Sigmoid Colectomy
Preparation
Patients undergoing a sigmoid colectomy will undergo the standard preparation for a general anaesthetic. Investigations and specific preparation will be dependent upon the underlying disease process and will be discussed on an individual basis. Again depending upon the clinical situation patients may require to take a laxative the day before the operation to clear the bowel of faeces.
Procedure
This operation involves removing the sigmoid colon which is situated on the left side of the abdomen. After the diseased segment of bowel has been removed the descending colon is joined onto the rectum. Normally there should be no reason to perform a side passage or stoma however if the operation is being performed for a disease in which there is a lot of infection present or there is any doubt about the blood supply to the colon it is safest to bring out a stoma. It is likely that this will be put back after a period of time dependent upon the clinical situation.
If possible this operation is performed using a laparoscopic assisted approach – what this means is that three small incisions (approx 1cm) are made to insert a camera and instruments to aid dissection. After the bowel has been prepared and mobilised a small incision (about 5cm) is made to remove the diseased segment of the bowel and through this incision the ends of the bowel are joined together. Alternatively in some situations it is better to perform the operation through a conventional abdominal incision.
Anaesthetic:
General
Post Operative Recovery:
In the immediate post operative period it is usual to monitor patients closely in a high dependency area. This allows a specialist nurse to measure certain parameters very closely and ensures that any untoward events are detected and treated early. Generally patients can expect to start drinking early and are then encouraged to take a light diet, as they manage this it is possible to remove intravenous drips and urinary catheters. Mobilisation is dependent upon adequate pain control and patients are encouraged to sit up and take a short walk (with assistance to start with) from an early stage. Patients can expect to stay in hospital for 4-7 days after their surgery but should expect to feel tired for several weeks after surgery.
It is usual that patients experience some change in bowel habit following a sigmoid colectomy – in most cases this is a slight increase in stool frequency.
A right sigmoid colectomy is usually a very straight forward operation however as with all surgery there is a risk of complications. These can be regarded as non-specific complications related to having an anaesthetic and being immobile in bed for some time and those specific to the operation. The non-specific complications include:
- Chest infections – more common in smokers or patients with pre-existing lung diseases. Prophylactic physiotherapy will hopefully prevent this complication developing.
- Venous thrombosis and pulmonary embolism – patients will be given drugs to thin the blood and try to prevent this and will receive physiotherapy and early mobilisation to minimise the risks.
- Cardiac complications -these are uncommon unless there is a specific risk factor in this situation appropriate measures will be taken to minimise the risks.
- The specific complications of a sigmoid colectomy are uncommon but include:
- a wound infection - a wound infection is usually manifest as pain, swelling and redness around the wound it may or may not discharge pus. In most cases a wound infection is treated with antibiotics.
- delayed return to normal gut function – this is known as an ileus and may require longer than normal intravenous fluids. In the most prolonged cases treatment with intravenous nutrition may be required.
- leakage from the join between the descending colon and the rectum – this may necessitate further surgery and possibly the formation of a side passage (or stoma)
- a hernia through the wound -this is obviously more common with open surgery and may require an additional operation to repair it.
OPC Code:
H1000
