Colon Anatomy and Function
The colon, or large intestine, is the terminal part of the digestive tract. A healthy colon has a smooth, protective lining. Colon tissue can undergo changes, however, and growths or other problems can occur that may require surgery. There are many disease processes that require surgical intervention in the treatment of colon disease. The most common reasons for surgery are polyps, cancer, and diverticulitis.
A benign polyp is a non-cancerous growth, ranging in size from a pea to a golf ball. The larger the polyp, the greater the chance of containing or developing cancer. The goal of early removal of polyps is to prevent them from progressing into cancer.
A cancer is made up of abnormal cells that are growing out of control. They can grow into the colon lining and spread, or metastasize, to other parts of the body. The earlier cancers are removed, the greater the chance of preventing cancer spread. Colon cancer usually spreads first to nearby lymph nodes, and then to the liver, lungs, or other organs.
These small outpouchings in the colon result from a diet that is too low in fiber. Complications that may result from diverticulosis include recurrent infection, bleeding, or perforation. Removal of the segment of colon containing diverticula will help to prevent these complications.
Preparing for surgery
Bowel Prep instructions for colon surgery – Click here for more info.
You should be on a clear liquid diet for 24 hours before surgery. No food or drink may be taken after midnight the night before surgery. To make sure that the colon is clean for surgery, you will be asked to drink a laxative solution or bowel prep to completely purge your system of stool. This will result in diarrhea. You may also be asked to take some oral antibiotics to decrease the number of bacteria in your colon. It is extremely important that you follow these instructions carefully, as incomplete cleaning of the colon may result in complications.
Most colon surgeries remove the affected piece of colon (resection) and connect the two new ends together (anastomosis). When cancer is suspected, lymph nodes surrounding the colon are removed with the colon and are reviewed microscopically to properly stage the cancer. Many elective colon surgeries are now approached through a minimally invasive technique either laparoscopically or robotically. While an incision is still required to extract the colon, the operation to be performed through several small quarter to half inch incisions. These minimally invasive methods are associated with less wound complications and shorter hospital stays.
Enhanced Recovery After Surgery Protocols (ERAS)
You may be given instructions by your surgeon or anesthesia representatives to follow an ERAS protocol. The instructions are designed to optimize your body’s ability to recover from your surgical procedure through preoperative counseling, optimization of nutrition, standardized pain management and anesthetic regimens and early patient mobilization. The protocol has been found to help shorten hospital stays and minimize use of narcotic pain medications.
A colostomy is a new opening (stoma) that is created for eliminating waste. The colon is brought out through an opening in the skin of the abdomen and formed into a stoma. After recovery, stool is passed through the stoma into a colostomy bag. Typically, patients who receive a colostomy are undergoing emergent surgery with an abdomen contaminated by stool. Other reasons may include previous radiation, inadequate anal sphincter tone, leaking of an anastomosis, and locally advanced cancers. Often, the colostomy is temporary and may be reversed later.
Immediately after surgery you will be closely monitored in the recovery room. After an hour or two you will be returned to your room. You may have a tube inserted through your nose into the stomach to remove secretions from the intestinal tract until the intestines resume normal motility. There may be a catheter in your bladder. You will have pain medications ordered for discomfort.
Walking helps circulation and bowel function return to normal. You will also do breathing exercises to make sure your lungs re-expand properly. You will have an intravenous line to give you fluids until you are able to eat and drink again. When appropriate, you will start a liquid diet and be gradually advanced to a regular diet. If you have had a colostomy, an enterostomal therapist will teach you how to handle and change the colostomy bag.
After discharge, you will gradually resume normal activities. Be active when you feel up to it, but avoid heavy lifting and strenuous exercise for about a month. Walking, climbing stairs, showering and bathing are fine. You may drive as soon as you are no longer taking pain medication, and you are comfortable doing so. You will need to make an appointment with your surgeon for approximately one week after the time of discharge.
Complications are not common, but may occur with any surgery. They include:
- Infectious complications such as wound infections or abscesses. Since the colon contains many bacteria, these are the most common.
- Ureter and bladder injury
- Leakage or constriction of the anastomosis,
- Bowel obstruction, hernias
- A need for a colostomy,
- Complications from anesthesia
Call your Surgeon if you:
- Have a fever over 101 degrees
- Are nauseated or vomiting
- Experience worsening abdominal bloating
- Notice unusual redness, swelling, or pain around your incision
- Become constipated or have uncontrollable diarrhea
- Have difficulty controlling your bowel movements