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.

GETTING READY:

The week before your surgery:

• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using any of your present medicines. These may include aspirin, ibuprofen, or blood thinners.
  
  
• Ask your caregiver before using any over-the-counter or herbal medicine or supplement. If you regularly use these medicines or supplements, tell your caregiver.
  
  
• You may need a blood transfusion if you lose a large amount of blood during surgery. Some people are worried about getting AIDS, hepatitis, or the West Nile virus from a blood transfusion. The risk of this happening is very low. Blood banks test all donated blood for AIDS, hepatitis, and the West Nile virus. You may be able to donate your own blood before surgery. This is called autologous blood donation. This must be done no later than three days before surgery. You may also ask a family member or friend with the same blood type to donate blood for you. This is called directed blood donation.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• If you have diabetes, ask your caregiver for special instructions about what you may eat and drink before your surgery. If you use medicine to treat diabetes, your caregiver may have special instructions about using it before surgery. You may need to check your blood sugar more often before and after having surgery.
  
  
• If you are a woman, tell your caregiver if you know or think you are pregnant.
  
  
• You may need to have an electrocardiogram (ECG), or different blood and urine tests. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.
  
  
• Ask caregivers about directions for eating and drinking.
  
  
  • A clear liquid diet or a diet that helps to clean out your bowel may be started 1 to 4 days before your surgery. Clear liquids may include plain gelatin, unsweetened fruit juices, clear soup, or broth.
    
    
  • Do not eat foods with residue or fiber that are hard to digest. These include fruits, vegetables, cereal, nuts, peas, beans, fried foods, and bread.
    
    
  • Increase the amount of water you are drinking. Make sure you drink 8 to 10 (eight-ounce) cups of liquid, especially on the day before your surgery.

The night before your surgery:

• Remove any nail polish.
  
  
• You may be given a pill to help you sleep.
  
  
• Bowel preparation: You will need to clean out your bowel to get ready for this surgery. Your caregiver may ask you to do one or more of the following:
  
  
  • You may need medicine called an enema. An enema uses warm water that is put into your rectum to help empty your rectum. Ask your caregiver how to do this, and follow the directions on the package.
    
    
  • You may be given 8 to 12 (eight-ounce) cups of special bowel prep medicine to drink. Drink one eight-ounce cup of bowel prep medicine every 10 minutes until you are passing clear fluid. Ask your caregiver for more information about this medicine.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• Bowel preparation:
  
  
  • Do not eat or drink anything on the morning of your surgery. Your bowel needs to be totally empty during your surgery. If you need to take medicines, you may have them the morning of your surgery with few small sips of water.
    
    
  • You may need an additional enema, using warm water, the morning of your surgery.
    
    
  • You may also be asked to drink 4 to 8 (eight-ounce) cups of special bowel prep medicine. This may need to be done if you drank the bowel prep medicine the night before.
  
  
• If you wear contact lenses, do not wear them on the day of your procedure or surgery. Glasses may be worn.
  
  
• Do not wear tight-fitting clothes on the day of your procedure or surgery.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.

TREATMENT:

What will happen:

• You will be asked to change into a hospital gown. You will be given medicine to help you relax or make you drowsy. You will be taken on a stretcher to the room where the surgery will be done. A medicine called general anesthesia will be given to keep you asleep and control pain during the surgery. You will be asked to lie on your back, with your legs spread, raised, and your knees bent. Your abdomen (stomach) and genital area will be cleaned and sheets will be put over. A nasogastric (NG) tube may be inserted to keep air and fluid out of your stomach during surgery.
  
  
• During surgery, your colostomy will be freed up from its attachment to the abdomen. Your caregivers will make 2 to 5 small incisions where the laparoscope and other special instruments may pass through. Your abdomen will be filled with a gas (carbon dioxide) to lift the abdominal wall away from the internal organs. The prepared ends of your colon and rectum will be brought close together. A stapling device will be inserted through your colostomy opening and anus to connect the ends from inside. The incisions will be 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.

Waiting room: This is a room where your family and friends can wait until you are ready for visitors. If your family leaves the hospital, ask them to leave a phone number where they can be reached.

CONTACT A CAREGIVER IF:

• You cannot make it to your appointment on time.
  
  
• You have a fever (increased body temperature).
  
  
• You have constipation (dry, hard stools) and the medicines are not helping to empty your bowel.
  
  
• You have questions or concerns about your surgery.

SEEK CARE IMMEDIATELY IF:

• You are not able to eat or drink, or are urinating less or not at all.
  
  
• You have blood in your bowel movement (BM).
  
  
• You have more BM's in one day than before your surgery.
  
  
• You have not had a BM for two or more days.
  
  
• Your abdomen becomes tender and hard.

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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