Colorectal Team

Incorporating hospital and community health services, teaching and research

Sigmoid Colectomy

Patient Information

This leaflet explains about the procedure known as Sigmoid Colectomy.

Before your operation you may have scans and x-rays to assess the extent of the cancer. While waiting for your operation it is important to prepare yourself physically. If you can, continue eating a normal diet and take gentle exercise. If you smoke, try and stop before your operation

Before the operation you will be asked to sign a consent form to say that you understand what the operation involves.

You may have to attend the pre-admission clinic where routine pre-operative tests take place e.g. blood tests, chest x-ray, ECG (electrocardiograph – trace of your heart); listening to your chest and checking your blood pressure. This is to make sure your admission to hospital is as smooth as possible. During this appointment you may see the nurse specialist who will be able to answer any of your questions.

Your bowel will need to be clear before your operation. You may be given some medicine to clear your bowel and encouraged to drink clear fluids only for one day before your operation. This will help to clean your bowel and reduce the risk of dehydration before the surgery.

You will be given:- 2 x Bisacodyl tablets and 2 x Picolax sachets

(powerful laxative drink) – to be taken the day before the operation.

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Before your operation

Pre-admission clinic

Your admission to hospital

It is important to drink plenty of fluids while taking the laxatives to prevent dehydration. Fluids allowed include water, squash or tea/coffee (without milk)

You may drink plain water (not fizzy) for up to 2 hours before surgery.

Your Colorectal CNS or your Consultant will advise on the appropriate bowel preparation before your surgery.

If you have been given energy drinks (Nutricia Pre-Op), drink them as soon as you wake up on the day of surgery before you come to the hospital.

Please do not eat sweets or chew gum on the day of surgery

Do not take your medications on the day of surgery. Bring all your medication with you to the hospital and the Doctors or nurses will advise you which medications to take.

Anatomy of the bowelhttp://www.bowel-control.co.uk/anatomy/index.htm

This operation involves the removal of the left side of the bowel called the sigmoid. After removal of the diseased portion the two free ends of bowel will be joined together to restore intestinal continuity and to help the stool to pass through as normal. This is called an Anatomises.

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Sigmoid colectomy

The sigmoid colon is mainly for the storage of waste matter, thus removing this part has little effect on opening of your bowels, although your stool may be a little softer. You may also find that you open your bowels more frequently than before because the capacity to hold motions is smaller.

Before Afterhttps://www.jhmicall.org/JHGI_Home.aspx?CurrentUDV=31

There is a possibility that an ileostomy (stoma) may be formed to allow the join to heal and prevent complications. A stoma is an artificial opening through the wall of the abdomen to collect the waste matter (either faeces or urine) into a bag instead of passing through your bottom. A bag fits over this to collect your stool and is completely disposable. The bag will need to be changed on a daily basis.

Stoma is the Greek word for "mouth" or "opening".

This kind of stoma is usually temporary; if the growth in the bowel is too low then it may have to be permanent.

You may need some further treatment after your operation, in the form of chemotherapy. The piece of bowel removed during surgery will be examined by the pathology

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department; your further treatment will depend on the basis of these results. It may take a few weeks before the results of these tests are completed.

If an ileostomy is required, further treatment may slightly delay the reversal of this. The stoma care nurse will help and support you to manage your stoma and provide you with any advice that you may need.

If possible your surgery may be performed using a laparoscopic assisted approach. Laparoscopic colorectal surgery also known as ‘keyhole surgery’ involves inserting laparoscopic (‘keyhole’) instruments through a number of small incisions in the abdomen (tummy).The instrument has a camera attached which projects images on the TV monitor to help with the dissection and thereby performing the entire surgery through a slightly larger incision .

The main aim of having this type of surgery is to:- Reduce hospital stay, minimise hospital infection- Quicker recovery- Minimise scarring- Reduce discomfort following surgery

Most operations are successful. However, every procedure has risks and potential complications. The risks and complications that are most relevant to the operation are listed below.

If there is anything you are unsure about you can discuss this with your Doctor or Nurse.

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Risks or complications of surgery

Laparoscopically assisted surgery

Choosing not to have this operation will depend on your diagnosis following investigations but may include the continuation or worsening of the symptoms possible obstruction of the bowel leading to emergency hospital admission.

The risks and complications can be divided into three areas:-

1. Complications of the anaesthesia2. General complications of any surgery3. Specific complications of this operation

1. Complications of the anaesthesia

Your anaesthetist will discuss to you about the risks of an anaesthetic.

2. General complications of any operation

Pain – this can occur with any operation. Post operatively the pain team will regulate the pain relief to fit your personal needs.

Bleeding – this can occur during or after the surgery. If this happens you may need a blood transfusion or very occasionally another operation may be required. If you have any religious or personal objections discuss this with your doctor before the surgery.

Infection in the surgical wound – this would usually be treated with antibiotics or occasionally further surgery (risk: 3-7 in 100).

Unsightly scarring - this is more likely if the wound has become infected.

A hernia – this can occur in the incision scar when the deep muscles fail to heal. The hernia will appear as a

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bulge around the incision line and is called an incisional hernia. If this causes problems, you may need another operation.

Blood clots – These can occur in the legs (thrombosis) and can move to the lungs to cause breathing problems. You will be asked to wear anti-thrombosis tights (long socks) and will be given blood thinning medication to reduce the risk. Exercising your legs and moving around as much as you are able to can help reduce the risk of blood cots.

Difficulty passing urine – You will have a catheter inserted at the time of the operation which will remain in place for approximately 1-2 days. Occasionally, when the catheter is removed, you may have difficulty passing urine. This is more common in men and/or if you have had difficulties passing urine prior to the operation.

Chest infection – the physiotherapist will give you deep breathing exercises to help prevent a chest infection.

3. Specific complications of this operation (sigmoid colectomy)

Anastomotic leak – this is a serious complication which occurs if the joined ends of the bowel fail to heal adequately, leaving a hole (leak) at the join (anastomosis). Treatment with antibiotics and resting the bowel generally helps with the healing.If this happens, you would probably require a further operation. If you have a stoma made as part of the operation you should be protected from the effects of any leaks.

Adhesions – are bands of scar like tissues that form inside the abdomen. This can occur following any operation on the abdomen and does not usually cause

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any problems. However, it can sometimes lead to bowel obstruction many years later.

Sexual disturbance – the nerves that supply the sexual organs in both men and women run very close to the rectum. When the cancer is removed these nerves can be damaged which may lead to impotence in men and vaginal dryness in women. Impotence following rectal cancer surgery is one of the licensed indications for receiving Viagra (a drug used to overcome impotence).

Following surgery you will go back to the ward. The nurse on the ward will carry out regular observations on you. You will be allowed to drink fluids freely and to eat when you feel able.

When you wake up you will find that you are attached to several tubes. These may be: -

A drip in your arm or neck, which gives you the extra fluids that you require. A PCAS (patient controlled analgesia system), which is another tube in the arm or in the back that slowly releases painkiller An NG tube (a nasogastric tube), which is a tube in your nose that goes down the back of your throat into your stomach, this tube helps prevent you from feeling sick and vomitingA catheter (tube), into your bladder to help drain and measure the amount of urine you pass.Drainage tubes to help clear any oozing fluid around the operation site.

These tubes are inserted while you are under anaesthetic and will be removed over a period of days after the

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After your surgery

operation. Depending on the recovery you will be in hospital for 4-6 days.

If your bowel function is normal you can eat and drink soon after your surgery. If the bowel function is slow to start food and drink may be restricted for a few days.To speed up your recovery, you will be given 3 supplements drinks each day. These will be given for 3 days after your surgery.It is important to try and move around soon after the operation. Becoming mobile will help you to recover quickly from the operation and also reduce the risk of complications.

After the operation, rest is very important as part of the recovery process, so it is advisable to restrict the number of visitors coming to see you so you don’t get overtired.

Visiting time is between 11.00am – 12.00pm and 4.00 – 8.00pm. Only 2 visitors are allowed at a time.

The medical staff will be able to advise you if some movements are restricted, like kneeling or bending down. This may last for a short period of time, as you get better you will be able to resume your daily activities.

For the first week or so you will feel tired and weak when you get home. It is therefore important that you rest although it is not good for you to stay in bed all the time. You should try gentle exercise first like walking around the house or to the end of the street. Your appetite may be reduced so try eating little and often to begin with.

For most people it will take 6-8 weeks to recover from this type of operation. You may feel some pain and ‘twinges’

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Going Home

Managing after surgery

around your wound for several months. This is normal as it takes a while for full healing to take place. Taking a mild painkiller will help you feel better and help with recovery.

For the first six weeks you are advised not to lift anything heavy such as shopping or wet washing, and not to do anything strenuous like digging the garden or mowing the lawn.

You should not drive until you can do an emergency stop without hesitation that your wound will hurt. To test if you could do an emergency stop, lift both feet off the ground at the same time. If it does not cause you abdominal pain you would be able to do an emergency stop. It is advisable to check your car insurance for any clauses regarding driving after an operation.

The length of time before you are fit to return to work will be individual and dependent on the type of work you do.

When you get home you may find that your bowel habit is still unpredictable. When you have had some of your large bowel removed you may find your stools are slightly loose, over time this will resolve itself. You may also find that you open your bowels more frequently than you did before your surgery. This could be anywhere between 1-4 times per day. If your bowel habit does not settle, there are medications that can help. If you have any queries ask the specialist nurse or your doctor.

The length of time before you are fit to return to work will be individual and dependent on the type of work you do.

You should not drive until you can do an emergency stop; you have to be able to do one with out hesitation that your wound will hurt. To test if you could do an emergency stop, stomp your foot, if it does not cause you abdominal pain you would be able to do an emergency stop. It also may be

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advisable to check your car insurance for any clauses regarding driving after an operation.

Once you have recovered from your operation there is no reason why you can’t go back to your normal sex life. However, operations on the rectum can cause damage to the nerves that connect to the sexual organs. If there is damage men may find in difficult to get or maintain an erection, and may have problems with ejaculation. Women may experience pain when having sex or a lack of lubrication fluids (natural fluids in the vagina). If you do have problems talk to you doctor or specialist nurse.

Doctors use a system to describe the different stages of cancer of the large bowel – Dukes’ staging. The staging system is based on the depth the tumour has invaded through the bowel wall and whether any cancer has spread to the lymph nodes (lymph node metastasis).

After your operation the histopathologist will examine the cancer under the microscope, we usually have the results within 14 days and will then be able to tell you about the stage of your bowel cancer.

Dukes’ Stage Extent of cancerDukes’ A The cancer is confined to the bowel

wallDukes’ B The cancer has spread through the

full thickness of the bowel wall, but the lymph nodes are not affected.

Dukes’ C The cancer has spread to the lymph nodes. The lymph nodes are part of the lymphatic system, which is part of the body’s natural defence against infection. This is one of the

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Dukes’ Staging

first places the cancer can spread to.

These are some of the medical words and terms you may come across during your investigation and treatment.

Abdomen Tummy or bellyAbscess A localised collection of pus in a

cavity formed by the decay of diseased tissue

Acute Sudden onset of symptomsAdjuvant therapy Chemotherapy and radiotherapy in

addition to surgeryAnaemia A reduction in the number of red

cells, haemoglobin (iron) or volume of packed red cells in the body

Analgesia Pain killers such as paracetamol and morphine

Anastomosis The joining together of two ends of healthy bowel after diseased bowel has been cut out (resected) by the surgeon

Anus The opening to the back passageBarium Enema A diagnostic x-ray of the large

bowel (colon). Barium is inserted into the rectum via the anus (back passage) and rolled around the bowel.

Benign Non-cancerousBiopsy Removal of small pieces of tissue

from parts of the body (e.g. colon – colonic biopsy) for examination under the microscope for diagnosis.

Caecum The first part of the large intestine forming a dilated pouch into which

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Medical words and terms

the ileum, the colon and the appendix opens.

Chronic Symptoms occurring over a long period of time

Chemotherapy Drug therapy used to attack cancer cells

CNS (Clinical Nurse specialist)

A qualified nurse that has specialised in a particular field of care.

Colitis Inflammation of the colonColon The large intestine (bowel)

extending from the caecum to rectum

Colonoscopy Inspection of the colon by an illuminated telescope called a colonoscope.

Colorectal Surgeon

Surgeon who specialises in the treatment of conditions in the large bowel and rectum including bowel cancer.

Colostomy Surgical creation of an opening between the colon and the surface of the body. Part of the colon is brought out of the abdomen creating a stoma. A bag is placed over this to collect waste material.

Constipation Infrequent or difficulty in the passage of bowel motion stool (faeces).

CT scan (CAT scan)

(computerised axial tomography) A type of x-ray. A number of pictures are taken of the abdomen and fed into a computer to form a detailed picture of the inside of the body.

Defaecation The act of passing faeces (having your bowels opened)

Diagnosis Finding out what is wrong with youDiarrhoea An increase in frequency and

liquidity of bowel motionsDistal Further down the bowel towards

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the anus.Diverticulum Small pouch-like projections

through the muscular wall of the intestine which may become infected, causing diverticulitis.

Dysplasia Alteration in size, shape and organisation of mature cells that indicate possible development of cancer.

Electrolytes Salts in the blood e.g. Sodium, potassium and calcium

Enema A liquid introduced into the rectum to encourage the passing of motions

Endoscopy A collective name for all visual inspections of body cavities with an illuminated telescope. e.g. colonoscopy, sigmoidoscopy, gastroscopy.

Exacerbation An aggravation of symptomsFaeces The waste matter eliminated from

the anus (other names – stools, motions, poo).

Fistula An abnormal connection, usually between two organs, or leading from an internal organ to the body surface (e.g. between the anus and skin surface – anal fistula)

Heredity The transmission of characteristics from parent to child

Ileostomy This is when the open end of the healthy ileum (small bowel) is diverted to the surface of the abdomen and secured there to form a new exit for waste matter (faeces).

Incontinence This is when you are unable to hold on to or control your waste products, e.g. stool or urine.

Inflammation A natural defence mechanism in

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which blood rushes to any site of damage or infection in the body leading to reddening, swelling and pain. The area is usually hot to touch.

Inoperable A growth or tumour that cannot be surgically removed

Laxative Medicine or tablet that acts to cause emptying of the bowel. This may be by purging (irritating the lining) or increasing the volume of stool (bulking)

Lesion A term used to describe any structural abnormality in the body

Malignant CancerMucus A white, slimy lubricant produced

by the large bowelNeutropenia Reduction in the number of white

cells which fight infectionOedema Accumulation (build-up) of

excessive amounts of fluid in the tissues resulting in swelling.

Oncologist A doctor who specialises in cancer care using drugs and radiotherapy

Palliative care Improving the quality of life by providing support and the control of pain and unpleasant symptoms.

Pathology The study of the cause of the disease

Perforation An abnormal opening (hole) in the bowel wall which causes the contents to spill into the normally sterile abdominal cavity.

Peritoneum The membrane lining the abdominal cavity

Peritonitis Inflammation of the peritoneum, often due to a perforation

Polyp A protruding growth from the mucous membrane (lining of the bowel) e.g. colonic polyp – in the

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colonProphylaxis Treatment to prevent a disease

occurring.Proximal Further up the bowel towards the

mouthRadiotherapy The use of high energy rays which

attack cancer cellsRectum The large intestine, above the anus

(the back passage)Relapse Return of disease activityRemission A reduction in symptoms caused

by the disease and return to good health

Sigmoid The portion of the colon shaped like a letter ‘S’ or ‘C’ extending from the descending colon to the rectum

Sigmoidoscopy Inspection of the sigmoid colon with an illuminated telescope called a sigmoidoscope

Stricture The narrowing of a portion of the bowel

Suppository A bullet-shaped solid medication put into the rectum

Tenesmus Persistent urge to empty the bowelTerminal ileum The last part of the ileum joining

the caecum via the ileo-caecal value

Tumour An abnormal growth which may be benign (non-cancerous) or malignant (cancer)

Ulcerative colitis Ulceration and inflammation of the large bowel

Ultrasound Use of high-pitched sound waves to produce pictures of organs on a screen for diagnostic purposes

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Useful Contacts

Beating Bowel CancerHarlequin House, 7 High Street, Teddington,TW11 8EEGeneral Helpline: 08450 719 301Nurse Advisory Service: 08450 719 301 (9.00am – 5.30pm)Email: nurse@beatingbowelcancer.orgWebsite: www.beatingbowelcancer.orgProvides expert knowledge support, raising awareness and information about bowel cancer so that individuals can make their own informed decisions of their treatment.

Bowel Cancer UK4 Rickett Street, London SW6 1RUTel: 020 7381 9711Advisory line: 0800 840 35 40 (10.00am – 4.00pm) Email: advisory@bowelcanceruk.org.ukWeb page: www.bowelcanceruk.org.ukAdvisory line staffed by specialist nurses providing advice and information service for all those affected or concerned about the disease. Bowel cancer information in other languages available.

Cancer Research UKCancer Research UK, P.O. Box 123, Lincoln's Inn Fields, London WC2A 3PXCancer information nurses: 0808 800 4040, 9am - 5pm Email: cancerhelpuk@cancer.org.uk Website: http://www.cancerresearchuk.org/cancer-help/Cancer Research UK is dedicated to cancer research, provides information on site specific cancers and influences public policies. The Website provides information for bowel cancer patients.

Colostomy Association2 London Court, East Street, Reading, RG1 4QLTel: 0118 939 1537 Helpline: 0800 328 4257 (24 hour)Email: cass@colostomyassociation.org.ukWebsite: www.colostomyassociation.org.uk

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Provides support and advice for colostomates, their families and their carers. Free literature and information is available about all aspects of living with a colostomy.

Core – Fighting Gut and Liver Disease3 St Andrews Place, London, NW1 4LBTelephone:  020 7486 0341Email: info@corecharity.co.ukWeb page: www.corecharity.org.ukFund research in order to prevent, cure or treat digestive disorders and provide information for sufferers, their families and friends.

Hackney Citizens Advice BureauLocal Office: 300 Mare Street, London E8 1HETel: 020 8525 6350Website: http://www.eastendcab.org.uk/Mare Street office offers drop-in clinics Monday-Thursday from 8.30am. Friday doors open at 9.30am.Advice line operates Tuesday and Wednesday from 1pm – 3pm and 10am-12pm (for clients with mobility problems). Tel: 0844 499 1195. The Citizens Advice service helps people resolve their legal, money and other problems by providing free information and advice from over 3,000 locations, and by influencing policymakers.

Ileostomy and Internal pouch support groupPeverill House,1 – 5 Mill Road, Ballyclare, Co. Antrim, BT39 9DR.Tel: 0800 0184 724 (Office hours)Email: info@iasupport.org Website: www.iasupport.org/uni_contact.aspxAims to help anyone who has had or is about to have their colon removed and has an ileostomy or internal pouch. Provides advice, information and leaflets.

Institute for Complementary Medicine (ICM)32-36 Loman Street, London SE1 0EHTel: 0207 922 7980

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Email: info@icnm.org.uk.Fax: 0207 922 7981Website: http://icnm.org.uk/Provides the public with information on Complementary Medicine

Macmillan Cancer Support 89 Albert Embankment, London SE1 7UQMacmillan cancer line: 0808 808 0000 (9am – 8pm)Website: www.macmillan.org.ukProvides specialist advice and support for cancer patients and financial advice and grants for people with cancer and their families.

NHS DirectTelephone: 111Website: www.nhsdirect.nhs.uk

The Polyposis RegistrySt. Mark’s Hospital, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJTel: 020 8235 4270Email: info@polyposisregistry.org.ukWebsite: www.polyposisregistry.org.ukProvides support and information to people who have, or may have, the familial adenomatous polyposis (FAP) gene, and so are at greater risk of developing bowel cancer.

Important informationPlease remember that this leaflet is intended as general information only. It is not definitive. We aim to make the information as up to date and accurate as possible, but please be warned that it is always subject to change. Please, therefore, always check specific advice on the procedure or any concerns you may have with your doctor.

Hand HygieneIn the interests of our patients the trust is committed to maintaining a clean, safe environment. Hand hygiene is a very important factor in controlling infection. Alcohol gel is widely

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available throughout our hospitals at the patient bedside for staff to use and also at the entrance of each clinical area for visitors to clean their hands before and after entering.

Other formatsIf you require this leaflet in any other format please speak to your clinical nurse specialist (Keyworker).

ReferenceThe following team members have been consulted and agreed this patient information: Consultant, Clinical Nurse Specialist (Keyworker), Macmillan Cancer Information and Support Manager and Patient.

Homerton Hospital Health and Cancer Information Centre Based at the front of the hospitalTel: 020 8510 5191 (Mon – Friday 9am – 5pm)Email: healthshop@homerton.nhs.ukHomerton Health Shop is a drop-in Health and Cancer Information Centre, based at the main entrance of the Trust. Macmillan Cancer Information and Support Manager provides cancer information, financial, practical and emotional support to anyone affected by cancer, their relatives, carers and friends.

Homerton Hospital PALS (Patients Advice & Liaison Service)PALS is based in the main entrance of the hospital.Tel: 020 8510 7315 (9am – 5pm)Email: pals@homerton.nhs.ukPALS provides confidential information and support, helping you to sort out any difficulties or concerns you have whilst in hospital, guiding you through the different services from the NHS.

Other sources of information Royal College of Anaesthetists - www.rcoa.ac.uk “You and your Anaesthetic” The Royal College of Surgeons - www.rcseng.ac.uk

Produced by: Colorectal Team

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Homerton University Hospital NHS Foundation TrustHomerton Row, London, E9 6SRT 020 8510 5555W www.homerton.nhs.ukE enquiries@homerton.nhs

Reviewed date: April 2014Next review: Date April 2016

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