Patient Information for Large Bowel Surgery. Left Hemicolectomy Right Hemicolectomy Anterior Resection

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1 Patient Information for Large Bowel Surgery Left Hemicolectomy Right Hemicolectomy Anterior Resection

2 Table of Contents Introduction... page 3 About Large Bowel Surgery... page 3 Glossary of Terms... page 4 Tests Your Doctor May Order... page 5 Your Health Care Team... page 6 Pain Control... page 7 The Pain Scale... page 8 Types of Pain Medication... page 9 About Your Hospital Stay... page 10 Before Your Surgery... page 11 The Day of Your Surgery... page 12 During Your Surgery... page 12 After Your Surgery... page 13 Going Home... page 14 Cancer Diagnosis... page 15 2

3 Introduction Your healthcare team has prepared this brochure to help you learn about your surgery and what to expect before and after. We know this may be a stressful time for you and your family. We encourage you to talk to us about your concerns and questions. About Large Bowel Surgery In this operation, the surgeon takes out the diseased section of the large bowel. The large bowel surrounds the small bowel starting at the right side of your abdomen, crossing the upper abdomen to the left side, down the left side and then toward your pubic bone. It is about 8 feet long and its main function is to eliminate our body s waste (feces) and absorb water back into our body. In this operation the surgeon takes out the diseased section of the bowel. The name of the operation depends upon where the diseased portion of the bowel is located. The operation takes about 2 hours. Your family may wait at the hospital or at home. What it Looks Like o o o Right Hemicolectomy \ \ \ Left Hemicolectomy x x x Anterior Resection The markings on the diagram show the area of the bowel to be removed. o o o o o o o o o o o o o o o o o o o o x x x x x x x x x 3

4 Glossary of Terms Your health care team will explain your surgery and what to expect before and after. We will also explain any medical terms we use. Don t worry about remembering them all. Here is a short list of terms and what they mean. Analgesic: A medication that is used to manage your pain. Bowel: The intestine it may be classified as small or large. Bowel Preparation: A strong laxative and an enema to empty your bowel. Colon: Name of the portion of bowel extending from the end of the small bowel to the anus. Colectomy: The term for surgical removal of a portion or all of the bowel. Drain: A small tube temporarily placed to drain fluid from your surgical wound. Dressing: Sterile bandages. These will be placed on your abdomen after your surgery. Epidural A common method of pain control. Pain medicine is given through a thin tube called an epidural catheter. It is placed into the lower back by an anaesthetist. Intravenous or IV A thin, flexible tube attached usually to your arm. It provides you with fluids and medicine during and after your surgery. It is taken out or capped about 5 days after your surgery. With a capped IV line, you are able to move about without an intravenous pole. Nasogastric or NG tube This is a long, flexible tube that runs from your nose into your stomach. It helps drain the contents of your stomach to prevent vomiting. It is usually removed 3 to 5 days after your surgery. You can still breathe and swallow normally when it is in place. Patient Controlled Analgesia or PCA A computerized pump that provides you with pain medication. It attaches to your intravenous line. Post Anaesthetic Recovery Room (PARR) This is the area you will recover in from your anaesthetic. Sutures or Staples The surgeon may use stitches or small metal clips to keep the edges of your wound together. They are removed when your wound is healed or about 8 days after surgery. 4

5 Tests Your Doctor May Order Your doctor may ask you to have several tests before your surgery. They may be done before you are admitted to the hospital or while you are in the hospital. They may include: Blood tests and X-Rays These tests are routine practice to assess your condition. Barium Enema This is an x-ray examination of the large bowel or intestine. A doctor places a lubricated enema tip into the rectum. A liquid called barium will run gently into your bowel. The barium will outline the inside of the large bowel so x-ray images can be taken. Sigmoidscopy This is an examination of the lower part of your bowel. A doctor puts a rigid tube through the rectum and takes images of the lower bowel. Colonscopy This is an examination of the entire large bowel. A doctor puts a long flexible tube through the rectum and passes it along through the large bowel and takes images. Samples of bowel tissue may be taken. Ultrasound This is an examination to assess the condition of organs such as your liver. 5

6 Your Health-Care Team Nursing Staff will care for you during all phases of your stay. A Home Care Nurse may visit you when you return home if needed. A Physiotherapist will help you with breathing exercises after surgery and help you return to your usual activity. A Dietitian will talk to you about a healthy diet after your surgery. A healthy diet is one of the best things to promote healing and to reduce the risk of infection after surgery. A Respiratory Therapist will visit after your surgery if you need help with your breathing. A Social Worker will help you make special home care arrangements if necessary. An Occupational Therapist will give you information on techniques and equipment if you think you may have problems at home with bathing and dressing. An Anaesthetist is a medical doctor responsible for the anaesthetics (medication) so you can sleep during your surgery. The Surgeon is a medical doctor who will perform the operation. Your Family Doctor may work with your surgeon during your operation. 6

7 Pain Control Many patients worry about coping with pain after their surgery. This is normal. Please know that your health-care team is committed to making sure that you are comfortable after your surgery. To assess your level of pain, you will be asked to rate your pain using the pain scale (see page 9). Don t be afraid to ask for pain medication. Some patients don t ask for pain medication because they are afraid of becoming addicted to the drug. For most patients there is very little chance of addiction. Your nurse needs to know when you hurt. Consistent severe pain can hamper your recovery. It can, for example, prevent you from moving, sleeping and following your exercise program. All these situations can lead to complications and delay your recovery. Fortunately, it is possible to relieve much of the pain with medication and comfort measures. Relaxation techniques and repositioning your body also helps. Studies have discovered it is best to treat pain before it becomes severe. Ask your nurse for pain medication before your pain becomes severe. You will also have gas pain after surgery. It is the result of your bowel waking up following surgery. This happens about 3 to 4 days after your surgery. This pain is generally fleeting. Unfortunately, pain medication does not relieve gas pain. However studies show gas pain is best managed with moving and repositioning your body. Walking also helps. To help you feel more comfortable in bed, ask your nurse for a warm blanket, to place over your abdominal area. 7

8 The Pain Scale On the day of your surgery, your nurse will explain ways your pain will be managed and how to use a pain scale. The pain scale is a simple system that uses numbers to measure your pain. On the scale, 0 is no pain and 10 is the worst pain possible. After surgery it is recommended that your pain be controlled so that it ranks at the number 4 or lower. If not, tell your nurse. Discuss any concerns about your medications with the nurse or doctor. Inform your nurse of any pain medication that you are currently taking. Remember to ask your nurse when you become uncomfortable. Do not wait until the pain is severe. Numeric Pain Intensity Scale 0 no pain Moderate pain Worst possible pain Your nurse will ask you about your pain, on a pain scale like this one. 8

9 Types of Pain Management You may receive pain medication after surgery in a variety of ways. Your anaesthetist or surgeon will decide which method is best for you. 1. A Patient Controlled Analgesic Pump (PCA) This is a computerized pump that helps you safely manage your pain. Whenever you want pain medication, press your hand control button and the pump will give you a dose through your intravenous. The pump is safe and works very well for many patients. For more information, you may want to watch the PCA Program on the Patient Education Channel while you are in the Hospital. or 2. Epidural With an epidural, you receive pain medication through a thin tube placed in your lower back. This tube is attached to a computerized pump, that provides ongoing pain relief. Some patients have a numb feeling in their legs from the epidural. This feeling goes away after a day or two. This form of pain control is usually stopped 4 to 5 days after your surgery. or 3. Pain Pills You may be given pain pills when your PCA pump or Epidural pump is removed. Taking pills depends on whether your digestive system can absorb medication. 9

10 About Your Hospital Stay You will be in the hospital for about 8 days. Let us know, when you arrive at the hospital, if you will need help when you go home. We can ask a hospital social worker to help you with special home or equipment arrangements. What To Bring With You A list of medications you may be taking at home A pair of shoes or sturdy slippers with non-skid soles Personal care items such as a toothbrush and paste, hand cream, shampoo A book or magazine A music player with ear phones and a selection of music If you wish, a housecoat or robe that opens all the way in the front Loose fitting comfortable clothes to wear on your discharge day Leave any valuables, such as jewellery, bank and credit cards at home. 10

11 Before Your Surgery The nurse from the hospital s Pre-Op Unit will telephone you a few days before your surgery. Tell the nurse if you or any member of your family has had trouble with anaesthetics in the past. The nurse will ask you about your health history. Let her know about any drugs, both over-the counter and prescription, you may be taking. This includes aspirin and blood thinners. Also, tell the nurse about any alcohol or drug use. The day before your surgery, your doctor may give you instructions about clearing your bowel. Once you have started bowel clearing, drink plenty of clear fluids. Do not eat any solid food. Do not have any chewing gum. Your surgeon or pre-op care unit nurse will give you instructions about the fluids you may drink before your surgery. These instructions will usually tell you not to have anything to eat or drink past midnight. Follow these instructions carefully. Take a shower the night before your surgery and again in the morning. This helps lower the chance of infection. Emergency Patients You may have been admitted into the hospital for your surgery through the Emergency Department. If so, you will not have gone through the steps outlined above. After your surgery, ask your family or friends to bring the personal items you may need to make your stay more comfortable. See page 11 for the list of what to have brought to you. 11

12 The Day of Your Surgery A member of the Admitting Department will direct you to the Pre-Op Care Unit. Here, the Pre-Op Care Nurse will review your health history. Your blood pressure, pulse and rate of breathing is noted. Tell the nurse about the medications you have taken. During Your Surgery Your operating room nurse will greet you in the Pre-Op Care Unit and will walk with you to the Operating Room. If you are unable to walk, a stretcher is provided. An intravenous will be started in your arm, if not started already. Generally, it is at this time your anaesthetist will insert a epidural catheter for pain control, if this is the choice for pain management. Your anaesthetist will monitor you during your surgery. While you are asleep, a urinary catheter may be inserted into your bladder. When you are asleep a nasogastric NG tube may be inserted through your nose to drain your stomach. When you are awake, you will be able to breathe and swallow normally with it in place. The surgeon will make an incision down the middle of your abdomen and take out the diseased portion of the bowel. The bowel is then reattached. The surgeon will use stitches or sutures to close the abdominal incision and it is covered with a sterile bandage. 12

13 After Your Surgery You will be moved from the operating room to the Post Anaesthetic Recovery room. A nurse will frequently check your vital signs (blood pressure, pulse, breathing), IV, surgical area and dressings. As your condition stabilizes, you will be moved to the nursing ward. The nursing staff will continue to check your vital signs as well as your dressings, drain and IV. As the days pass, these checks will become less frequent. Tell your nurse if you are having pain or nausea. Activity After your surgery, the physiotherapist and nurses will help with your deep breathing and coughing exercises. This will help you keep your lungs clean to prevent lung complications. Move your legs and bend your knees as often as you can to prevent formation of blood clots. The physiotherapist will help you sit on the side of your bed the day of your surgery. As the days pass, we will continue to assist you to become more active and independent. Bowel Sounds and Diet At least twice a day after your surgery, your nurse will use a stethoscope to listen for bowel gas sounds in your abdomen. Bowel gas sounds are a sign that your bowel is waking up after the surgery. The bowel function returns in about 3 to 5 days after your surgery. At this time the NG tube is usually removed. Don t worry if you have liquid bowel movements for the first few days. Your bowel movements will soon become more formed. The dietitian is available to talk to you about a healthy diet and what foods to eat and what foods you should avoid. Over the next week, your diet will slowly return to normal. 13

14 Going Home You will go home 6 or 7 days after your surgery. Discharge time is 10:00 am. Please arrange for family or a friend to pick you up at the hospital. Before you go home, your nurse will review your condition with you and explain what to watch for at home. Call your doctor if you have any of the following: increased redness or pain in your wounds; oozing of any type from the wound; high temperature (above 38.5 Celsius or 100 Fahrenheit scale); sudden pain or swelling in your legs; sudden shortness of breath or chest pain. When you are at home, slowly increase your activities. Alternate periods of activity such as walking with periods of rest. Listen to your body. If it hurts, slow down. Your abdominal wound will heal in about 7 to 8 days after your surgery. When the wound is healed, your doctor will remove the sutures or staples. Before your sutures are removed, shower with protective waterproof dressings. After your sutures are removed, wait 24 hours before you shower. You may loosely cover your incisional area if this is more comfortable, however, it is best to leave it uncovered. Before you leave, make sure you have: all your belongings, including any medications you brought with you your house keys a prescription for your pain medication a follow-up appointment with your surgeon We hope this brochure is helpful to you. Please talk to your nurse or doctor if you have any concerns or questions. Your nurse, along with the other health care team members, are there to guide you to a full recovery. 14

15 Cancer Diagnosis Most hospitals have a community cancer program that you may talk to after your surgery. A doctor and a nurse clinician are part of this team. The doctor will direct your treatment. The nurse clinician is available to talk with you about your cancer diagnosis. She also provides emotional support. She will teach you about managing your symptoms. If your surgeon recommends chemotherapy, an appointment will be made to see the oncologist and the nurse clinician in the chemotherapy clinic. There is also an outpatient clinic. Its team members include: registered nurses a nutritionist a social worker a pharmacist. The clinic offers several cancer support groups. They are for patients, family and friends. The clinic also has a well-stocked library. You may borrow any pamphlets, audio and video tapes, especially about cancer treatment and support. For more information contact the Chemotherapy Clinic in your area. The sequence of events outlined here describe a typical case. Minor changes from this routine are sometimes made. 15

16 Patient Evaluation of Health Education Materials Name of the material Patient s name: Date: I would like to know if this health education material gives you the information that you need and want to know. Please read the material and mark your answers on this checklist. Your help will give us important feedback that we can use to improve our materials. Please give this form to your nurse or ask to see the Surgical Nurse Clinician. Statement Circle the number that best fits your answer This material was clear and easy to understand. yes not at all The material gave me useful information. yes not at all This material did not give me enough information. yes not at all The instructions were easy to follow. yes not at all The format of the material presented the information yes not at all clearly and simply. The pictures made the material easier to understand. yes not at all Please write any comments here. For more copies, go online at or and quote Catalogue No. FK.230.L324 Vancouver Coastal Health, December 2014 The information in this document is intended solely for the person to whom it was given by the health care team.

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