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Your Health. Our Priority.

www.stockport.nhs.uk Surgical and Critical Care | Stepping Hill Hospital

LEFT HEMICOLECTOMYYOUR OPERATION

Information Leaflet

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IntroductionThis leaflet explains the procedure known as a Left Hemicolectomy. It includes the commoncomplications associated with this surgery. It is not meant to replace the discussion betweenyou and your Consultant or Colorectal Nurse Specialist but as a guide to be used in conjunctionwith what is discussed. This leaflet is appropriate for both benign (non-cancerous) andmalignant (cancerous) conditions. At this point you should be aware of the reasons why surgeryis required.

What is it?A Left hemicolectomy is the removal of the left side of the bowel that is affected by disease, thisis shown by the shaded area in the diagram below, along with this section of bowel, bloodvessels and lymph glands will also be taken.

The operation means removing the left hand side of the bowel and then joining the two healthy

ends of the bowel back together (anastomosis) this is done by either stitching or stapling.

The wound on the abdomen maybe closed with clips, stitches or skin glue.

Shaded area indicates approximate section of bowel to be removed

Laparoscopic or Open SurgeryThere are two ways that surgery can be performed. Open (Laparotomy) where the surgeon

makes a large incision in your abdomen (tummy) to remove the affected area of bowel andLaparoscopic (Keyhole), where a number of small incisions in your abdomen are made andspecialist instruments guided by a camera are used to remove a section of your large bowel.Both techniques are believed to be as equally effective in removing the cause of your conditionand risks of complications are the same.

Recognised benefits of keyhole (Laparoscopic) surgery include:

Faster recovery time and earlier discharge Reduced post operative pain Minimised scarring

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Early return of bowel function

The choice of surgical approach will be discussed and decided between you and yourConsultant. The approach used often depends on your general health and medical conditions,fitness and BMI (Body Mass Index). It is important to note that if you are to undergo

laparoscopic surgery sometimes operations may begin laparoscopically but then convert to anopen procedure for technical reasons.

Depending on the surgical approach, the wounds on the abdomen are closed differently. Foropen surgery the wound is often large and runs down the middle of the abdomen, this isgenerally closed with clips which are removed approximately 10 days after surgery. Forlaparoscopic surgery, keyhole sites and/or smaller wounds running down the middle of theabdomen are often closed using skin glue. In this instance the skin glue dries and falls offnaturally over time. In either situation stitches maybe used, some are dissolvable and somerequire removal approximately 10 days following surgery. Your ward nursing staff will assessthis and advise on the type of stitches which have been used.

Will I have a stoma? (Colostomy, ileostomy - sometimes called abag)In this operation, it is extremely uncommon that a stoma is required. It is only if the bowel endsare unhealthy, or if the operation is done as an emergency, will the surgeon think it safer tobring the end of the bowel onto the abdominal wall as a stoma. If this happens it will usually betemporary and the ends of the bowel will be rejoined later

Before your operation your Consultant or Colorectal Nurse will explain the procedure involved

although details will vary according to individual cases. It is important to note that sometimesduring the operation that if the disease or operation is more complicated than first anticipated,the type of surgery may then have to be changed to achieve the desired result. This may meanremoving more bowel, or part of nearby organs such as the bladder. The consent form willaddress this option which you will need to sign to confirm that you agree to have surgery.

Benefits of surgeryThe condition affecting part of your large bowel will be removed. In most cases this will give youthe best chance of a cure or a significant improvement in your bowel problems.

Surgical complicationsMost will not experience any serious complications from their surgery; however risks doincrease with age and for those who already have established medical conditions such as heart,chest, diabetes, obesity or who smoke. As with any surgery there are risks of complicationswhich are unusual but can occur. To reassure, these are rapidly recognised and dealt with bynursing and surgical staff. Although risks are often very small it is important you are aware ofthem so you have all the information you need prior to agreeing to the operation.

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Potential short term complications/risks specific to Left Hemicolectomy surgery:

Stoma formationthis is very unlikely but the surgeonmay decide the bowel needs to healbefore it can be reattached. This may also be necessary if complications have occurred postoperatively and emergency surgery is required.

Ileus - temporary stoppage in bowel movement. The bowel is often slow to start workingtherefore your bowel needs to be rested (restricted fluid intake orally and no food), you willbe given intravenous fluids via a drip to replace fluids lost and instead of drinking you mayneed a nasogastric tube (tube placed via the nose into the stomach) inserted to preventvomiting. This would remain in place until the bowel recovers and starts to work.

Anastomotic leak(an-as-tom-ot-ic) - is a breakdown along the join in the bowel(anastomosis) which causes fluids or faeces to leak, potentially causing severe infection,resting the bowel and treatment with antibiotics through the vein is usually successful. Insome cases this condition can be serious, if there is no improvement in your condition furthersurgery to form a stoma may be necessary.

Damage to the bowelcan occur due to surgical instruments and close proximity of other

organs. Repair will be undertaken at the time of surgery if necessary. Anastomotic stricture (an-as-to-mot-ic) - a narrowing in the diameter of the bowel which

can lead to a blockage. This generally is not an immediate complication following surgeryand can occur in the months following. Symptoms such as a feeling of permanently wantingto open your bowels although only passing a small amount each time, discomfort whenhaving your bowels opened or a bloated feeling in your tummy caused by a hold up of stool,in some cases it may be necessary for you to have a minor procedure to stretch thenarrowed area.

Bowel obstruction - blockage of bowel movement, generally resting the bowel (restrictedoral fluid intake and no diet) will resolve this issue. If no improvement a further operationmaybe required. This may occur at an early or late stage in your recovery. In the majority ofcases a bowel obstruction is caused by adhesions (scar tissue), which may restrict bowelactivity or narrow the width of the colon. There is a leaflet available explaining Adhesions.Please ask your Colorectal nurse if you would like to read one.

General complications/risks following any major bowel surgical procedure, short term:-

Chest infection - anaesthetics and surgery can interfere with the normal way in which thelungs clear secretions and prevent infections. Pain from surgical wounds and reducedmobility can make breathing and coughing more difficult, increasing the risk of infection. We

encourage cooperation with the physiotherapists, deep breathing exercises and if you smoketo stop. Retention- the inability to urinate (pass urine). This is often temporary and is relieved with a

urethral catheter. Following your surgery you will have a catheter, your surgical team willassess the need for this to stay and when it can be removed. In some cases due to thesurgery and pre-operative treatments you may have received, you may be unable to passurine following the catheter removal. In this case the catheter would be reinserted and youmay be discharged home with the catheter insitu, you would return a few weeks later to havethis removed.

UTI (Urinary tract infection) -bacterial infection affecting any part of the urinary tract.

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Haemorrhage- this can occur from the wound or operation site (internal bleeding). This maybe due to pre-operative anticoagulants or unrecognised bleeding. Blood transfusion may berequired and very rarely further surgery to control bleeding.

Wound infection- all clinical practice in both surgery and nursing are geared towardsinfection prevention and control. However, there is an increased risk of wound infections with

any bowel surgery due to the nature of the surgery itself. Wound infections tend to presentwith localised pain, redness and slight discharge.

Wound dehiscence- generally this refers to the failure of a wound to heal completely,becoming apparent between 7 and 10 days. It is separated into two groups, full thicknessand superficial. Full thickness refers to the breakdown of the whole wound, this is a seriouscomplication requiring surgical intervention to re-suture the abdomen. Superficial refers to apartial breakdown of the wound and is managed with dressings only. This may take severalweeks/months for full healing to occur

Risk to life- major surgery can carry risk to life this will be discussed with you. For a LeftHemicolectomy this is approximately 5%.

DVT (Deep vein thrombosis)- major surgery carries risk of clot formation in the leg. Many

cases are silent but may present with swelling of the leg, tenderness of the calf muscleand/or increased warmth of the calf. A DVT can occur following surgery or some weeks later.Preventative measures: heparin given as a daily injection, compression stockings andmovement as much as possible.

PE (Pulmonary embolism) - is a blood clot stuck within the blood vessels of the lungs,usually having travelled from the deep veins of the legs. Symptoms include shortness ofbreath, chest pain, confusion, expectoration of blood (haemoptysis). Preventative measuresare the same as above. A PE can occur following surgery or some weeks later.

General complications/risks following any major bowel surgical procedure, long term:-

Incisional hernia -presents as a bulge in the abdominal wall close to the wound site. Thisoccurs in 10-15% of abdominal wounds and usually appears within the first year followingsurgery but can be later. Usually they provide little trouble but can sometimes causepain/discomfort or increase in size over time.

Adhesions (scar tissue) - scar tissue that forms between tissues and organs after anyoperation. Typically, scar tissue begins to form within the first few days of surgery, but theymay not produce symptoms for months or years. In some cases these can causecomplications such as pain, affect the activity of the bowel leading to hospital admission orfurther surgery.

Aches and pains -you may experience numbness around the wound for 2-3 months and

general abdominal aches and pains for approximately 6 months following surgery as youand your body recovers from surgery.

If you are concerned about any of these risks, have any questions or would like furtherinformation and advice please speak to your Consultant, Anaesthetist or Colorectal NurseSpecialist.

Your bowel function post operativelyFollowing any bowel operation the function of bowel can change. It is often difficult forhealthcare professionals and yourselves to predict what your bowel function will be like as

everyone is different.

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Some of the problems that could be experienced are

Constipation or diarrhoea

Increased frequency - needing to go more often.

Persistent wind or bloating - losing the ability to distinguish between wind/stools.

In most people these improve with time but can take several months to settle down. You maysometimes need medication to help control your bowel habit. It is recognised that each situationis different, with very different outcomes and experiences. We therefore encourage you to behonest, speak openly and seek advice from your Consultant, Colorectal Nursing Team and/orStoma Care Nursing Team.

If you have a stoma formed during this procedure, you may find that you still have a feeling ofneeding to go to the toilet and may experience rectal discharge. If there are any questions which

arise from this leaflet please do not hesitate to contact us

Contact usMr M SaeedSecretary: 0161 419 4267

Mr E ClarkSecretary: 0161 419 2028

Mr S RaiSecretary: 0161 419 4268

Mr F ReidSecretary: 0161 419 4275

Mr M MarsdenSecretary: 0161 419 4265

Colorectal Cancer Nurse Specialist

Doreen Dooley, Jill Taylor, Rebecca Costello24 hour answer phone: 0161 419 4088Alternatively through switch: 0161 483 1010

Stoma Care Nurse Specialist

Jean Sellars, Caroline Dowson, Janet Land, Eleanor ThompsonSecretary Sue Daniels24 hour answer phone:0161 419 5052

Contact via switchboard: 0161 483 1010

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If you would like this leaflet in a different format, for example, in large print, or onaudiotape, or for people with learning disabilities, please contact:Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: 0161 419 5678.Email:[email protected].

Our smoke free policySmoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free

NHS Premises' to find out more.

Leaflet number SUR86

Publication date August 2015

Review date August 2017

Department Surgical and Critical Care

Location Stepping Hill Hospital
mailto:[email protected]:[email protected]:[email protected]:[email protected]

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