Laparoscopic Proctocolectomy Surgery

 

 

 

What is Laparoscopic Proctocolectomy Surgery?

Laparoscopic Proctocolectomy Surgery is performed to remove the colon and rectum. This is the standard surgical procedure for patients with ulcerative colitis where medical therapy has failed or serious life-threatening complications have ensued.

 

 

 

Proctocolectomy is followed by either:

ILEAL POUCH ANAL ANASTOMOSIS (RESTORATIVE PROCTOCOLECTOMY):

This procedure preserves part of the anus, which allows the patient to have normal bowel movements. The surgeon removes the diseased part of the colon and the inside of the rectum, leaving the outer muscles of the anus. The surgeon then creates a pouch from the end of the ileum and attaches it to the inside of the anus. Waste is stored in the pouch and passed through the anus in the usual manner. Bowel movements may be more frequent and watery than before the procedure and inflammation of the internal pouch is a possible complication. This is known as pouchitis. However, patients who have an ileoanal anastomosis do not have to wear a permanent external ileostomy pouch.

ILEOSTOMY:

During this surgical procedure, the surgeon creates a small opening in the abdomen, called a stoma, to which he or she attaches the end of the small intestine, called the ileum. Waste will travel through the small intestine and exit the body through the stoma, which is about the size of a penny and is usually located in the lower right part of the abdomen near the beltline. A pouch is worn over the opening to collect waste, and the patient empties the pouch as needed.

 

PREPARATION FOR YOUR SURGERY

Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.

Before your departure your records will be reviewed thoroughly by our surgeon. This includes X-rays and a complete medical and surgical history as well as your specific issues.

After traveling to Cyprus, a new set of X-rays will be taken as well as an in person physical examination. The surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will discuss your procedure and answer any questions.

Getting your house ready before your surgery

It is also important to get your house ready for after you come home from the hospital. At first it will be harder for you to move around, so arrange your furniture and household items ahead of time to make it easier for you during your rehabilitation.

• Remove all your throw rugs or anything on the floor that may cause you to trip.
• Move phone and electrical cords close to the walls.
• Move necessary personal items you need to reach to shelves and tables that are above your waist level.

Preparation for the hospital

Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:

Clothing
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:

• Loose shorts or pants
• Loose tops or T-shirts
• Underwear and socks
• Short robe or pajamas
• Toiletries

Day before surgery

You will need to do a bowel prep to clean the stool out of your colon. Your doctor or nurse will give you more instructions based on the type of prep. You should not eat or drink anything after midnight the evening before your surgery.

Morning of surgery

Bring all your medicines in their original containers with you to the hospital. You will meet with the anesthesiologist. This doctor will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery. You will have an IV or intravenous line put in to give you fluid and medicine during your surgery. When it is time for you to go to surgery, your family will be asked to wait in the waiting area. Your doctor will talk to your family there after your surgery is done.

 

RECOVERY AFTER SURGERY

When you wake up after your surgery, you will be in the recovery room. You will stay there until you are awake and your pain is under control. Most patients return to their room after a few hours, but some will need to stay overnight for observation.

You will receive oxygen through a thin tube called a nasal cannula that rests below your nose. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.

You will have an analgesia pump device to deliver pain medication into your IV or epidural space (in your spine). You will have a catheter in your bladder to monitor the amount of urine you are making. You will also have compression boots on your lower legs to help your circulation. They will be taken off when you are able to walk. You will also have 1 or 2 drains in your lower abdomen to drain extra liquid from the area. Most of the time, the drains are removed after a few days. If you will go home with a drain, your nurse will show you how to care for it.

Hospital discharge and home instructions

You are fitted with a pouch immediately after surgery. However, it takes a few days for your digestive system to become active again, which is signaled by the passage of gas and then stool through the stoma.

Your diet is slowly increased from ice chips to liquids to solid foods as your intestines start functioning. While you are recovering in the hospital, your nurse will demonstrate how to care for your stoma. You will also receive instructions and be coached through the process of managing your stoma for after your return home.

Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom, managing steps at home and getting in and out of a car.

You will be able to leave the hospital when you are:

• Able to eat a regular diet and drink fluids
• Passing gas or you have had a bowel movement
• Passing urine
• Not having a fever or other signs of infection
• Walk for short distances
• Most people are able to go home 4-7 days after their surgery.

LIFE AFTER SURGERY

These guidelines give you an overview of what you may expect as part of your care after you leave the hospital. Be sure to follow your doctor’s discharge instructions if they are different from what is listed here.

Your Activity 

It is fairly common to feel weak and tired immediately after discharge from the hospital. The body needs time to recover from the stress of a major operation.

• Walking is permitted and encouraged beginning the next day after surgery. At home, start short, daily walks and gradually increase the distance you walk.
• Going up and down stairs is permitted. Initially, have someone assist you.
• You may lift light objects (less than 10lbs.) after your discharge. This may be increased gradually after one month. If lifting an object causes discomfort, you should discontinue the activity. This restriction helps prevent hernias at the sites of your incisions.
• Showers are permitted 2 days after surgery. Wash over your incisions gently with soap and water. Be careful to rinse well. Pat the incisions dry.
• Driving is not permitted for 2 weeks after surgery or your first follow-up visit with your surgeon. If you are taking prescription pain medications or narcotics, DO NOT DRIVE.
• Sexual intercourse may be resumed as your comfort level permits.
• People with sedentary jobs have returned to work as early as two weeks postoperatively. A physically demanding job may require 4-6 weeks before returning to work. This may be determined by you and your employer. Some people have residual fatigue several weeks after surgery.

Your bowel habits

You may have different bowel habits after your surgery. Loose stools are common for the first week or two after surgery. If you have watery diarrhea, call your surgeon. This may be a sign of a bowel infection. Severe constipation should be avoided. See the section below on medicines for constipation.

Your diet

There are generally no dietary restrictions following surgery. Avoid foods that cause diarrhea or digestive discomfort. You will eventually be able to resume your regular diet. A dietary supplement or drink can be used.

Medications

Your medicines: Take the medicines you were taking before surgery, unless your surgeon has made a change.

• For pain

Your surgeon will order a prescription pain medicine for you after surgery. As your pain lessens, over the counter pain medicines such as acetaminophen or ibuprofen can be used. They can also be used instead of your prescription for mild pain.

• For constipation

Prescription pain medicines can cause constipation. Your doctor may order a stool softener to prevent this. You should be back to your normal bowel routine in about 2 weeks. If the stool softener does not work, take Milk of Magnesia. If you still are not getting relief, call your surgeon.

Call your surgeon right away if you have:

• Diarrhea that lasts more than three days
• Nausea and vomiting that will not go away
• Pain in your abdomen that gets worse or is not eased by the pain medicine
• Pus drainage or redness around your incision
• Fever with a temperature of 100.5 or higher

FOLLOW-UP

Follow-up after surgery is extremely important and our surgeons at Salus are committed to providing all the post surgical care you need. In order to identify and treat any complications as they may arise, close, lifetime follow-up is essential.