Laparoscopic Colostomy Reversal

WHAT YOU SHOULD KNOW:

• Laparoscopic (lap-ah-ROS-ko-pik) colostomy (ko-LOS-to-me) reversal is surgery to reconnect your colon (large intestine) with your rectum after a previous colostomy. A colostomy is an opening in the abdomen (stomach) to drain stool (bowel movements) into a bag. A laparoscopic colostomy reversal restores the appearance and function of your abdomen, intestines, and rectum. 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. It is made up of the duodenum, jejunum, and ileum. The colon is the long tube that connects the small bowel with the rectum. The colon absorbs water from digested foods and turns the digested food into stool. The rectum and anus are where the stool leaves your body.
  
  
• In a laparoscopic colostomy reversal, your caregiver makes small incisions (cuts) in the abdomen. 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 ends of your rectum and large intestine are then connected, and the incisions are closed with stitches. With a laparoscopic colostomy reversal, you may be able to have bowel movements normally again. You may also be freed from the trouble of taking care of a colostomy, and return to your usual activities.

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, you will continue living with the troubles of taking care of a colostomy. Your abdomen may not return to its usual appearance and your bowel movements will continue to go out through your colostomy. 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.
  
  
• 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.
  
  
• Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
  
  
• Enema: You may need to have an enema before your surgery. This is liquid put into your rectum to help empty its contents.
  
  
• 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.
  
  
• 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.
  
  
• Nasogastric (NG) tube: A nasogastric (NG) tube may be inserted to keep air and fluid out of your stomach during surgery.
  
  
• 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.
  
  
• 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.
  
  
• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.

During your surgery:

• Your abdomen (stomach) and genital area are cleaned. Sheets are put over you to keep the surgery area clean.
  
  
• During surgery, your colostomy is freed up from its attachment to the abdomen. Your caregivers will make an incision where the laparoscope is passed through. Your abdomen is then filled with a gas (carbon dioxide) to lift the abdominal wall away from the internal organs. This gives your caregiver more room to work in. Two to five smaller incisions are made where other special instruments may be inserted. Your bowel and rectum are cleaned up and unhealthy tissues are removed. The prepared ends of your colon and rectum are brought close together. A stapling device is inserted through your colostomy opening and anus to connect the ends from inside. The incisions are closed with stitches (threads) and covered with bandages.

After your surgery: You may be taken to a recovery room until you are fully awake. Caregivers will watch you closely for any problems. Do not get out of bed until your caregiver says it is OK. 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.

• Activity:
  
  
  • Until you can get out of bed, start doing leg exercises. Do this by drawing circles with your toes. This will make your legs stronger and stop blood clots from forming.
    
    
  • It is important to get moving as soon as possible after surgery. Ask your caregiver when you can get up for the first time. Any time you feel weak or dizzy, lie down right away and call your caregiver.
  
  
• Diet after surgery: 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. You may also be given special drinks that are complete with nutrients you need everyday.
  
  
• Medicines: Your caregiver may give you the following kinds of medicines:
  
  
  • 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.
    
    
  • Medicines for pain, swelling, or fever: You may be given medicines to treat pain, swelling, or fever while you are in the hospital. These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Tell caregivers if you have liver or kidney disease, a history of bleeding in your stomach, or any other medical problems. Also tell your caregiver about any allergies you have to medicines. Tell your caregiver about all other medicines, herbs, and supplements that you have taken lately.
  
  
• 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.
  
  
• 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.

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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