Colostomy

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Preoperative Care

Preparation for colon surgery begins a few days prior to the procedure unless the surgery is being done on an emergency basis, such as for an injury or intestinal bleeding. Most patients have undergone a colonoscopy, sigmoidoscopy, or barium enema to diagnose the disease. These tests generally are not repeated. Prior to the operation, 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 and precautions are taken to reduce this risk. Oral antibiotics are started several days before the operation is scheduled and the colon must be as empty as

possible.

The procedure for colon cleansing depends on the physician, the patient's health and diagnosis, and the facility where the procedure is being performed. Generally, for 2 or 3 days prior to surgery, a soft or semi-liquid diet (i.e., foods that are quickly and easily digested) is ordered. For some patients, only clear liquids are permitted. These include fruit juice, sports drinks, clear broth, and gelatin. All patients must go on a clear liquid diet 24 hours prior to surgery. After midnight, the night before surgery, nothing may be taken by mouth.

Cleansing solutions and laxatives are used to cleanse the colon before surgery. Patients are given a laxative solution to drink that can cause severe diarrhea, so they may be admitted to the hospital the day before the surgery to receive intravenous fluids that prevent dehydration.

If the patient is unable to comply with this regimen, it is necessary to inform the physician as soon as possible. It may be unsafe to do the surgery as scheduled and it may have to be postponed.

During this period, it may not be possible to continue prescription medications. This must be discussed with the surgeon as soon as the decision to have the surgery is made. Blood "thinning" medications, including aspirin, must be discontinued one week before the operation to avoid excessive bleeding during the procedure.

The anesthesiologist (doctor who administers the anesthesia) speaks with the patient prior to surgery and performs a brief physical assessment. The anesthesiologist must be aware of medications that are being taken, any history of allergies, and prior adverse reactions to anesthesia. This information helps the anesthesiologist select the most suitable anesthetic agents and dosage and avoid possible complications.

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 then taken to a preoperative holding area and must remain in bed except to use the bathroom. An intravenous (IV) is started for fluids and medication, if one is not already in place. A sedative is given through the intravenous to induce drowsiness. Anesthesia is administered in the operating room.

After surgery, the patient is taken to the postanesthesia care unit (PACU) and is closely monitored by the nursing staff until the anesthesia wears off. If no problems are observed in the PACU, the patient is transferred to a hospital room after about 2 hours.

The catheter that was inserted prior to surgery and the IV remain in place. The catheter is removed in a day or so, depending on recovery. Food and fluid cannot immediately be taken by mouth, so the intravenous keeps the patient nourished and hydrated. Medication is delivered through the IV.

Postsurgical abdominal pain is common, and medication is given to relieve it. If the pain is unusually severe and the medication does not provide relief, the doctor must be notified as soon as possible because this may indicate a complication.

Nothing may be taken by mouth until it is certain that normal bowel function has resumed. This is determined by listening through the abdomen for bowel sounds (the passage of gas). Bowel sounds indicate that the normal movement inside the colon has returned. The passage of stool is another indication that the colon is healing.

In some cases, a nasogastric tube is passed through the nose and into the stomach during surgery and may remain for several days until bowel function returns. After bowel function returns, clear liquids are given and the nasogastric tube is removed. Once clear liquids are tolerated, the diet slowly progresses to solid foods.

On the day after surgery, most patients get out of bed and walk around. It is important to get up as soon as possible to stimulate bowel function and help blood circulation return to normal.

The most difficult part of the postoperative period is adjusting to the colostomy. The opening is on the right or left side, depending on where the removed section of colon was located. The stoma is red and, immediately after surgery, there may be a bandage covering it. When stool starts to come out through the stoma, the colon is healing.

Stools from a stoma are generally softer and looser. The opening must always be kept covered by a special pouch designed to hold the stool. The pouch is changed after a bowel movement.

An enterostomal therapist teaches the patient how to care for the colostomy and provide assistance with any problems that occur with an ostomy. It is vital that patients and/or their family members learn proper care of the colostomy before the patient is discharged from the hospital.

Hospitalization ranges from 3 to 10 days, and normal activity can usually be resumed within 1 to 3 weeks. It takes longer for the body to heal completely and strenuous exertion and heavy lifting must be avoided for 4 to 6 weeks.

Having a colostomy puts few restrictions on the patient, once initial healing has occurred. There are usually no limitations on diet, sports, activities, work, or travel. Sports that involve rough and frequent body contact and jobs involving very heavy lifting are not advised.

Complications that may occur with a colostomy are

• bleeding,
• infection,
• leakage around the stoma, and
• injury to surrounding organs during the procedure.

If there is drainage, bleeding, or swelling at the incision site, pain that is not relieved by medication and comfort measures, a sudden fever, or rectal bleeding, the surgeon must be contacted immediately. If the stoma is painful to the touch, draining blood, or swollen, infection or other complications may be indicated.

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