Sigmoid-Colectomy Surgery in India :
Minimally Invasive Surgery
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What is it?
The bowel is a tube of intestine which runs from the stomach to the back passage. The lower half of the bowel is called the colon. The colon runs from the right side of the waistline, up to the right ribs, loops across the upper part of the belly and passes down the left side. There it runs backwards into the pelvis (the lower part of your tummy) as the back passage, where it is called the rectum. In your case, the 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.
You will have a general anaesthetic, and will be asleep for the whole operation. A cut is made in the skin in the middle lower part of the abdomen about 40cm (15 inches) long. 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 which opens in the front of your tummy (a colostomy), and you need to wear a bag. This looks like a big nipple of pink bowel stuck to the tummy skin. Usually the ends are joined up at a later date. Sometimes the ends are joined up at the first operation, but a short-term colostomy is made as well. This keeps the bowel waste away from the join while it is healing up. You should plan to leave hospital two weeks after the operation. Very rarely, if the problem area is in the lower part of the rectum, at operation, the back passage may need to be removed as well. You would be warned about this before the operation.
Simply waiting and seeing is not a good plan. The trouble you are having with the bowel will simply get worse and may well lead to very serious problems. Tablets and medicines will not be helpful, neither will X-ray and laser treatment.
Before the operation
Stop smoking and get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation. Bring all your tablets and medicines with you to the hospital.
On the ward, you will be checked for past illnesses and will have special tests to make sure that you are well prepared and that you can have the operation as safely as possible. You will be asked to fill in an operation consent form. You will have the operation explained to you and will be asked to fill in an operation consent form. Before you sign the consent form, make sure that you fully understand all the information that was given to you regarding your health problems, the possible and proposed treatments and any potential risks.
Feel free to ask more questions if things are not entirely clear. Any tissues that are removed during the operation will be sent for tests to help plan the appropriate treatment. Any remaining tissue that is left over after the tests will be discarded. Before the operation and as part of the consent process, you may be asked to give permission for any ’left over’ pieces to be used for medical research that has been approved by the hospital. It is entirely up to you to allow this or not. Many hospitals now run special preadmission clinics, where you visit a week or so before the operation, where these checks will be made.
The primary treatment for colon cancer is surgery. The part of the large bowel with cancer is removed, along with surrounding lymph nodes. Removal of the colon is called a colectomy. The remaining bowel is then joined together. Joining the bowel is called an anastomosis.
When cancer is found in the sigmoid colon, the sigmoid colon is removed. The descending colon is then reconnected to the rectum.
The Sigmoid Colon before surgery. The grey area shows the part of the bowel the surgeon will remove.
The Sigmoid Colon after surgery. The descending colon is now connected to the rectum.
At We Care India partner hospitals, the majority of colon and rectal operations are performed using minimally invasive techniques (laparoscopy). Laparoscopy, however, may not be suitable for all patients. Ask your surgeon if you are an appropriate candidate for minimally invasive surgery.
After - in hospital
You will most likely have a fine plastic tube coming out of your nose and connected to another plastic bag to drain your stomach. This is to decompress your stomach which, along with the bowel, may feel sluggish after an operation.
Swallowing may be a little uncomfortable. You will have a dressing on your wound and a drainage tube nearby, connected to another plastic bag. This is to drain any residual blood from the area of the operation. You may have a colostomy. The wound is painful and you will be given injections and, later, tablets to control this. Ask for more if the pain is not controlled or is getting worse. Many hospitals are now using what is called PCA (patient controlled analgesia). By pressing a button on a device you can inject painkillers into your bloodstream through a very fine plastic tube that goes into one of the small blood vessels (veins) in your hand. A small computer controls the amount of painkiller that is released and prevents any accidental overdose. Alternatively, you may have a fine tube in your back through which pain relief can be given to help control the pain.
You will most likely be able to get out of bed with the help of the nurses the day after the operation despite some discomfort. You will not do the wound any harm, and the exercise is very helpful for you. The second day after operation you should be able to spend an hour or two out of bed. You may be given a blood-thinning injection in your skin once a day to prevent any blood clots in your legs. This can happen in the first few days after the operation until you can move around a bit more. Those clots can be very dangerous because they can ‘travel north’ through your blood stream to your heart and lungs and cause very serious problems and even death.
By the end of four days you should have little pain. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important decisions during this time. You will probably have a fine drainage tube in the penis or front passage to drain the urine from the bladder until you are able to get out of bed easily. Make sure that you are able to pass water comfortably after the catheter is removed. If you can’t, and this can sometimes happen soon after an operation, let the doctor or nurses know. It may be that you need a catheter (fine plastic draining tube) put in your bladder for a few more days.
You should be eating and drinking normally after about four days. 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. Sometimes seven or eight stitches are put across the wound to add strength. Stitches and clips are removed after about 7 to 10 days. The drain tube is removed after four days or so. You can shower and bath as frequently as you want but try to keep the wound area dry until the stitches come out. If you have a colostomy, special nurses will show you how to manage it. You will be given an appointment to visit the outpatient department for a check-up about one month after you leave hospital. You will know the results of the examination of the bowel by then. The nurses will advise about sick notes, certificates etc.
After - at home
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 by the time three months have passed you will be able to return completely to your usual level of activity. You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about three weeks. You can restart sexual relations within two or three weeks when the wound is comfortable enough. Sometimes the operation will upset the nerves which control sex in the male. This is more frequent (some studies show in up to 50% of cases) if during the operation the surgeon believes that your back passage (rectum) has to be removed. The surgeon will discuss this with you. You should be able to return to a light job after about six weeks and any heavy job within 12 weeks.
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 and will bring the risk for such complications very close to zero.
Complications are unusual but are rapidly recognised and dealt with by the surgical staff. If you think that all is not well, let the doctors or the nurses know. Chest infections may arise, particularly in smokers or obese patients. Getting out of bed as quickly as possible, being as mobile as possible and co-operating with the physiotherapists to clear the air passages is important in preventing infection. Do not smoke. Occasionally the bowel is slow to start working again. This requires patience. Your food and water intake will continue through your vein tubing until you pass wind or open your bowels. Sometimes there is some discharge from the drain by the wound. Wound infection is sometimes seen. This happens relatively more frequently in any bowel operation compared to other 'clean' operations such as taking out your gallbladder and the reason is that the bowel has many bugs that can cause an infection. The infection settles down with antibiotics in a week of two.
Very rarely, during the operation, another part of your bowel, your bladder or a blood vessel can be damaged and this may require another operation to deal with the problem.
One potential 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% and is more frequent in patients whose wounds take longer to heal such as elderly people, diabetics and patients suffering from cancer. If a leak happens 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 via a catheter in one of your veins. This often corrects the problem but sometimes another operation is needed to control the leak.
Aches and twinges may be felt in the wound for up to six months. Occasionally there are numb patches in the skin around the wound which get better after two to three months. If you have a colostomy, you will be given help and advice from the stoma nurses.
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