Colon Resection

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Preoperative Care

Preparation for colon surgery begins a few days prior to the procedure. Most patients have already undergone a colonoscopy or barium enema, two tests used to diagnose colon disease. Blood tests, a chest x-ray, an EKG, and an abdominal CT scan may be ordered. The colon contains bacteria and waste products that can cause infection if they leak into the abdomen during surgery. Therefore, a number of precautions are taken to reduce this risk.

First, oral antibiotics may be prescribed several days before the operation. Second, the

colon is emptied as much as possible to reduce the risk for infection during surgery.

Generally, 2 or 3 days prior to surgery, a soft or semiliquid diet (only foods that are quickly and easily digested) is ordered. Sometimes, only clear liquids (e.g., fruit juice, sports drinks, clear broth, gelatin) are permitted. All patients go on a clear liquid diet 24 hours before surgery and nothing may be taken by mouth after midnight.

On the day before surgery, patients are asked to drink a laxative solution. Because the solution can cause severe diarrhea, some facilities admit patients for this and give them intravenous fluids to avoid dehydration.

If the patient is unable to comply with this regimen, it is necessary to inform the surgeon right away. It may be unsafe to perform the surgery and the procedure may be postponed.

Many patients take over-the-counter and prescription medications. Some medications can be discontinued until after the surgery and others cannot. This issue needs to be discussed with the physician. Medications that "thin" the blood, including aspirin, must be discontinued several days before the operation to avoid excessive bleeding during the procedure.

The anesthesiologist (i.e., doctor who administers anesthesia) speaks to the patient prior to surgery and performs a brief physical assessment. The anesthesiologist must be informed about medications being taken, any history of allergies, and previous adverse reactions to anesthesia. The patient's physical condition and history helps determine the choice and dosage of anesthesia and whether special precautions need to be taken.

An informed consent form must be signed acknowledging that the patient understands the procedure, the potential risks, and that they will receive certain medications.

The patient is taken to a preoperative area and must stay in bed except to use the bathroom. An intravenous (IV) is started for fluid, medication, and sedatives. Anesthesia is administered in the operating room.

After surgery, the patient is taken to the postanesthesia recovery unit (PACU) and is closely monitored by the nursing staff until the anesthesia wears off. When vital signs are stable and the patient is awake and coherent, he or she is transferred to their hospital room.

The intravenous remains in place until the colon has recovered sufficiently for food and fluid to be taken by mouth, and it is no longer needed to administer medication. The urinary catheter remains until bladder control returns.

As the anesthesia wears off, abdominal pain is felt, particularly by those who underwent the open procedure, and pain medication is prescribed and administered by injection or through the intravenous. Antibiotics may also be given postoperatively. This depends on a number of factors, including the original diagnosis.

Nothing may be taken by mouth until it is certain that normal colon function has resumed. This is determined by listening to the abdomen with a stethoscope to hear "bowel sounds" (the passage of gas), indicating that normal movement inside the colon has returned. The passage of stool is another indication that the colon is healing. In some cases, in order to keep the stomach empty, gastric contents are aspirated through a nasogastric tube, which is passed through the nose and down into the stomach.

After colon function returns, the patient is given clear liquids and the nasogastric tube is removed. If clear liquids are tolerated, the diet is slowly advanced until the patient is eating solid foods.

On the day after surgery, most patients can get out of bed and move around. It is important to get up as soon as possible, because physical activity stimulates bowel function and helps blood circulation return to normal.

Patients who undergo a laparoscopic colon resection generally experience less postoperative pain and leave the hospital within 2 to 3 days. Open surgery without complications usually involves a hospital stay from 3 to 10 days. Normal activity for all patients generally resumes within 1 to 3 weeks, but it takes much longer for the body to heal completely. So, patients must avoid strenuous exertion and heavy lifting for 4 to 6 weeks.

The open procedure leaves an abdominal scar a few inches long, which fades over time. Scarring from the laparoscopic procedure is minimal.

Most colon resections, both open and laparoscopic, heal without problems; however, all surgical procedures carry risk. Complications associated with colon resection are infection, injury to surrounding organs during the procedure, and leakage from the anastomosis.

Symptoms that can indicate a postsurgical complication include:

• Drainage, bleeding, or swelling at the incision site
• Pain unrelieved by medication and comfort measures
• Rectal bleeding
• Sudden fever

The appearance of any one of these symptoms should be reported immediately to the surgeon.

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