RIGHT HEMICOLECTOMY YOUR OPERATION EXPLAINED

RIGHT HEMICOLECTOMY YOUR OPERATION EXPLAINED Information Leaflet Your Health. Our Priority.

of 8 Introduction This leaflet explains the procedure known as a Right Hemicolectomy. It also includes the common complications associated with this surgery. It is not meant to replace the discussion between you and your Consultant or Colorectal Nurse Specialist but as a guide to be used in conjunction with what is discussed. This leaflet is appropriate for both benign (non-cancerous) and malignant (cancerous) conditions. At this point you should be aware of the reasons why surgery is required. What is it? A Right Hemicolectomy is basically the removal of the right hand side of your large bowel (colon) including the lowest part of the small bowel. Occasionally, the transverse section (middle section of large bowel that lies across the abdomen) may also be removed. This is known as an Extended Right Hemicolectomy. As indicated by the diagrams below the shaded area highlights the approximate area of bowel to be removed. The operation will remove the diseased area of bowel as well as a length of normal bowel at either side of the disease. This appears a large area of bowel to be removed; however it is necessary to remove so much due to the blood supply that looks after the bowel rather than the disease itself. In the majority of cases the two ends of healthy bowel are then rejoined together (anastomosed) by stitching or stapling the ends together. The wound on the abdomen maybe closed with clips, stitches or skin glue. Shaded areas indicate approximate section of bowel to be removed Laparoscopic or Open Surgery There are two ways that surgery can be performed. Open (Laparotomy) where the surgeon makes a large incision in your abdomen (tummy) to remove the affected area of bowel and Laparoscopic (Keyhole), where a number of small incisions in your abdomen are made and specialist instruments guided by a camera are used to remove a section of your large bowel. Both techniques are believed to be as equally effective in removing the cause of your condition and risks of complications are the same. Recognised benefits of keyhole (Laparoscopic) surgery include:

of 8 Faster recovery time and earlier discharge Reduced post-operative pain Minimised scarring Early return of bowel function The choice of surgical approach will be discussed and decided between you and your Consultant. The approach used often depends on your general health and medical conditions, fitness and BMI (Body Mass Index). It is important to note that, if you are to undergo laparoscopic surgery, sometimes operations may begin laparoscopically but then convert to an open procedure for technical reasons. Depending on the surgical approach, the wounds on the abdomen are closed differently. For open surgery the wound is often large and runs down the middle of the abdomen, this is generally closed with clips which are removed approximately 10 days after surgery. For laparoscopic surgery, keyhole sites and/or smaller wounds running down the middle of the abdomen are often closed using skin glue. In this instance the skin glue dries and falls off naturally over time. In either situation stitches maybe used, some are dissolvable and some require removal approximately 10 days following surgery. Your ward nursing staff will assess this and advise on the type of stitches which have been used. Will I have a stoma? (Colostomy, ileostomy, sometimes described as a bag ) It is highly unlikely that you will require a stoma following this operation. However, in a minority of cases the surgeon may decide that the bowel needs time to heal before it can be reattached. In this case it is necessary for waste products to be removed from your body without the stools passing through your anus by using a stoma. Stoma formation involves the surgeon making a small hole in your tummy and a section of the bowel is brought to the abdominal surface (tummy) and stitched to your skin, the bowel waste comes out of the stoma and collects in a bag that covers it. In most cases the stoma will be temporary and can be put back together at a later date, this involves a second operation when you and your bowel have healed and recovered from the effects of the initial surgery. The timing of this is variable, whether a stoma is likely to be permanent or temporary or when a stoma will be reversed can be discussed with you by your Surgeon, Colorectal and/or Stoma Nurse. Before your operation your Consultant or Colorectal Nurse will explain the procedure involved although details will vary according to individual cases. It is important to note that sometimes during the operation the disease or operation is more complicated than first anticipated, the type of surgery may then have to be changed to achieve the desired result. This may mean removing more bowel, or part of nearby organs such as the bladder. The consent form will address this option which you will need to sign to confirm that you agree to have surgery. Benefits of surgery The condition affecting part of your large bowel will be removed. In most cases this will give you the best chance of a cure or a significant improvement in your bowel problems.

of 8 Surgical complications Most will not experience any serious complications from their surgery; however risks do increase with age and for those who already have established medical conditions such as heart, chest, diabetes, obesity or who smoke. As with any surgery there are risks of complications which are unusual but can occur. To reassure, these are rapidly recognised and dealt with by nursing and surgical staff. Although risks are often very small it is important you are aware of them so you have all the information you need prior to agreeing to the operation. Potential short term complications/risks specific to Right Hemicolectomy surgery:- Stoma formation it is unlikely that this will occur, however the surgeon may decide the bowel needs to heal before it can be reattached or that too much of the bowel has been removed to make reattachment possible. This may also be necessary if complications have occurred post operatively and emergency surgery is required Ileus - temporary stoppage in bowel movement. The bowel is often slow to start working therefore your bowel needs to be rested (restricted fluid intake orally and no food), you will be given intravenous fluids via a drip to replace fluids lost and instead of drinking you may need a nasogastric tube (tube placed via the nose into the stomach) inserted to prevent vomiting. This would remain in place until the bowel recovers and starts to work Anastomotic leak (an-as-tom-ot-ic) - is a breakdown along the join in the bowel (anastomosis) which causes fluids or faeces to leak, potentially causing severe infection. For those who have had an ileostomy formed, treatment with antibiotics through the vein is usually successful. For those who have not, resting the bowel and antibiotic use is required; in some cases this can be serious or if there is no improvement in your condition further surgery to form a stoma may be necessary Damage to the bowel can occur due to surgical instruments and close proximity of other organs. Repair will be undertaken at the time of surgery if necessary. Potential long term complications/risks specific to Right Hemicolectomy surgery:- Ureter damage - the operation is close to the urinary system affecting bladder and ureter (muscular tubes transporting urine from kidneys to the bladder) function. Some may have problems passing urine following surgery; again often this is temporary and will improve with time Anastomotic stricture (an-as-to-mot-ic) - a narrowing in the diameter of the bowel which can lead to a blockage. This generally is not an immediate complication following surgery and can occur in the months following. Symptoms such as a feeling of permanently wanting to open your bowels although only passing a small amount each time, discomfort when having your bowels opened or a bloated feeling in your tummy caused by a hold up of stool, in some cases it may be necessary for you to have a minor procedure to stretch the narrowed area. It must be stressed at this point this is a small risk Bowel obstruction - blockage of bowel movement, generally resting the bowel as above will resolve this issue. If no improvement, a further operation maybe required. This may occur at an early or late stage in your recovery. In the majority of cases a bowel obstruction is caused by adhesions (scar tissue), which may restrict bowel activity or narrow the width of the colon.

of 8 There is a leaflet available explaining Adhesions. Please ask your Colorectal nurse if you would like to read one. General complications/risks following any major bowel surgical procedure, short term: Chest infection - anaesthetics and surgery can interfere with the normal way in which the lungs clear secretions and prevent infections. Pain from surgical wounds and reduced mobility can make breathing and coughing more difficult, increasing the risk of infection. We encourage cooperation with the physiotherapists, deep breathing exercises and if you smoke to stop Retention - the inability to urinate (pass urine). This is often temporary and is relieved with a urethral catheter. Following your surgery you will have a catheter, your surgical team will assess the need for this to stay and when it can be removed. In some cases due to the surgery and preoperative treatments you may have received, you may be unable to pass urine following the catheter removal. In this case the catheter would be re inserted and you may be discharged home with the catheter insitu, you would return a few weeks later to have this removed UTI (Urinary tract infection) - bacterial infection affecting any part of the urinary tract Haemorrhage - this can occur from the wound or operation site (internal bleeding). This may be due to pre-operative anticoagulants or unrecognised bleeding. Blood transfusion may be required and very rarely further surgery to control bleeding Wound infection - all clinical practice in both surgery and nursing are geared towards infection prevention and control. However, there is an increased risk of wound infections with any bowel surgery due to the nature of the surgery itself. Wound infections tend to present with localised pain, redness and slight discharge Wound dehiscence - generally this refers to the failure of a wound to heal completely, becoming apparent between 7 and 10 days post operatively. It is separated into two groups, full thickness and superficial. Full thickness refers to the breakdown of the whole wound, this is a serious complication requiring surgical intervention to re-suture the abdomen. Superficial refers to a partial breakdown of the wound and is managed with dressings only. This may take several weeks/months for full healing to occur Risk to life - major surgery can carry risk to life and this will be discussed with you. For this surgery it is approximately 5% DVT (Deep vein thrombosis) - major surgery carries risk of clot formation in the leg. Many cases are silent but may present with swelling of the leg, tenderness of the calf muscle and/or increased warmth of the calf. A DVT can occur following surgery or some weeks later. Preventative measures: heparin given as a daily injection, compression stockings and movement as much as possible PE (Pulmonary embolism) - is a blood clot stuck within the blood vessels of the lungs, usually having travelled from the deep veins of the legs. Symptoms include shortness of

of 8 breath, chest pain, confusion, expectoration of blood (haemoptysis). Preventative measures are the same as above. A PE can occur following surgery or some weeks later. General complications/risks following any major bowel surgical procedure, long term:- Incisional hernia - presents as bulge in abdominal wall close to the wound site. This occurs in 10-15% of abdominal wounds and usually appears within the first year following surgery but can be later. Usually they provide little trouble but can sometimes cause pain/discomfort or increase in size over time Adhesions (scar tissue) - scar tissue that forms between tissues and organs after any operation. Typically, scar tissue begins to form within the first few days of surgery, but they may not produce symptoms for months or years. In some cases these can cause complications such as pain, affect the activity of the bowel leading to hospital admission or further surgery Aches and pains - you may experience numbness around the wound for 2-3 months and general abdominal aches and pains for approximately 6 months following surgery as you and your body recovers from surgery. If you are concerned about any of these risks, have any questions or would like further information and advice please speak to your Consultant, Anaesthetist or Colorectal Nurse Specialist. Your bowel function post operatively Following any bowel operation the function of bowel can change. It is often difficult for healthcare professionals and yourselves to predict what your bowel function will be like as everyone is different. Following this procedure you may experience: Constipation or diarrhoea If you have a stoma formed during this procedure, you may find that you still have a feeling of needing to go to the toilet and may experience rectal discharge. Following a period of recovery your bowel function returns but is unlikely to be the same as what it was before your surgery. During the first few weeks your bowel function maybe erratic and it can take a period of a few weeks or months to settle into a pattern. It is recognised that each situation is different, with very different outcomes and experiences. We therefore encourage you to be honest, speak openly and seek advice from your Consultant, Colorectal Nursing Team and/or Stoma Care Nursing Team. There are numerous remedies to trial. If there are any questions which arise from this leaflet please do not hesitate to contact us. Further written information and advice is available that may assist with your individual circumstances. Contact us: Consultants

of 8 Mr M Saeed Secretary: 0161 419 4267 Mr E Clark Secretary: 0161 419 2028 Mr S Rai Secretary: 0161 419 4268 Mr F Reid Secretary: 0161 419 4275 Mr M Marsden Secretary: 0161 419 4265 Colorectal Cancer Nurse Specialist Team Doreen Dooley, Jill Taylor, Rebecca Costello 24 hour answer phone: 0161 419 4088 Contact via switchboard: 0161 483 1010 Stoma Care Nurse Specialist Team Jean Sellars, Caroline Dowson, Janet Land 24 hour answer phone: 0161 419 5052 Pager through switch: 0161 419 5059 Contact via switchboard: 0161 483 1010

of 8 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: 0161 419 5678 Information Leaflet. Email: PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number SUR89 Publication date November 2014 Review date November 2016 Department Surgical and Critical Care Location Stepping Hill Hospital