONSENT TO THE SURGERY

The large bowel (intestine) is made up of the colon and rectum (back passage). This part of the digestive tract carries the remains of digested food from the small bowel and gets rid of it as waste through the anus. Cells that line the colon and rectum may begin to grow out of control, forming a polyp or tumor (a growth of abnormal cells). The large intestine has four sections: the ascending colon, the transverse colon, the descending colon and the sigmoid colon. Tumors can start in any of these areas or in the back passage. Tumors start in the innermost layer and can grow through some or all of the other layers.

The Operation
Surgery is the main treatment for tumors of the bowel. Removal of the diseased bowel is the first treatment for a tumor of the bowel. The goal of the surgery is to give you the best chance of cure through total removal of the tumor. Usually, the tumor and a length of normal bowel on either side of the tumor (as well as nearby lymph nodes) are removed. The healthy parts of the bowel are then stitched or stapled together (anastomosis). If it is not possible to join the bowel back together, an opening (stoma) will be made on the outside of the body for waste to pass out of the body. This is called an ostomy and is made to allow waste to pass through an opening in the abdominal wall. Sometimes, a temporary ostomy is needed until the joined bowel has healed, and then it can be reversed. This is done by further surgery. However, in some cases, the colostomy is permanent, which means it can never be put back, and there will always be an opening on the skin for bowel waste to pass through. A number of different surgical procedures are used depending on where the tumor is. This will be reviewed in detail by your surgeon.

Preparation for Surgery
Before surgery, the bowel may need to be cleansed to facilitate the operation.. You will be on a clear fluid diet and given a cleansing solution the day prior to the operation. This can cause diarrhea and cramps, and may be tiring. The solution will completely empty your bowel. You will then fast for at least 6-8 hours before your surgery.

General Risks of Surgery
• Secretions may collect in the lungs causing collapse and pneumonia. This risk is increased in smokers.
• Clotting may occur in the deep veins of the leg. Rarely part of this clot may break off and go to the lungs. This can be life threatening and its risk is increased in smokers and obese patients.
• Circulation problems to the heart or brain may occur which could result in a heart attack or stroke. Smokers and obese individuals are at increased risk.
• Death is possible during or after an operation due to severe complications.

Specific Risks of Surgery
Leakage of Bowel fluid inside the abdomen (anastomotic leak)
This situation occurs when there is infection at the where the two ends of bowel are joined. The risk is about 5%. If mild it is treated with antibiotic, moderate infection is treated with non-surgical drainage. If severe (1-2%), further surgery and a temporary colostomy may be required. The risk is increased in smokers, obese patients and those with weakened immune systems due to disease or medications.

Ileus (intestinal paralysis)
This occurs for 48-72 hours after all colon operations. In 2-5% of cases, it is prolonged and severe requiring bowel rest (nothing to eat or drink), insertion of a tube through the nose to empty the stomach and sometimes intravenous high calorie supplementation is needed. The vast majority of cases resolve on their own, further surgery is rarely required. Xrays and/or a CAT scan are used to diagnose this condition.

Wound Infection
The surgical incision may become infected. This is treated with antibiotics by mouth or by vein or the wound may need to be opened to drain. Although it takes longer, the wound will eventually heal as if it were closed with sutures. The risk is increased in smokers and obese patients.

Urinary Tract Infection
Bacteria enter the tube draining the bladder. The earlier, the catheter is removed, lower the infection rate. Generally, the tube is removed 2-4 days following surgery. If infection occurs, antibiotics are used to treat it. In some cases, prolonged catheter drainage is required because of pressure on the bladder required during the operation. This is more common in men, especially those with an enlarged prostate. Damage to the Ureter (tube that leads form the kidney to the bladder)

The ureter is a delicate tube that carries urine from the kidney to the bladder. It lies directly in the operative field and therefore can be damaged during surgery if the bowel next to it is diseased. As a precaution, colon operations are commonly preceded by a procedure that inserts a guide into this tube to avoid this complication. If an injury occurs, it is usually corrected at the time of the operation. Rarely, procedures or further surgery may be required.

Postoperative Bleeding
Significant bleeding occurs in about 5% of patients and either requires no treatment or with blood transfusion. Rarely, further surgery to control the bleeding is required.

Bowel Blockage (Obstruction)
This occurs when scar tissue often referred to as adhesions, form internally as a part of the natural healing process. This can result in kinking or twisting of the small intestine. Patient then experience bowel movement stoppage, abdominal distention, nausea and vomiting. While the symptoms are identical, this is different thean “ileus” described above. Only your surgeon can distinguish the two and xrays or a CAT scan are required. Treatment is the same as for ileus. Obstruction may occur immediately after surgery or many years later. It is the most common abdominal complication of colon surgery long term. Precautions are taken at the time of surgery to reduce this problem but it cannot be eliminated.

Stoma Problems (for those with a colostomy or ileostomy)
Skin irritation: This happens to everyone with a stoma at some point. This usually occurs in response to irritation form the appliance or the glue that causes it ti adhere to the skin. Various medicines can be applied to relieve this or a change in the type of appliance may be required. The ostomy nurse will assist with this.
Prolapse: This is excessive protrusion of the stoma. Usually no treatment is required as it can be easily pushed back in in most cases by applying a warm moist washcloth and gentle pressure. If large, surgery may be required. For temporary stomas, reversal of the stoma corrects the problem.
Hernia: A bulge that occurs around the stoma due to weakening of the abdominal wall due to the presence of the stoma. Small hernias require no treatment, klarger hernia require a truss or support device to be worn. If large, symptomatic and unsightly, surgical repair may be required.
Loss of blood Supply: This occurs due to pressure around the stoma due to conditions in the abdomen at the time of construction, particularly obesity. The blood supply is choked off and the stoma can die. Most times this resolves when the swelling from surgery subsides however surgical correction may be required early after surgery or later when chronic lack of blood supply results in narrowing (stricture).

WHAT TO EXPECT AFTER YOUR SURGERY

In- Hospital Care
After the operation the nursing staff will closely watch you until you have recovered from the anesthetic. You may even be cared for in the intensive care unit immediately following your surgery.
The recovery period after colon surgery varies. It usually involves a stay in the hospital from 3-7 days in uncomplicated cases. On return from your surgery you will have a catheter (plastic tube) in the bladder to measure and drain your urine.

After surgery you will be given intravenous fluids (a drip) through which antibiotics may be given. The drip will remain in place until you are able to drink enough fluids. It general requires 3-4 days before the colon has healed well enough to tolerate anything by mouth. You know the bowel has started to work again when you pass gas and/or have a bowel movement. You will then begin to take liquids by mouth and then solid food.

It is likely that on your return from surgery you will be wearing tight fitting stockings that are used to reduce the risk of blood clots forming in your legs. In addition, it is very important that you start moving as soon as possible. This helps to prevent blood clots forming in your legs and possibly going to your lungs. This can be fatal.

Also, you need to do your deep breathing exercises. Take ten deep breaths every hour to prevent secretions in the lungs from collecting. If this happens, you may develop pneumonia. At all costs, avoid smoking after surgery as this increases your risk of chest infection. Coughing is painful after abdominal surgery do not hesitate to use the pain medication provided.

Colostomy (“stoma” or “bag”)
Many patients undergoing colon surgery require a stoma. The colostomy or ileostomy drains bowel waste into an external bag attached to the abdomen. Most colostomy waste is softer and more liquid than normally passed bowel waste. The thickness of the bowel waste depends on where the stoma is. You will be taught how to clean around the colostomy and change the colostomy bag. The colostomy bag sticks to the skin around the stoma with special glue, and can be thrown away when dirty. This bag does not show under clothing, and most people learn to take care of these bags themselves. Stomas may be temporary or permanent, if reversible a second operation is always required.

Wound
Your wound will usually have no visible stitches or staples and is usually covered with a dressing. In certain cases staples or stitches are used to close the incision and will need to be removed at a later date.

Drains
You may also have a small tube that drains into a bag or a bottle from near your wound. This drain removes fluid from the surgical site and is usually removed within a few days after surgery at the bedside.

Pathology Report/Need for further treatment

  • Depending on the pathologist’s report, which is available 5- 7 days after the operation, further treatment may be required. These include:
  • Surgery- in rare circumstance an additional operation is required
    Radiation Treatment- this been used for some people as the main treatment for rectal tumors but is not normally used in colon tumors. Radiation therapy is not as effective as surgery for patients who could normally be treated by bowel removal.
  • Chemotherapy (use of drugs to treat tumor) is usually used together with surgical removal and may not be offered as the only treatment”.

Postoperative Instructions (after Discharge)

  1. Soft diet for first week. Try eating six (6) small frequent meals rather than 3 big meals. Excessive sweets tend to make the stools more liquid. Add one new food at a time in small mounts. Drink plenty of fluids.
  2. Fiber: Avoid raw vegetables and raw fruits for 1-2 weeks. Gradually increase the fiber in your diet, as this will thicken the stool. Lessen the doses of Metamucil, Konsyl or Citrucel if abdominal cramps or bloating occur.
  3. Activity: Avoid activity which causes pain. Walking and climbing stairs OK. No lifting more than 20 lbs and no vigorous sports for 4-6 weeks or as directed.
  4. Resume home medications except: Aspirin or NSAIDS unless otherwise directed by the Doctor.
  5. No driving until seen in the office, riding in the car as a passenger is permitted.
  6. Common problems
    1. Wound problems: It is okay to shower and get the incision and staples wet. Some drainage from the incision is common; a light gauze pad over the incision can be helpful. If drainage is cloudy or associated with fever > 101 degrees, call the office.
      b) Medication reactions: Reactions to medicines can occur. The most common symptoms are nausea, vomiting, or itching related to taking the medication. If this occurs stop the medication and contact the office.
      *Note: All Narcotics cause constipation*
    2. Urinary difficulties: Urinary tract infections occasionally occur following abdominal surgery. Pains with urination and/or blood in the urine are symptoms of infection. Bring these symptoms to the doctor’s attention at your post-op visit.
    3. Bowel obstructions: abdominal cramps, bloating, nausea, vomiting, and constipation. When these develop, call your physician for advice. If the symptoms are mild, you may restrict intake to liquids only and avoid solid food. If the symptoms are severe or if persist beyond 24 hrs, call your physician.
    4. Irritation around anus from severe diarrhea: Use Destin ointment or Skin protective paste. Avoid vigorous wiping after a bowel movement. Instead use a shower nozzle attachment to clean the area. A warm tub bath or sitz bath is also helpful. Pat gently dry afterwards. Baby wipes can be used instead of toilet paper.
    5. Steroid withdrawal: If you had been on prednisone for a long time and have now stopped the medication, you are at risk for steroid withdrawal if the weaning is too rapid or if you are in a stressful situation. The manifestations may be vague with sever fatigue, nausea, fever/chills and joint aches being the most common. If there is no improvement within 24 hours, call your physician.
    6. Infection: If you experience fever above 101 degrees, shaking, chills, lower abdominal discomforts, difficulty in passing urine and sometimes drainage of pus from wound, call your physician.
    7. Call the office on the day of your discharge to make follow up appointment in 1 to weeks (as directed at time of discharge).
      On-call physician: To reach the doctor on call, dial the office number anytime day or night 631-862-3600.

The following is a brief list of the most common issues for which you should contact the physician:
• Large amounts of bloody leakage from the wound.
• Blood in the stool.
• Fever and chills.
• Pain that is not relieved by prescribed pain killers.
• Tender, swollen abdomen.
• Swelling, tenderness, redness at or around the incision

References for further study
The Surgical Clinics of North America Murray, John, J. (Ed), W. B. Saunders Company, Philadelphia, Volume 73, Number 1, February 1993,
Medical Oncology A Comprehensive Review, Pazdur, R. (Ed),
Huntington, New York, 1993.
Comparison of manually constructed and stapled anastomoses in colorectal surgery Docherty, J., McGregor, J., Arkyol, A., Murray, G. and Galloway, D
Annals of Surgery, 221: 76-184, 1995.
In-Hospital mortality and associated complications after bowel surgery
Ansari, M., Collopy, B., Hart, W., Carson, N., and Chandraraj, E
Australian and New Zealand Journal of Surgery, Vol. 70 pps 6-10, 2000. Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomized controlled trials, Song, F., and Glenny, A.
British Journal of Surgery, Vol. 85, pps 1232 -1241, 1998.
Risk Factors for Morbiditand Mortalit After Colectomy for Colon Cancer,
Longo, W et.al. Dis Colon Rectum, Vol 43, No. 1., pps 83-91, January 2000
Post Colectomy Syndrome, World Journal of Surgery, Schoetz, D Vol. 15, pps 605 -608, 1991.
Bladder and Sexual Dsfunction after Surgery for Rectal Cancer, Kinn, A. and Ohman, U, Dis Colon Rectum., January 1996.
Effect of anterior resection on anal sphincter function, Horgan, P., O’Connell, P., Shankwii, C. and Kirwan, W., British Journal of Surgery, Vol. 76, pps 783-786, 1989.

Laparoscopic Colon Surgery


Laparoscopic Surgery – What Is It?

What is laparoscopic surgery?
Laparoscopic or “minimally invasive” surgery is a specialized technique for performing surgery. In the past, this technique was commonly used for gynecologic surgery and for gall bladder surgery. Over the last 10 years the use of this technique has expanded into intestinal surgery. In traditional “open” surgery the surgeon uses a single incision to enter into the abdomen. Laparoscopic surgery uses several 0.5-1cm incisions. Each incision is called a “port.” At each port a tubular instrument known as a trochar is inserted. Specialized instruments and a special camera known as a laparoscope are passed through the trochars during the procedure. At the beginning of the procedure, the abdomen is inflated with carbon dioxide gas to provide a working and viewing space for the surgeon. The laparoscope transmits images from the abdominal cavity to high-resolution video monitors in the operating room. During the operation the surgeon watches detailed images of the abdomen on the monitor. This system allows the surgeon to perform the same operations as traditional surgery but with smaller incisions.

In certain situations a surgeon may choose to use a special type of port that is large enough to insert a hand. When a hand port is used the surgical technique is called “hand assisted” laparoscopy. The incision required for the hand port is larger than the other laparoscopic incisions, but is usually smaller than the incision required for traditional surgery.

What are the advantages of laparoscopic surgery?
Compared to traditional open surgery, patients often experience less pain, a shorter recovery, and less scarring with laparoscopic surgery.

What kinds of operations can be performed using laparoscopic surgery?
Most intestinal surgeries can be performed using the laparoscopic technique. These include surgery for Crohn’s disease, ulcerative colitis, diverticulitis, cancer, rectal prolapse and severe constipation.

In the past there had been concern raised about the safety of laparoscopic surgery for cancer operations. Recently several studies involving hundreds of patients have shown that laparoscopic surgery is safe for certain colorectal cancers.

How safe is laparoscopic surgery?
Laparoscopic surgery is as safe as traditional open surgery. At the beginning of a laparoscopic operation the laparoscope is inserted through a small incision near the belly button (umbilicus). The surgeon initially inspects the abdomen to determine whether laparoscopic surgery may be safely performed. If there is a large amount of inflammation or if the surgeon encounters other factors that prevent a clear view of the structures the surgeon may need to make a larger incision in order to complete the operation safely.

Any intestinal surgery is associated with certain risks such as complications related anesthesia and bleeding or infectious complications. The risk of any operation is determined in part by the nature of the specific operation. An individual’s general heath and other medical conditions are also factors that affect the risk of any operation. You should discuss with your surgeon your individual risk for any operation.