Hemicolectomy - Right


Rcolectomy

What is it?

The bowel is a tube of intestine which runs from the stomach to the back passage. The lower part of the bowel is called the colon. The colon starts just to the right of the waistline and runs up under your ribs, across the tummy and down the left side where it becomes the rectum.

Your problem is on the right hand side of the colon. The diseased part of the right colon and a small piece of the small bowel have to be taken out. The ends of the rest of the bowel are joined up inside the tummy.

The Operation

You will have a general anaesthetic and will be asleep for the whole operation. This operation is usually suitable for minimally invasive techniques such as laparoscopic(keyhole) surgery. The right side of the colon and the lowest part of the small bowel are freed. The diseased bowel is taken out. The cut ends of the small bowel and of the middle of the colon are joined together. The cut is then closed up. You will usually not require a colostomy or need to wear a bag to collect the bowel waste, unless the operation is done as an emergency or there are complications. You should plan to leave hospital about 5-10 days after your operation.

Any Alternatives?

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 medicine will not be helpful, neither will x-ray or laser treatment. Key hole operation to remove this segment of bowel is now a safe proven alternative.

Before the Operation

Stop smoking and get your weight down if you are overweight. 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).

If you take any blood thining medications such as warfarin or even plavix or clopidegral, these will usually need to be stopped prior to surgery. Your doctor must be made aware of these tablets.

If you have a heart condition or are in a certain age group you may be asked to have a heart test such as an echocardiogram prior to your surgery.

Please bring your relevant scans and X-Rays into hospital.

You may be required to take bowel preparation to clear the bowel prior to your admission. Please follow the instructions carefully. If you come into hospital the day of your surgery, you must fast for 6 hours prior to your operation.

Check that you have a relative or friend who can come with you to hospital, take you home and look after you for the first week after the operation.

Bring all your tablets and medicines with you to hospital. On the ward you may be checked for past illnesses and may have special tests ready for the operation. You will be asked to fill in an operation consent form. Many hospitals now run special pre-admission clinics, where you visit for an hour or two, a week or so before the operation, for these checks.

After - In Hospital

You may have a fine plastic tube coming out of your nose and connected to another plastic bag to drain your stomach. Swallowing may be a little uncomfortable.

You will have a dressing on your wound and perhaps a drainage tube nearby, connected to another plastic bag. The wound is painful and you will be given injections, and later tablets, to control this. Ask for more if the pain is still unpleasant.

A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. Do not make important decisions during that 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.

You should be eating and drinking normally after about 4 days.

The wound has 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 7 or 8 stitches are put across the wound to add strength. Stitches and clips are removed after about 8 days. The drain tube is removed after 4 days or so. You can wash the area as soon as the dressing has been removed. Soap and tap water are entirely adequate. Salted water is not necessary. You can shower or bath as often as you want.

You will be given an appointment to visit the Outpatient Department for a check up about one month after leaving hospital. The results from the laboratory about your colon will be ready by then. The nurses will advise about sick notes, certificates, etc.

After - At Home

You are likely to feel very tired and need rests 2-3 times a day for a month or more. You will gradually improve so that by the time 3 months has 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, ie. after about 3 weeks.

You can restart sexual relations within 2-3 weeks when the wound is comfortable enough. You should be able to return to a light job after about 6 weeks and any heavy job within 12 weeks.

Possible Complications

Complications are unusual but are rapidly recognised by the nursing and surgical staff. If you think that all is not well, ask the nurses or doctors.

You will be given injectable medication and stockings to avoid blood clots occurring in the leg. If pain or swelling occurs in either leg please alert nursing and medical staff immediately.

Chest infections may arise, particularly in smokers. Co-operation with the physiotherapists to clear the air passages is important in preventing the condition. Do not smoke.

Occasionally the bowel is slow to start working again. This may take a week or more. Your food and water intake will continue through your vein tubing.

Sometimes there is some discharge from the drain near the wound. This stops given time. Sometimes the join in the bowel may leak. The doctor will talk to you about this. Wound infection is sometimes seen. This settles down with antibiotics in a week or two.

Aches and twinges may be felt in the wound for up to 6 months. Occasionally there are numb patches in the skin around the wound which get better after 2-3 months.

Because of loss of some of the bowel you may need vitamin replacement. This will be discussed with you.

General Advice

The operation should not be underestimated. Some patients are surprised how slowly they regain their normal stamina, but virtually all patients are back doing their normal duties within 3 months.

We hope these notes will help you through your operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little.

If you have any queries or problems, please ask the doctors or nurses.