Bowel surgery

There are different types of bowel surgery. This information is about surgery to remove all or part of your large bowel (colon), which is called a bowel resection. This type of surgery is commonly used to treat bowel cancer. You may also need it to treat conditions like Crohn’s disease, ulcerative colitis or diverticular disease.

About bowel surgery

There are different types of bowel surgery. The exact procedure you have will depend on:

• the reason why you need bowel surgery
• if you need to have all or part of your bowel removed – how much of your bowel is affected

The procedures to remove part of or all your bowel are named by what section of bowel is removed and include:

• total colectomy – all of your large bowel is removed
• proctocolectomy – your large bowel and back passage (rectum) are removed
• panproctocolectomy – your large bowel, anus and back passage are removed
• hemicolectomy – either the left or right side of your large bowel is removed
• sigmoid colectomy – the part of your bowel that’s closest to your back passage is removed
• proctectomy – all or part of your back passage is removed

The middle part of your large bowel may also be removed (transverse colectomy) as part of a hemicolectomy operation, or in a total or subtotal colectomy.

Your surgeon will explain what the most appropriate procedure is for you.

Preparation for bowel surgery

Your doctor will discuss your bowel surgery with you and explain what will happen before, during and after your procedure. They’ll also explain the risks and benefits. Ask your doctor if you have any questions or need more information. You’ll be asked to sign a consent form before the procedure, so it’s important that you understand.

Getting ready for bowel surgery

You’ll be assessed before your operation to check that you’re fit for surgery. This may happen at a preoperative assessment clinic when they’ll also explain how to prepare for your operation.

You may see a stoma nurse before your operation, in case you need a temporary bag for your bowel to heal from surgery

You may be given a carbohydrate-rich drink to have the night before your bowel surgery and again a few hours beforehand. And you may need to take laxatives on the day of your bowel surgery or the night before, to clear out your bowel. Or you may need to have an enema. This is when a small amount of liquid medicine is put into your back passage (rectum) to help you empty your bowel.

You may need to stay in hospital between three and 10 days for bowel surgery, so make any necessary preparations for this. Ask your surgeon how long you should expect to be in hospital for your operation.

On the day

You’ll have bowel resection surgery under general anaesthesia, which means you’ll be asleep during your operation. Your hospital team will give you instructions about when to stop eating and drinking before your anaesthetic.

When you come into hospital, one of the team will talk you through what will happen and answer any questions. They’ll check that you’re well and still happy to go ahead. They may give you some compression stockings to wear and also give you an injection of an anti-clotting medicine called heparin. This will help to prevent blood clots forming in the veins in your legs. You may also have an antibiotic injection before your operation to reduce your risk of infection.

Bowel surgery

In bowel resection surgery, your surgeon will remove the diseased parts of your bowel and, if possible, join the two healthy ends together. They’ll use stitches or staples, and this is called an anastomosis.

Sometimes, your surgeon may need to bring the healthy end of your bowel through your tummy (abdominal) wall and onto the surface of your skin. This is called a stoma. If the operation involves your large bowel, it’s called a colostomy; if it involves your small bowel, it’s called an ileostomy. The waste from your bowel will pass out of the stoma, and collect in a bag that you wear over the stoma. A stoma can either be temporary or permanent, depending on the type of bowel surgery you have and how much bowel your surgeon removes.

If your surgeon thinks you may need a stoma, they’ll arrange for you to see a specialist stoma nurse before your operation.

If you’re having a proctocolectomy to remove all your large bowel and back passage, your surgeon may create a ‘pouch’ from the end of your small bowel. This can store the waste from your bowel and allow you to pass poo through your bottom (anus).

Keyhole and open bowel surgery

There are two main ways you can have bowel surgery: keyhole (laparoscopic) and open bowel surgery.

• In keyhole bowel surgery, your surgeon will insert instruments and a tube-like telescopic camera through small cuts in your tummy (abdomen). They then remove a section of bowel through a larger cut. Images from the camera are shown on a monitor so your surgeon can see what they’re doing.
• In open bowel surgery, your surgeon will make a single, large cut into your tummy to reach your bowel and remove the affected section.

People often (but not always) recover more quickly from keyhole surgery, don’t have to stay in hospital for so long and may have less pain afterwards. Not everyone can have keyhole surgery though – ask your surgeon if it’s an option for you. Sometimes your surgeon will need to switch from keyhole to open bowel surgery during the operation. They’ll talk to you about the possibility of this happening and what it will mean, before your surgery.

Robotic surgery

Robotic surgery uses robotics for surgery on the back passage (rectum). The robotic machine has several arms – one holds the camera, and the others hold surgical instruments. Your surgeon will control the arms of the machine to operate on you.

This is a relatively new technique, so it’s not available in all hospitals. It’s still being investigated to understand how it compares to open and keyhole bowel surgery.

Aftercare for bowel surgery

You’ll spend the first few hours after your operation in a recovery unit, before you’re transferred to a ward or other unit. You might have some discomfort as the anaesthetic wears off, but you’ll be offered pain relief as you need it. This will often be patient-controlled analgesia or an epidural. In patient-controlled analgesia, morphine is delivered directly into a cannula or drip. In an epidural, pain-relieving medicine is delivered into the space that surrounds your spinal cord (the epidural space).

At first, you’ll have a catheter to drain pee (urine) from your bladder into a bag. You may also have fine tubes (drains) running out from your tummy to drain fluid into another bag for a few days. You’ll have a drip in your hand or arm to give you fluids for a day or so. Your hospital team will encourage you to eat and drink as soon as you feel ready.

To help prevent deep vein thrombosis (DVT), you’ll have a daily injection of an anti-clotting medicine and will need to keep wearing compression stockings. Try to get out of bed and move around as soon as possible. A physiotherapist or nurse may show you some exercises you can do while you sit or lie down, including breathing exercises to clear your lungs.

When you can go home after surgery will depend on the type of bowel surgery you had, and your recovery. If you had keyhole surgery to treat bowel cancer, you’ll usually go home between one to five days after your operation but it may be longer if you had open surgery. If you had surgery to treat Crohn’s disease it can vary between individuals. Before you go home, your nurse will give you some advice on how to care for your healing wounds and stoma if you have one.

Recovery for bowel surgery

Bowel surgery recovery can take weeks or months. Don’t lift anything heavy or do any strenuous exercise for at least six weeks – ask your surgeon how long.

It’s normal to feel tired while you recover and to need to sleep and rest more than usual. It’s important to take time to rest. But do try to get up and move around as much as you can, and keep up any exercises your physiotherapist gave you. This can help you to feel better and get your strength back as well as reduce your risk of complications.