What to Expect from Colorectal Surgery

When surgery is needed to help treat or correct conditions in the lower abdomen and colon, patients can have minimally invasive surgery, or laparoscopic surgery, at WakeMed.

In the past, traditional surgery on the colon, rectum, or intestines required a large incision. Now, thanks to laparoscopic-assisted surgeries, patients have less pain and discomfort, a much smaller incision, quicker recovery, faster return to a normal diet and fewer complications. We offer the Da Vinci surgical system for robot-assisted procedures, a proven technology for minimally invasive surgery.

We can perform both robotic and laparoscopic options for many procedures, including left colectomy, right colectomy, low anterior resection, abdominoperineal resection (APR), and others.

Most patients can have laparoscopic colorectal surgery; however, if you have had multiple previous abdominal surgeries, morbid obesity, or some heart/lung conditions, you may not be eligible. WakeMed’s colorectal surgeons can help determine the best procedure to treat your condition.

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How Laparoscopic Colorectal Surgery Is Performed

Once a patient is under general anesthesia, the gastroenterologist will make three to five tiny incisions — normally less than ¼ inch — in the lower abdomen. Gas is introduced to create space in the abdominal cavity and improve visualization. A small camera is inserted in one of the incisions, and it transmits images to a nearby monitor. Instruments are placed through other incisions to remove diseased sections in the colon or to excise growths or tumors. In some cases, a slightly longer incision may be needed if a large section of the colon needs to be removed.

After the diseased or damaged section is removed, the surgeon will then reconnect the digestive system. In some cases, the colon may be stitched together again and stool (waste) will continue to be expelled as it did before the surgery.

Some procedures may require that the colon is connected to an opening in the abdomen where waste leaves the body through an opening called a stoma. At the site, a bag is attached that can be changed as needed. An ostomy bag may be temporary or permanent based on the condition. If all of the colon and rectum are removed, the surgeon may use a portion of the small intestine to create a pouch to connect to the anus, so that waste is removed normally.

If the patient receives an ostomy bag, they will meet with a member of WakeMed’s nursing team to learn how to care for the stoma and how to change the bag.

Enhanced Recovery After Surgery (ERAS) Pathway Guidelines for Patients

Before Bowel Surgery

Talk to your doctor about any medications, vitamins and herbs you’re taking; as you may need to stop certain ones before surgery.
Stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), clopidogrel (Plavix), warfarin (Coumadin) and other blood thinners one week before the procedure.
Discontinue any diet medications or St. John’s Wort two weeks before the procedure.
Discuss any possible bleeding disorders or other medical conditions that you may have.
You will need to complete a bowel prep that will remove all waste from the region. This may include an enema and a beverage that will clean the bowels. You may also need to follow a liquid diet for eight hours before surgery.
You will have blood samples taken in case you need a blood transfusion.
Most surgeons will prescribe oral antibiotics to be completed in advance of surgery.
The day before surgery, do not eat after midnight the night before the surgery. You can drink clear liquids until 2 hours before arrival at the hospital.
Do not smoke. This will help you to recover quicker.

On the Day of Surgery

Follow the instructions provided by your surgeon.
Take the drugs your doctor told you to take with a small sip of water.
Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

Most patients will remain in the hospital for two to three days following surgery. Patients need to remain hospitalized until their pain is adequately controlled with oral pain medications; they can eat without nausea; walk independently; and pass gas.
You may have some fullness, gas and mild cramping for the next 24 to 48 hours. This will improve over time.
You may have tubes to drain your stomach and to empty your bladder.
We will stop IV fluids after surgery. You will drink liquids on the day of surgery and resume a normal diet the day after surgery.
Although IV pain medications are available, most patients require very little of it.
You will be expected to walk at least four times the day after surgery as this will help reduce the risk of lung infection or blood clots and will aid in overall recovery.

Recovery

Full recovery takes four weeks. There are activity restrictions, including no heavy lifting or working at a physically demanding job for up to six weeks. If you have a desk job, you may be able to return to work in four weeks (six weeks if you have a more physical job), but your doctor will recommend what is best for you based on how you feel.

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