Following your procedure there are a number of things of which you need to be aware.
Pain relief (analgesia)
Pain is an inevitable feature of surgery but it will be adequately controlled. This is achieved by either an epidural – a small tube inserted around the nerves in the back where they exit from the spinal cord, which continuously delivers anaesthetic; or Patient Controlled Analgesia (PCA) whereby a narcotic such as morphine is delivered into the blood stream at the push of a button by you. Both methods will be discussed with you by your anaesthetist prior to surgery. Whichever method is used, your pain should diminish so that by day 3 or 4 it will be adequately controlled by painkillers taken by mouth.
When you wake from operation you will be attached to various tubes:
- An epidural, if used (see above).
- A urinary catheter to drain the bladder. This is usually removed on day 3 or 4.
- An intravenous drip to supplement oral fluids and to deliver morphine if a PCA is used (see above). After an operation on the bowel it temporarily ceases to push things through, so care must be exercised as to how much is taken in by mouth. The nurses will advise you how much you can take, but during this period, the fluid in the drip makes up for any deficit. When the bowel starts to work properly the first thing you will experience is the passage of flatus which usually happens on day 2 or 3. At this point it is safe to take in unrestricted fluids and the drip is taken down. The first bowel motion usually happens on day 4 or 5 (but can sometimes take an extra few days), at which point a light diet is started.
- A drain (thin tube) coming from the abdomen to drain any fluid (a natural reaction of the body) formed at the operation site.
Prevention of Deep Vein Thrombosis (DVT)
As in long-haul plane trips there is an increased risk of this occurring due to your relative immobility. You will be fitted with graduated compression stockings and mechanical compression devices to promote blood flow in the legs. These will not stop you from mobilising which you will be encouraged to do, with the close assistance of ward staff. A blood thinning agent will also be administered on a daily basis until you are fully mobile. With these measures, less than 1% of patients will suffer from a DVT.
Prevention of chest infections
If required a physiotherapist will help you with breathing exercises to ensure proper lung inflation which will help prevent a chest infection. Less than 1% of patients will suffer from a chest infection.
Bowel function
The main function of the rectum is to act as a storage organ for the faeces so removing it will partially remove some of this ability. You will therefore notice an increase in the frequency of defaecation. Initially the motions will be quite loose but will firm up over time. If the tumour is low down necessitating removal of the whole rectum (but preserving the anus and therefore continence), then your surgeon will construct a new reservoir from the portion of colon that is being joined, partially restoring rectal function.
Potential Complications
A need to convert to the open operation
This is viewed not so much as a complication but as a necessity, for two main reasons - severe inflammation or significant anatomical variation. Continuing with the laparoscopic operation can be dangerous under these circumstances and it is therefore safer to convert to the open operation. This is necessary in approximately 10% of cases. If this happens; your expected hospital stay and return to normal activity effectively doubles.
Wound infection
Approximately 1% of patients will suffer a wound infection. This is kept to a minimum with antibiotics used at surgery. It may require a further course to help clear it.
DVT and chest infection
As described above.
Internal bleeding
This is not common and nearly always stops without further surgery.
Anastomotic dehiscence
Leakage from the join in the bowel within the pelvis or abdomen will occur in a small percentage of patients at about a week after surgery. The effects are very much dependant on the size of the defect and hence the amount of leakage (of faecal material): small leaks are often not even noticed. Larger leaks may produce a localised abscess requiring drainage, usually under with a local anaesthetic. Substantial leaks will require a second operation and it may be necessary to give you a temporary colostomy (bag), which can be reversed at a later date.
Urinary function
You may experience difficulty voiding the bladder and increased frequency initially. If this does happen it usually improves with time and physiotherapy.
Sexual function
Unusually, men may experience failure of erection and women vaginal dryness. It is rarely permanent.
Discharge from hospital
This will happen only when you, your specialist and the nursing staff are all happy that you have recovered sufficiently such that you manage independently at home with day-to-day activities such as feeding, dressing and washing. For most people this will be at 7-10 days after surgery.
Follow up
Arrangements will be made upon discharge for removal of stitches or clips (if appropriate) and a follow-up with Dr Renaut. This will generally be 4 weeks after your operation.