The colon (the large bowel or large intestine is the tube-like part of your digestive tract that stores stool and pushes it out from your body. It is five to six feet long. Food you have eaten arrives at the colon after passing through the stomach and small intestine. Fluids and nutrients are absorbed into the bloodstream, stool is consolidated, and then moved down to the anus for elimination. A healthy colon has a smooth, protective lining. Colon tissue can undergo changes, however, and growths or other problems can occur that may require surgery.
There are many disease processes that require surgical intervention in the treatment of colon disease. The most common reasons for surgery are large polyps, tumors, and diverticulitis.
A benign polyp is a non-cancerous growth, ranging in size from a pea to a golf ball. The larger the polyp, the greater the chance of developing cancer. Early removal of polyps may prevent them from progressing to cancer.
A cancer is made up of abnormal cells that are growing out of control. Cancers are usually the size of a mushroom or larger. They can grow into the colon lining and spread to other parts of the body. The earlier cancers are removed, the greater the chance of preventing cancer spread.
Colon cancer usually spreads first to nearby lymph nodes, and then to the liver, lungs, or other organs, establishing new cancers. This spread is called metastasis.
These small outpouchings in the colon result from a diet that is too low in fiber. They may result in recurrent infection, bleeding, or perforation. Removal of the segment of colon containing diverticulae will help to prevent these complications.
Preparing for your surgery
Bowel Prep instructions for colon surgery – Click here for more info.
You should be on a clear liquid diet for 24 hours before surgery. No food or drink may be taken after midnight the night before surgery. To make sure that the colon is clean for surgery, you will be asked to drink a laxative solution or bowel prep to completely purge your system of stool. This will result in diarrhea. You may also be asked to take some oral antibiotics to decrease the number of bacteria in your colon. It is extremely important that you follow these instructions carefully, as incomplete cleaning of the colon may result in complications.
Most colon surgeries remove the affected piece of colon (resection) and stitch or staple the two new ends together (anastomosis). This operation is often preformed through an incision running vertically in the middle of the abdomen. If you have colon cancer, surgery removes the cancer as well as the nearby lymph nodes. These lymph nodes are evaluated in the laboratory for signs of cancer spread. Some colon surgeries may be performed with a laparoscopic technique. In this type of surgery, smaller incisions are made. A camera is inserted through one of the small incisions and is used to see the colon and other structures. This method is associated with quicker recovery, less pain, and less scarring.
A colostomy is a new opening (stoma) that is created for eliminating waste. It may be done if the rectum or sphincter muscles need to be removed, if the colon is not completely clean during surgery, or if there is infection present. The colon is brought out through an opening in the skin of the abdomen and formed into a stoma. After recovery, stool is passed through the stoma into a colostomy bag. Often, the colostomy is temporary and may be reversed at a later date.
Immediately after surgery you will be closely watched in the recovery room. After an hour or two you will be returned to your room. You may have a tube inserted through your nose into the stomach to remove secretions from the intestinal tract until the intestines resume normal motility.
There may be a catheter in your bladder. You will have pain medications ordered for discomfort.
Walking helps your circulation and bowel function return to normal. You will also do breathing exercises to make sure your lungs re-expand properly. You will have an intravenous line to give you fluids until you are able to eat and drink again, usually in three to five days. When appropriate you will start a liquid diet and be gradually advanced to a regular diet.
If you have had a colostomy, an enterostomal therapist will teach you how to handle and change the colostomy bag.
After discharge, you will gradually resume normal activities. Be active when you feel up to it, but avoid heavy lifting and strenuous exercise for about a month. Walking, climbing stairs, showering and bathing are fine. You may drive as soon as you are no longer taking pain medication, and you are comfortable doing so. You will need to make an appointment with your surgeon for approximately one week after the time of discharge.
Complications are not common, but may occur with any surgery. Since the colon contains many bacteria, infectious complications such as wound infections or abscesses are the most common. Other complications can include bleeding, ureter and bladder, leakage or constriction of the anastomosis, bowel obstruction, hernias, a need for a colostomy, complications from anesthesia, and others.
Call your Surgeon if
- You have a fever over 101 degrees
- You are nauseated or vomiting
- You experience worsening abdominal bloating
- You notice unusual redness, swelling,or pain around your incision
- You become constipated or have diarrhea
- You have difficulty controlling your bowel movements