Bowel Surgery

4 sections of the Bowel:

1. ascending colon
2. transverse colon
3. descending colon
4. sigmoid colon. 

Causes: Common Bowel Diseases

Inflammatory bowel disease (IBD)

Crohn’s disease

Ulcerative colitis

The condition

The large bowel (intestine) is made up of the colon and rectum (back passage). This part of the digestive tract carries the remains of digested food
from the small bowel and evacuate it as waste through the opening to the back passage (anus). Cells that line the colon and rectum may begin to grow
out of control, forming a tumour (a growth which can be benign or malignant [cancer]).

Stoma surgery

A stoma is an artificial opening in the bowel that can be temporary or permanent. The new outlet created is through a surgical opening onto the
abdominal wall. 

There are three different types of stomas:

· Colostomy – solid faecal output.

                                                                                  
· Ileostomy - soft faecal output.   

· Urostomy (Ileal Conduit) - urine output.

A colostomy or ileostomy can be temporary or permanent. A urostomy is always permanent.

Colostomy

The most common reasons for a colostomy are:

· Cancer of the bowel.

· Bowel function disorders e.g. faecal incontinence.
· Trauma.
· Diverticular disease.  

The stoma is red in colour, moist and has no feeling. A colostomy is usually situated on the left side of the abdomen below the waistline. The specialist
nurse will discuss all aspects of stoma care prior to surgery.
Types of colostomy:

>Permamnent

>temporary

Ileostomy

The most common reasons for forming an ileostomy are:

 
· Ulcerative colitis.
· Crohn’s disease.
· Bowel cancer.
· Trauma.
· Faecal incontinence.

An ileostomy is usually on the right side of the abdomen,the output will be soft to liquid. An ileostomy is where the small bowel is brought to the surface
of the abdominal wall through a surgical incision and a ‘spouted stoma’ is formed. 

Urostomy or Ileal Conduit Surgery

This is a permanent stoma formed if the bladder has to be removed or is not able to be used. Reasons include:

· Cancer of the bladder.

· Trauma.
· Neurological disorders.
· Interstitial cystitis.
· Severe urinary incontinence.

The two ureters or tubes from the kidneys are plumbed into a small isolated segment of small bowel, which protrudes out from the abdominal wall (see
diagram).

Urine will drain from the stoma and collect into a pouch (with a drainage tap), which is worn on the abdomen.

Your bowel habit should not be affected by this operation: you will still pass faeces in the normal way. 

As small bowel is used, mucus may still be produced and will be drained into the pouch with your urine. This can be confused with a urinary tract
infection. The specialist nurse will be able to advise you on the management of the stoma.

Ileal Conduit/Urostomy
 ==============================
Surgical Procedures

As no one person with bowel disease or cancer has it in exactly the same location in the bowel, a number of different surgical options are
available to the surgeon. The diagnosis will determine the type of surgical procedure you are likely to have. Your surgical options will be
discussed with you by your surgeon, stoma nurse specialist or other members of the surgical team. 

This section discusses the main types of surgical procedures in detail, with diagrams to help aid your understanding. 

Surgery to the Rectum and anus (back passage)

    Abdominal perineal excision of the rectum (APER)

        Post Operative Period

    Anterior resection

        Post Operative Period

Surgery to the colon

    Hemicolectomy

    Hartmann’s procedure

    Sigmoid colectomy

    Total colectomy

    Ileo Rectal anastomosis

    Panproctocolectomy

Surgery to the Rectum and Anus (back passage)

There are many conditions that can occur in the rectum / anus including rectal and anal cancer, haemorrhoids (piles), fistulas and fissures. Whilst most
of these problems can be easily treated many find it embarrassing to talk about them with the General Practitioner (GP).

Some of these conditions may need surgery to remove the affected area (particularly if it is rectal cancer). In most cases the two ends of the bowel will
be rejoined either at the time of the operation or a short while afterwards.

This section examines some of the different types of rectal operations with diagrams to aid your understanding.

Abdominal Perineal Excision of the Rectum (APER)

Post-Operative Period

Anterior Resection
Post-Operative Period

Abdominal Perineal Excision of the Rectum (APER)

This operation is performed if you have a cancer that is situated very low down in the back passage (2mm) from the anus and
cannot be removed in any other way.
The lower part of the colon and back passage, together with the sphincter muscles will be removed. (See diagram)

Abdominal Perineal Excision of the Rectum (APER)

The operation is performed by two surgeons. One removes the colon through the abdominal incision and a colostomy is formed.
The second surgeon removes the back passage. The original exit for faeces through the anus is then sewn up.

Post Operative Period

You may experience strange and different sensations, such as a tightness where your anus was. Feelings of tightness and numbness after
the operation are not uncommon because of the location of the wound and healing process. It may help to sit on a soft cushion with
frequent position change or to walk around.

Anterior Resection

This operation is performed for a cancer low in the bowel or if you havediverticular disease.

The operation is performed through an incision on your abdomen. The upper part of the rectum is removed but the anal sphincters are left intact. The
remaining colon is sewn onto the remaining rectum (See diagram).

You may need a temporary loop ileostomy for a while to allow the colon to heal.

Anterior Resection

Post-Operative Period

Following stoma reversal, it will take time for your bowels to settle down. You may find that you have frequency and urgency to get to the
toilet. Medicine such as Immodium may help you. The skin around your bottom may become sore in the early weeks. To overcome this you
should ensure that your bottom is washed and dried thoroughly with warm water and a soft cloth after each bowel movement. You can use
a protective cream such as Vaseline. Do not use baby wipes, talcum powder or impregnated toilet tissue as this could irritate the skin. 

Surgery to the colon

If the left side of the colon is removed, it is called a left hemi colectomy.
A hemicolectomy is performed for bowel cancer, diverticular disease, Crohn’s disease, trauma and certain rarer bowel disorders.

If the middle part of the bowel is removed (the transverse colon) it is called a transverse colectomy / extended hemicolectomy

If the right side of the colon is removed, it is called a right hemi colectomy.

If the sigmoid colon is removed it is called a sigmoid colectomy.

This operation is performed for cancer of the sigmoid colon, diverticular disease and trauma. A mid line incision is performed. The sigmoid colon is

removed and the remaining colon is sewn to the rectum

Hartmann Procedure

This operation is often carried out as an emergency if there has been a perforation of the bowel, especially if you have diverticular disease, colorectal
cancer or had a trauma to the bowel. 

The lower part of the colon is removed from the rectum, the bowel is divided and the top end is brought out on to the abdomen as a colostomy. The top
of the rectum/back passage is oversewn and left inside (See diagram).

Hartmann Procedure
Total Colectomy

This operation is performed for inflammatory bowel disease and bowel cancer. A total colectomy removes most of the large bowel, leaving the rectum
and anus. The stoma could be either a permanent or temporary ileostomy.

Total Colectomy Procedure

Ileo Rectal Anastomosis

In some circumstances the small bowel can be joined to the rectum and this is known as an ileorectal anastomosis.

This operation may result in very frequent bowel actions, urgency and possible incontinence. You may also have a sore anus. To help this you should

wash and dry your bottom thoroughly after each bowel movement with warm water and a soft cloth. You can use a proprietary protective cream

available from the chemist. It is inadvisable to use baby wipes, talcum powder or impregnated toilet tissue as this may irritate the anal skin. 

Panproctocolectomy

This procedure removes the large bowel, rectum, anus and sphincters. It is often performed for Ulcerative Colitis and Familial Adenomatous
Polyposis (FAP).

In a panproctocolectomy the entire large bowel i.e. colon and  rectum are removed. This results in a permanent ileostomy (see diagram).

Panproctocolectomy

The space where the anus and any remaining rectum is, will be sewn up. Reconstruction may be available to avoid a permanent ileostomy, but this
would have been discussed with you by your surgeon.