This information sheet has been provided to help answer some of the questions you, your family and friends may have about what to expect after your laparoscopic colorectal surgery.
What is laparoscopic colorectal surgery
Laparoscopic (‘keyhole’) colorectal surgery is a form of minimally invasive surgery that uses instruments with long, narrow tubes to view, cut and remove diseased parts from the colon and rectal areas. The surgeon is able to see the problem areas by using a videoscope, which is a special camera on the end of a tube. The videoscope and other instruments are inserted through small incisions (cuts) in the abdomen (tummy). The operation is done while you sleep under a general anaesthetic.
Colorectal conditions that can be treated laparoscopically include:
Diverticular disease
Appendicitis
Large colon and rectal tumours or polyps
Rectal prolapse (when rectal tissue relaxes or is no longer supported by the surrounding muscle)
Colon volvulus (twisting or displacement of the intestines causing obstruction)
Inflammatory bowel disease (IBD—Crohn’s or ulcerative colitis)
Benefits of laparoscopic surgery
The benefits of using laparoscopic surgery compared with an ‘open’ operation (where a larger incision is made) may include:
Better cosmetic results—small cuts are made on your abdomen (tummy) which, when healed, result in smaller scars
Your stay in hospital will be shorter (3–5 days) than if you had an open operation (10–12 days)
You will be able to resume your usual activities in 2–3 weeks and your usual diet the day after laparoscopic colorectal surgery—patients who have an open operation usually take a little longer to get back to normal
As a laparoscopic wound is smaller, you will have less pain and discomfort after this type of operation
Please note: Not all patients qualify for laparoscopic surgery. Medical conditions which may make you less suitable for this type of operation include previous abdominal surgery, cancer, obesity or advanced heart, lung or kidney disease. If you are found to be unsuitable for laparoscopic surgery, we will offer you the treatment as an open operation instead. Occasionally, the operation may start as laparoscopic, but need to be converted to an open procedure if there are difficulties.
Alternatives to laparoscopic surgery
This will depend upon your existing medical condition. Your doctor or nurse specialist will discuss the options with you if appropriate.
Risks associated with laparoscopic surgery
As with any operation, there are risks associated with having a general anaesthetic. Specific to this operation:
less than 10% risk of an adverse reaction to the anaesthetic
less than 5% risk of bleeding in the abdomen, which would require a blood transfusion
less than 5% risk of infection in the abdomen or in the wounds
less than 10% risk of obstruction (blockage) in the intestines due to scar tissue
less than 15% risk of leakage from the bowel
less than 15% risk of heart attack or pneumonia due to the general anaesthetic
less than 5% risk of blood clots (DVT or deep vein thrombosis) in the legs or lungs
less than 5% risk of accidental damage to other organs—the injury may be apparent at the time of surgery and repaired, or not known about until a few days later when further treatment may be required
less than 30% chance that the operation cannot be completed safely using this technique and so the surgeon will need to make a larger incision (cut) for an open operation—this decision may be made due to bleeding or because the surgeon is unable to get a good view of the area to be operated on
Before the operation
We will ask you to attend the preassessment clinic before your operation. This appointment is an opportunity to check that you are fully prepared for your admission, treatment and discharge home.
You may need to have further tests such as a colonoscopy, barium enema, ECG (recording of your heart), chest X-ray, CT scan of the abdomen and blood tests to check your fitness for surgery.
Please bring with you to this appointment a list of all your current medications. In particular, please tell your surgeon if you take blood-thinning medications (such as warfarin or aspirin) and if you are allergic to any medications.
The anaesthetist who will be putting you to sleep for the operation may see you at this appointment to check you are fit for the anaesthetic. They will then ask you for your written consent for having a general anaesthetic.
You will be given carbohydrate drinks to take before your surgery—your nurse specialist will advise you about this.
We will admit you to the ward on the day of your operation. Your temperature, blood pressure, respiration rate, height, weight and urine will be measured to give the nurses a baseline (normal reading) from which to work.
We will measure you for special stockings (known as TED stockings) to prevent blood clots (DVT or deep vein thrombosis) from forming in your legs following surgery. You will be advised to wear these throughout your stay in hospital. We will also start you on anti-coagulant (blood-thinning) injections to help minimise this risk.
You will be advised to drink the carbohydrate drink that the preassessment nurses have given you at 6am if you are scheduled to have your surgery in the morning and at 11am if your surgery is scheduled for the afternoon.
We may ask you to stop taking some of your medications before having your operation. Your surgeon will advise you.
On the day of the operation
Please have a shower or bath at home before going to the operating theatre. Remove all make-up, nail varnish, jewellery (except wedding rings, which can be taped into place), body piercings and dentures. One of the nurses will then come and prepare you for the operating theatre.
Your surgeon will review you, explain the procedure to you in detail and ask you to sign a consent form if you have not done so previously in clinic. This is to make sure that you understand the risks and benefits of having the operation.
After the operation
You will wake up in the recovery room before you are taken back to the ward.
How will I feel after the operation?
Please tell us if you are in pain or feel sick. We have tablets/injections that we can give you as and when required, so that you remain comfortable and pain-free.
You may feel light-headed or sleepy after the operation. This is due to the anaesthetic and may continue until the next morning.
It is also common to have a sore throat for 2–3 days after having a general anaesthetic. This sometimes happens because the anaesthetist has to pass a tube down your windpipe to give you the anaesthetic gases that keep you asleep during the operation.
The nurses will take your temperature, pulse and blood pressure at regular intervals to check your recovery. It is very important that we monitor your progress after your operation, so please be patient with the nursing staff during this time.
A catheter (tube) will be inside your bladder to drain urine away and allow the nurses to closely monitor your urine output after the operation. The tube will be removed when your condition is stable, usually the following day.
A ‘drip’ will also be attached to a small plastic straw (cannulae) left in the vein in your arm to provide you with fluids and prevent dehydration. Usually we advise you to eat and drink soon after your operation.
Your wound will have been closed either with dissolvable stitches, staples or steri-strips. If you do not know which method was used to close your wound, check with the nursing staff on the ward before you leave. The nurses on the ward will advise you to contact your GP practice who can remove these after your operation.
On the evening after your operation, we will help you get out of bed and into a chair, perhaps walking a short distance. A member of the team will advise you on deep breathing exercises, as well as how to move easily without discomfort. It is important that you move about as much as possible, as this will reduce the risk of any complications and speed up your recovery.
The morning after your surgery it is important that you walk around the ward with the assistance of the nurses/physiotherapist. This will speed up your recovery.
When can I go home?
You will be able to go home once you are eating, drinking and walking about with minimal discomfort. This is usually 3–5 days after having laparoscopic colorectal surgery.
However, if it was necessary to change your surgery to an open operation, you should be able to go home after approximately 7–10 days in hospital.
Please arrange for someone to come and collect you by car on the day of your discharge home, as you will not be able to drive yourself or travel on public transport.
It is important that you make the necessary plans as you will be expected to make your own way home unless your doctor feels that there are special reasons why you need hospital transport.
We will give you a two-week supply of medication to take home with you. Any further medication will need to be prescribed by your GP. Please make sure that you arrange this before your two-week supply runs out.
Will I need to visit the hospital again?
Yes, for a check-up at the clinic in Outpatients 2, six weeks after your discharge home. We will either give you an appointment before you leave or post one to you. Your doctor will give you the results of your operation at this appointment, make plans for any further treatment with you and answer any questions you may have.
When can I get back to normal?
Diet
You will eventually be able to resume your usual diet, but immediately after the operation you should avoid foods that give you diarrhoea or indigestion. You may like to use a dietary supplement or drink (such as Ensure®) until you are able to eat normally again.
Prescription medicines and some painkillers can cause constipation. If you are not back to your normal bowel routine within two weeks, ask your GP for a stool softener, such as lactulose or contact the nurse specialist.
Bowel function
It can take a while for bowel function to return to a manageable pattern. Your nurse specialist will discuss this with you as it will depend on the exact type of surgery you had and experiences vary for individual patients.
Your stools may become loose or you may become constipated. If you are passing loose stools more than four times a day for more than four days, we advise taking medication such as loperamide, which you can buy from pharmacies without a prescription.
Driving
Unless your doctor advises you otherwise, do not drive until you have had your check-up in the outpatient clinic. Your strength and speed of movement must be back to normal, as you must be able to perform an emergency stop. It is important that you inform your insurance company that you have had an operation to ensure that you are covered in the event of an accident.
Exercise and general activities
It is common to feel weak and tired immediately after discharge home from hospital. Aim to increase your level of activity gradually. Go for short walks every day, gradually increasing the distance you walk and frequency.
Most patients are able to get back to normal (including participating in sport or exercise) approximately 6–8 weeks after they go home.
You should not go swimming until your wound is completely healed.
You should not lift anything heavier than 4.5 kg (10 lb) for the first six weeks, but this can be increased gradually. If lifting anything causes pain or discomfort, stop and put it down.
Sexual activity
In most cases, sexual intercourse can be resumed once you have recovered from your operation and your wound is fully healed.
Men can sometimes experience difficulties achieving an erection because of bruising around the nerves in the pelvis. This is normally temporary and can be treated by your GP.
Some women find the shape of the vagina feels different and that it feels dry. Experimenting with different positions and using lubricants (such as K-Y Jelly) may help. It is normal to be a little anxious at first, but try to be patient. If difficulties persist, please do discuss them with your doctor, who will be able to help and advise.
Work
Patients with ‘light’ occupations (such as office work) may be able to return to work approximately three weeks after surgery. However, if your work is physically demanding, you may need to stay off for 4–6 weeks.
Check with your surgeon and your employer if you are not sure. Please note that you may continue to feel very tired for some weeks after your operation.
Looking after your wound at home
It is safe to get your wound wet, unless the doctor has told you otherwise. Please do not use antiseptic, bubble bath or anything else in the bath water until the wound has healed, unless instructed by your doctor.
Wash over your wound gently using soap and water, then rinse thoroughly. Pat your wound dry with a clean towel.
If stitches were used to close your wound, these will dissolve about six weeks after your operation and will not need to be removed. Often, patients notice a small white string-like material (stitch) appearing from their wound. This string can be cut and trimmed as close to the skin as possible using a clean pair of scissors.
If your wound was closed with staples, these will need to be removed. The nurse on the ward will advise you about this before you are discharged home.
Steristrips are small pieces of tape sometimes used to hold wounds together. If there were used in your case, you can remove them once they start to peel off your wound. If they are still in place ten days after your operation, you should remove them yourself in the bath or shower.
Is there anything I need to watch out for at home?
Sometimes after bowel surgery you experience a feeling that your bladder is not emptying completely. This usually resolves within 2–3 weeks. However, if it does not, or if you have excessive stinging when passing urine, please contact us as you may have an infection.
You may feel different sensations in your wound, such as tingling, itching or numbness. This is normal and is part of the healing process.
Please contact your GP or your nurse specialist if you experience any of the following:
Persistent nausea (feeling sick) or vomiting (being sick)
Persistent bleeding from the rectum (back passage)
Fever or a high temperature (37.5°C / 101.5°F or above)
Pus or increasing redness around the wound
Increasing pain
Increasing diarrhoea
Please contact your nurse specialist (details at the beginning of this leaflet) or the staff on the ward you were discharged if you have any queries or concerns.
Contact information
Colorectal Nurse Specialists
Chelsea and Westminster Hospital T: 020 3315 8354
West Middlesex University Hospital T: 020 8321 5892
