Overview of bowel surgery
Bowel surgery (colorectal surgery) is an operation to remove part of the large bowel (colon), and many of these operations can now be done by keyhole surgery through small cuts. The large bowel is the lower part of the digestive tract. The bowel is a long, tube-shaped organ made up of the small bowel, the large bowel and, as its last section, the rectum. After you swallow, food is partly digested in the stomach and moves into the small bowel, where nutrients are absorbed. What remains passes through the large bowel to the rectum and leaves the body. The large bowel and rectum take water out of the stool and store it until you empty your bowels.
In keyhole colon removal (laparoscopic colon resection), a minimally invasive method, many operations on the large bowel are done through small cuts. Depending on the type of operation, you may be able to go home after a few days and return to your usual activities sooner than after open surgery.
Who is it for?
Bowel surgery may be needed for conditions of the large bowel such as bowel cancer, polyps that cannot be removed during a colonoscopy, diverticular disease or inflammatory bowel disease. Most conditions of the large bowel are found with one of two tests:
- Colonoscopy: a soft, flexible tube about as thick as a finger is passed through the back passage (anus) to the far end of the large bowel. You can read more on the gastroscopy and colonoscopy page.
- Barium enema: a white liquid (barium) is put into the rectum. X-rays are taken while it fills the whole large bowel under gentle pressure.
Sometimes a CT scan of the abdomen is also needed. Before the operation, you may have blood tests, an ECG (heart tracing) or a chest X-ray.
The keyhole method is not suitable for everyone. Whether it is right for you is discussed in detail with your surgeon.
Risks
As with any major operation on the abdomen, complications can occur. Possible complications include:
- bleeding
- infection
- a leak where the bowel has been joined back together (anastomotic leak)
- injury to nearby organs, such as the small bowel, the ureter (the tube from the kidney to the bladder) or the bladder
- a blood clot in the lungs
The operation cannot be done by keyhole surgery in every patient. These factors can make open surgery from the start, or a change to open surgery during the operation, more likely:
- severe obesity
- extensive scar tissue (adhesions) from previous abdominal operations
- a poor view of the organs
- bleeding problems during the operation
- large tumours
Your surgeon decides on open surgery before or during the operation, in the interest of your safety.
Preparation
Careful preparation is especially important before bowel surgery, because the bowel must be completely empty for the operation to be safe:
- After a discussion of the benefits and risks of the operation, you give your written consent.
- Depending on your situation, blood transfusions and/or other blood products may be needed.
- You should shower the evening before or the morning of the operation.
- The rectum and large bowel must be completely empty before the operation. Usually you drink a special bowel-cleansing solution. In the days before, a liquid diet, laxatives and enemas may be added.
- You will usually be prescribed an antibiotic to take by mouth. Your surgeon will give you the exact instructions.
- Follow these instructions closely. If you cannot complete the bowel preparation or cannot take the antibiotics, please tell your surgical team. Without full preparation the operation may not be safe and may need to be rescheduled.
- You must not eat or drink anything from midnight before the operation. Take only the morning medicines you have been told to take, with a little water.
- Blood-thinning and anti-inflammatory medicines, and vitamin E, are stopped for one week before the operation.
- Weight-loss medicines are stopped two weeks before the operation.
- Stop smoking and drinking alcohol, and arrange for someone to help you at home after you leave hospital.
What happens
On the day
Most keyhole bowel operations start in the same way. The operation is done under general anaesthesia, so you are asleep throughout. The surgeon enters the abdomen through a thin tube (trocar). The laparoscope, a small telescope with a video camera, is passed through the tube so that the organs can be seen enlarged on a screen. Instruments are passed through further tubes and used to remove part of the large bowel, and the two ends are then joined back together. Usually four or five small openings are used. Sometimes one of them is lengthened to 5 to 10 cm to complete the operation.
Compared with open surgery, the keyhole approach means less pain after the operation, a shorter hospital stay and a quicker return to solid food. Bowel function also returns to normal sooner, and you can get back to everyday life more quickly.
After the procedure
You will be asked to get up and walk on the first day after the operation. Many people feel well after a few days, but the body needs time to heal. So follow your doctor's instructions closely.
Aftercare
You can go back to most of your usual activities after one to two weeks. Build up your activities gradually, and avoid heavy lifting for as long as your surgeon advises. As part of your follow-up, a routine blood test check is done at 6 months, and the results of the tissue removed during the operation are discussed with you.
Please contact your doctor if you have:
- a fever above 39 °C that does not go away
- bleeding from the back passage
- increasing swelling of the abdomen
- pain that does not ease despite medicines
- nausea or vomiting that does not stop
- shivering (chills)
Keyhole techniques are also used in other operations on the abdomen, such as gallbladder removal.