Laparoscopic Bowel Resection

WHAT YOU SHOULD KNOW:

• Laparoscopic bowel resection is surgery to remove all or parts of the small or large intestine (bowel). This is done to treat conditions that affect the intestines, such as bleeding, blockages, inflammation (swelling), or infections. It may also be done to remove large polyps (growths) or early signs of tumors in the intestines. The intestines are part of the gastrointestinal (GI) system where food is digested (broken down). The small intestine is the tube that runs from the stomach to the colon (large intestine). It is made up of the duodenum, jejunum, and ileum. The colon is the long tube that connects the small bowel with the anus (rear end). The colon absorbs water from digested foods and turns the digested food into stool (bowel movements).
  
  
• In a laparoscopic bowel resection, your caregiver makes small incisions (cuts) in the abdomen (stomach). He uses a laparoscope and other special tools to do the surgery. A laparoscope is a long metal tube with a light and tiny video camera on the end. This gives your caregiver a clear view of the abdominal area while watching the images on a screen. The amount of bowel removed depends on the reason why this surgery is needed. An ileostomy or colostomy, which is an opening in the abdomen to drain stool into a bag, may also be made. With a laparoscopic bowel resection, problems of the small and large intestines may be treated, and their symptoms relieved.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• Not doing bowel preparation correctly can cause problems during surgery, or your surgery may need to be cancelled, delayed, or done again. Problems may happen during your laparoscopic surgery that may lead to an open surgery. Your stomach, liver, intestines, blood vessels, or nerves may get injured while having the surgery. This may cause too much bleeding and blood loss, or the bowel contents to leak. You could also have trouble breathing or an infection during or after surgery. The special gas used during your surgery may cause shoulder or chest pain for 1 to 2 days after your surgery. Following your caregiver's advice may decrease the possible problems.
  
  
• Without this surgery, your signs and symptoms may continue and become worse. Your intestines may get blocked or the infection may spread to other parts of the body. This may lead to serious medical problems, such as peritonitis (infection of abdominal wall membrane) and sepsis (blood infection). If a polyp or tumor is not removed, it can cause further blockage. Ask your caregiver if you are worried or have questions about your surgery, medicine, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• Enema: You may need to have an enema before your surgery. This is liquid put into your rectum (rear end) to help empty your bowel.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• Anesthesia:
  
  
  • General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.
    
    
  • Spinal or epidural anesthesia: This is medicine put into your back to numb you below the waist. With spinal anesthesia, the medicine is given through a shot. Feeling returns in about two hours. Epidural anesthesia is put into your back through a tiny tube. The tube may be left in place to give you more medicine later if needed. After epidural anesthesia, feeling returns to your legs when the medicine wears off.
  
  
• Foley catheter: A foley catheter is a tube that is put into your bladder to drain your urine into a bag.
  
  
• Monitoring:
  
  
  • Heart monitor: This is also called an ECG. Sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen. This shows caregivers a tracing of the electrical activity of your heart.
    
    
  • Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.

During your surgery:

• Your abdomen and genital area is cleaned with soap and water. Sheets are put over you to keep the surgery area clean.
  
  
• During your surgery, a small incision is made near your belly button to insert the laparoscope through. Your caregiver inserts other instruments by making 2 to 5 smaller incisions on your abdomen. The abdomen is then filled with a gas (carbon dioxide) to lift the abdominal wall away from the internal organs. This gives caregivers more space to work. Tools are used to separate the affected bowel from the healthy part. Certain blood vessels are tied and cut. Part or all of the small or large bowel is removed. The remaining healthy parts of the bowel are attached or sewn together.
  
  
• Your caregiver may send samples of bowel tissue to the lab for tests. Lymph nodes may also be removed during surgery. Thin rubber tubes may be put into your skin to drain fluid or pus from the abdomen. A colostomy or ileostomy may be made. The incisions are closed by stitches or surgical tape and covered with bandages.

After your surgery: You may be taken to a recovery room until you are fully awake. The ET tube may be removed after you are awake and can breathe well on your own. The NG tube going into your stomach may stay in place for a while. Caregivers will watch you closely for any problems. When caregivers see that you are OK, you will be taken back to your hospital room. The bandages used to cover your stitches keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your surgery to check your wound, tubes, drains, or ostomy.

• Activity: Caregivers may help you get out of bed to walk on the same day of surgery, or the day after. Ask caregivers if there are exercises that you may do while in bed. Exercise helps blood move through your body and may help prevent blood clots from forming. Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you feel weak or dizzy while standing up, sit or lie down right away and call your caregiver.
  
  
• Colostomy: This is an opening in the colon (intestine) which is attached to a hole in your abdominal wall. The opening in your skin may be called a stoma or an ostomy. With a colostomy, stool (bowel movement) comes out of this opening into a sealed bag. Your stool may be softer or more formed, depending upon which part of the colon was used for the colostomy.
  
  
• Diet: You may be able to eat when bowel sounds (stomach growlings) are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope. If you have a colostomy or ileostomy you may not be able to eat solid food for several days. Ice chips are usually given first. Liquids such as water, broth, apple juice, or lemon-lime soda pop may be allowed within a few days.
  
  
• Nasogastric (NG) tube: A nasogastric tube is put into your nose and down into your stomach. The tube may be attached to suction (vacuum) to keep your stomach empty. You may need a NG tube if your stomach gets too full or if you throw up a lot after surgery. You may also need it if you cannot use your mouth to eat. An NG tube may also be used to help get your bowels working. Food or medicine may be given through your NG tube.
  
  
• Medicines: You may need any of the following:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
    
    
  • Pain medicine: You may need medicine to relieve or decrease your abdominal pain. Tell your caregiver if the pain medicine does not help or if you have any questions about your medicine.
    
    
  • Stool softeners: You may be given stool softeners to soften your bowel movements, making them easier to pass.
  
  
• Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.
  
  
• Pneumatic boots: These are plastic boots or leggings put on your feet or legs over pressure stockings or ace wraps. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the pneumatic boots. This helps push the blood back up to the heart to keep clots from forming.
  
  
• Post-operative ileus: Post-operative ileus is when the bowel does not start working as expected after surgery. This may cause nausea (upset stomach), vomiting (throwing up), and you may have no flatus (gas) or bowel movements. You may also have abdominal (stomach) pain and feel bloated (full). This condition may last for a few days. Your caregiver may ask you to get out of bed and start walking to get your bowels moving. He may also give you medicines and start you on a liquid diet, or you may need an NG tube.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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