Bowel Surgery

Each year, a number surgical procedures are performed in the United States to treat diseases of the intestines. A number of different disease processes and problems occur in the GI tract.  Fortunately not all of them require or are best treated by surgery.  Although surgery is not always a cure, it is often the best way to stop the spread of disease and/or alleviate symptoms.

The upper GI tract is made up of the oropharynx, esophagus, stomach and duodenum.  The lower GI tract is comprised of the jejunum, ileum, colon, appendix, rectum and anus.  The primary purpose of the GI tract is to break down our food, absorb the nutrients while protecting us from toxins and dangerous organisms and eliminate the wastes.  This sounds simple but is an extraordinarily complex process. The surface area of the digestive tract is estimated to be the surface area of a football field.  This is required to  adequately process the food we ingest everyday.  The GI tract represents a significant portion of our immune system in order to protect us from harmful bacteria present in the gut.  There are many hormone secreted in the GI tract which control various digestive mechanisms.

Advance Tests

Most diseases of the GI tract are diagnosed by imaging, endoscopy and/or blood tests.  CT scans, ultrasound, MRI and nuclear medicine imaging are all useful in various GI problems.  A gastroscope is a soft, bendable tube about the thickness of the index finger which is inserted into the mouth and then advanced through the esophagus and stomach to the duodenum. A colonoscope is a similar scope used to evaluate the colon from below.  Endoscopic retrograde pancreaticocholangiography (ERCP) allows visualization of the openings of the pancreatic duct and common bile duct through a specialized gastroscope.  Biopsies and brushings of the bowel and ducts can be obtained through these scopes. Endoscopic ultrasound evaluation is often helpful.  A barium upper GI study and barium enema are special X-rays where pictures or videos of the bowel are taken. These tests allow the surgeon to look inside of the gastrointestinal system and may be useful.  Prior to the operation, other blood tests, electrocardiogram (EKG) or a chest x-ray might be required.

Before Surgery

• Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
• After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
• Blood transfusion and/or blood products may be needed depending on your condition.
• It is recommended that you shower the night before or morning of the operation.
• Antibiotics by mouth are sometimes prescribed. Your surgeon or his/her staff will give you instructions.
• After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon and/or anesthesiologist have told you to take with a sip of water the morning of surgery.
• Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
• Diet medication or St. John’s Wort should not be used for the two weeks prior to surgery.
• Quit smoking and arrange for any help you may need at home.

Open bowel surgery requires an abdominal incision.  Usually, the incision is in the midline.  Occasionally, a diagnostic laparoscopy is done to establish the diagnosis or prepare the area for the procedure.  The problem must then be identified and surgically managed.  The surgeons of University Surgeons Associates are skilled in these procedures and perform them regularly.  Occasionally, a drain or even an ostomy is necessary to manage the problem.  Sometimes the wound is packed open if there is significant contamination within the abdomen.  This helps to prevent a wound infection.  Most patients cannot eat immediately after bowel surgery and it takes several days for the resumption of bowel function.  Most patients are in the hospital at least 3-5 days after open bowel surgery.

After the operation, it is important to follow your doctor's instructions. Although many people feel better in a few days, remember that your body needs time to heal.

• You are encouraged to be out of bed the day after surgery and to walk. This will help diminish the soreness in your muscles.
• You will probably be able to get back to most of your normal activities in two to three weeks time. These activities include showering, driving, walking up stairs, light exercise and even working.
• No heavy lifting for six weeks after this type of surgery.
• Call and schedule a follow-up appointment within 2 weeks after your operation.

These complications include:

• Bleeding
• Infection
• Leakage of bowel  contents
• Injury to adjacent organs
• Blood clots to the lungs.

It is important for you to recognize the early signs of possible complications. Contact your surgeon if you notice severe abdominal pain, fevers, chills, drainage or rectal bleeding.

Be sure to call your physician or surgeon if you develop any of the following:

• Persistent fever over 101 degrees F (39 C)
• Bleeding from the rectum
• Increasing abdominal swelling
• Pain that is not relieved by your medications
• Persistent nausea or vomiting
• Chills
• Persistent cough or shortness of breath
• Purulent drainage (pus) from any incision
• Redness surrounding any of your incisions that is worsening or getting bigger
• You are unable to eat or drink liquids