Anterior Resection of Rectum

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 waist line, 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 as the back passage, where it is called the rectum.

In your case, the problem lies in the left side of the colon or rectum. The left side of the colon and upper rectum is taken out and the ends are joined up whenever possible.

The Operation
You will have a general anaesthetic and will be asleep for the whole operation. This ooperation is often suitable for minimally invasive techniques such as laparoscopic (keyhole) or robotic surgery. 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. 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 5-10 days 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 will be warned about this before the 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 medicines will not be helpful, neither will x-ray and laser treatment. Key hole surgery is a proven safe alternative in selected cases where the tumour is located a short distance above the rectum.

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 are on blood thinning medication such as warfarin or plavix or clopidegral you should usually stop this well before your surgery. Your doctor must be made aware of these medications.

If you have aheart condition or are of a cetain age you may have a heart test such as an echocardiogram prior to your surgery.

You may be required to take bowel preparation to clear the bowel prior to admission. Please follow those instructions carefully.

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.

You may be asked to see a stomal therapist prior to your admission, or on admission, to hospital. This person is specially trained in siting and manging colostomy bags.

After – In Hospital
You will probably 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 a drainage tube nearby, connected to another plastic bag. You may have a colostomy; this will have been discussed with you prior to your surgery.

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. You will be expected to get out of bed the day after the operation despite the discomfort. You will not do the wound any harm and the exercise is very helpful for you. The second day after the operation you should be able to spend an hour or two out of bed. By the end of four days you should have little pain.

A general anaesthetic may 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 in 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. If you have a colostomy, special nurses will show you how to manage it.

You will be given an appointment to visit the Outpatient Clinic Department for a check up about one month after you leave hospital. You will know the result 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 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. Sometimes the operation will upset the nerves which control sex in the male. The surgeon can discuss this with you.

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 and dealt with by the nursing and surgical staff. If you think 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 requires patience. Your food and water intake will continue through your vein tubing.

Sometimes there is some discharge from the drain by the wound. This stops given time. Sometimes the join in the bowel can leak. 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. If you have a colostomy, you will be given advice from the stoma nurses.

General Advice
The operation is a major one, but is routine for most hospitals. 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.

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