Surgical Treatment

One way of treating diseased bowel is to remove it. This surgical procedure is called an intestinal (or bowel) resection. The procedure is performed in an operating theatre whilst the patient is under general anaesthetic.

Once unconsciousness has been induced, an abdominal incision (either vertically or horizontally) is made. Small instruments are inserted through the incision. This is to view and move the organs.

After the diseased piece of bowel has been cut out and removed, the remaining healthy bowel is then reattached via staples or sutures.

Length of operation

The length of time taken to complete the operation typically ranges between 1 to 3 hours.

What to expect postoperatively

• Expect a 5-7 day stay in hospital, with full recovery at about 6 weeks
• Hospital stay managed by a team of healthcare professionals, including: pain management team, physiotherapist (to get you up and walking and prevent you from developing blood clots and breathing problems), your doctor, surgeon, and nursing staff
• Delivery of fluid and nutrients intravenously until bowel activity resumes

Intestinal resections – commonly asked questions

What options exist for pain management

Three main options exist. These include “Patient Controlled Analgesia”, an epidural or pain pills.

How long before I can resume physical activity?

This depends on the surgery performed and whether there were any complications from the surgery. Recovery times also differ from open surgery (laparotomy) and keyhole surgery (laparoscopy). It is always encouraged to resume physical activity as soon as your doctor is happy for you to do so.

What will my bowel motions be like after surgery?

It depends on which type of surgery was performed and whether a stoma is in place. With a stoma, it also depends on whether it is a large or small bowel stoma. Expect looser and more frequent bowel actions especially with a small bowel stoma.

Can medical treatment be ceased after surgery?

For Crohn’s Disease, treatment is advised at least in the initial months to reduce the chance of relapse.

It depends on indication and also the type of surgery performed.

One of the greatest fears of many IBD patients is the prospect of having a stoma. This may due to perceived ideas related to odour, stoma management, wearing an appliance and reactions from others.

A stoma is a result of a surgical procedure that produced an artificial opening in the abdominal wall through which faecal waste is excreted. Faecal waste is collected in a stoma pouch that adheres to the body and is discretely hidden under clothes.

There are different types of stomas that are distinguished by section of bowel that they originate from. For example, a colostomy is fashioned in the large bowel that produced normal faecal waste. An ileostomy is fashioned in the terminal ileum (part of the small intestine) and discharges faeces that produced faecal matter in a toothpaste consistency.

Not all stomas are designed to be permanent; temporary stomas can be closed after the resolution of the underlying disease. This period may be sustained for as little as several months to as many as several years in length..

Ostomy: Adult perspective

Stoma formation gives rise to a number of challenges and issues, some of which include:

• Quality of life
• Body image: stoma leads to both physical and visible changes to body image
• Stoma management problems caused by leakage, ballooning of bags, poor sitting and inappropriate appliance selection
• Sexuality (includes concerns surrounding body image, specific sexual dysfunction, and management of the stoma during sexual activity)

Ostomy: Adolescent perspective

Adolescents can be affected by their ostomy. Common issues include:

• Secrecy: considerations in deciding whether to tell others about having a stoma
• Body intrusion and body image challenges
• Decreased independence and control
• Adjustment over time
• Challenges for the family
• Sources of strength: family and friends

Can you date with a stoma? http://www.youtube.com/watch?v=q_8fY750Ik0&feature=related

Stoma adjustment has been found to be improved in individuals who have the following:

• Development of specialised stoma care nurses who provide pre- and post-operative support, education, and management
• Development and advances in stoma appliances now caters for differences in stoma types
• Acceptance. Research has found that individuals who accept their stoma are more likely to report positive outcomes in relation to quality of life, relationships, etc
• Self-efficacy (refers to ones’ belief in their ability to perform tasks). Whilst stoma management skills are important, it is whether or not you believe in your management ability that really makes a difference. You may have the skills to change an appliance, for example, but if you do not believe you have those skills then it will impact your behaviour and thoughts. Subsequently you might start avoiding going out and doing things you normally would enjoy
• Social support.
• Positive perceptions of their illness and how they can cope/manage it
• Coping style. Styles of coping that reflect adjustment include acceptance, humour (e.g., strategies such as naming stoma), recognition of position changes from stoma (e.g., focusing on aspects of surgery that improved your life quality), and problem-solving (e.g., always carry a small supply of stoma appliances in an emergency).

View Stoma image (Warning: medical image)

One of the greatest fears of many IBD patients is the prospect of having a stoma. This may due to perceived ideas related to odour, stoma management, wearing an appliance and reactions from others.

A stoma is a result of a surgical procedure that produced an artificial opening in the abdominal wall through which faecal waste is excreted. Faecal waste is collected in a stoma pouch that adheres to the body and is discretely hidden under clothes.

There are different types of stomas that are distinguished by section of bowel that they originate from. For example, a colostomy is fashioned in the large bowel that produced normal faecal waste. An ileostomy is fashioned in the terminal ileum (part of the small intestine) and discharges faeces that produced faecal matter in a toothpaste consistency.

Not all stomas are designed to be permanent; temporary stomas can be closed after the resolution of the underlying disease. This period may be sustained for as little as several months to as many as several years in length..

Ostomy: Adult perspective

Stoma formation gives rise to a number of challenges and issues, some of which include:

• Quality of life
• Body image: stoma leads to both physical and visible changes to body image
• Stoma management problems caused by leakage, ballooning of bags, poor sitting and inappropriate appliance selection
• Sexuality (includes concerns surrounding body image, specific sexual dysfunction, and management of the stoma during sexual activity)

Ostomy: Adolescent perspective

Adolescents can be affected by their ostomy. Common issues include:

• Secrecy: considerations in deciding whether to tell others about having a stoma
• Body intrusion and body image challenges
• Decreased independence and control
• Adjustment over time
• Challenges for the family
• Sources of strength: family and friends

Can you date with a stoma? http://www.youtube.com/watch?v=q_8fY750Ik0&feature=related

Stoma adjustment has been found to be improved in individuals who have the following:

• Development of specialised stoma care nurses who provide pre- and post-operative support, education, and management
• Development and advances in stoma appliances now caters for differences in stoma types
• Acceptance. Research has found that individuals who accept their stoma are more likely to report positive outcomes in relation to quality of life, relationships, etc
• Self-efficacy (refers to ones’ belief in their ability to perform tasks). Whilst stoma management skills are important, it is whether or not you believe in your management ability that really makes a difference. You may have the skills to change an appliance, for example, but if you do not believe you have those skills then it will impact your behaviour and thoughts. Subsequently you might start avoiding going out and doing things you normally would enjoy
• Social support.
• Positive perceptions of their illness and how they can cope/manage it
• Coping style. Styles of coping that reflect adjustment include acceptance, humour (e.g., strategies such as naming stoma), recognition of position changes from stoma (e.g., focusing on aspects of surgery that improved your life quality), and problem-solving (e.g., always carry a small supply of stoma appliances in an emergency).

View Stoma image (Warning: medical image)

What is a fistula

An intestinal fistula is an abnormal connection or passageway between the bowel and other organs or the skin.

They form when inflammation extends through all of the layers of the bowel and then proceeds to tunnel through the layers of other tissues.

There are a number of different types of fistulas, possible types include: Perianal, enteroenteric, enterocutaneous, peristomal, enterovaginal, enterovesical, perineal.

What is a fistulotomy (‘lay open’ technique)?

A fistulotomy is a procedure that involves laying open or cutting along the length of the fistula (tunnel or tract) to the skins surface. This allows the wound to heal slowly from the base upwards.

What is a seton?

A seton is a thread of foreign material inserted through the fistulous track. This allows drainage and it will slowly cut through.

What is an advancement flap?

This operation involves covering the anal opening of the fistula with the lining of the anus or rectum. If this heals no more faecal contamination of the fistula tract can occur and the fistula will heal.

A procedure whereby the entire colon and rectum are removed while preserving the anal sphincter.