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What to Expect After Surgery
With both open surgery and minimally invasive procedures (MIP), you will need time to heal. You will be on intravenous (IV) fluids and pain medication and will not be able to eat for the first couple of days. You also will probably feel tired or weak and experience loose bowels for a period of time.
Side effects of colon surgery typically include short-term pain and tenderness and temporary constipation or diarrhea. If you have a colostomy, you may develop an irritation of the skin around the opening (stoma).
Recovery Is a Team Activity
Remember that your body is unique, and so are your emotional needs and your personal circumstances. In some ways, your colon disease is like no one else's, and no one can predict how your body will respond to treatment. Statistics can paint an overall picture, but you may have special strengths, such as a healthy immune system or a strong family support system. These have an impact on how you cope with colon disease. If at any time you are having trouble coping, talk with your doctor, nurse, or social worker about your concerns. They may also suggest a therapist or mental health professional to help you.
Your healthcare team will monitor your progress and work to get you back to normal as quickly as possible.
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In the Long Run
After your surgery, regular follow-up exams will be very important for you. These exams, which may include a physical and a rectal exam, a colonoscopy, and blood tests, can determine if your colon disease has come back. If you had MIP for colon cancer, other tests, such as chest x-rays and CT and MRI scans, may also be done if anything suggests that the disease has returned. If colon cancer returns, it is often within the first two to three years after surgery.
If you’ve had a colostomy, follow-up is an important concern. You may feel worried or isolated from normal activities. Whether your colostomy is temporary or permanent, there are healthcare professionals trained to help you. Ask your surgeon about programs offering information and support in your area.
If your MIP was for colon cancer and you had subsequent radiation therapy, it could affect your feelings about your body and could lead to changes that affect sexuality. Your cancer care team can help with these issues, so don't hesitate to share your concerns.
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Risks and Complications of Surgery
As with any surgical procedure, there are some risks that accompany open and laparoscopic colon surgery. This is why it is important to weigh the benefits of the surgery against the risks. Complications are unplanned events, such as excessive bleeding, infection, or reaction to anesthesia. Some of the risks can occur in any type of surgery. Infection—deep or at the skin level—can occur. Infections can involve the abdominal incision. Deep infections, known as peritonitis, can occur and may involve the abdominal cavity. These deep infections may require long-term antibiotics and surgery. Bleeding during or after the operation may require a blood transfusion or additional surgery. And painful or ugly skin scars are always a possibility.
Colon surgery problems that can occur include the following: damage to the spleen, perforation of the stomach and/or intestines, injury to the bladder and the connecting tubes, injury to the internal female organs (including the uterus and ovaries), unexpected difficulties resulting in a temporary or permanent colostomy, hernias through the incision, or abdominal wall disruption or breakdown that would require additional surgery.
It is important to discuss possible complications with your surgeon prior to your operation.
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Possible Complications of Open Surgery
Complications of open surgery can include muscle stripping, organ failure, blood clotting, or injury to blood vessels.
Because of the larger incision, patients undergoing open surgery require a longer recovery period.
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Possible Complications of Minimally Invasive Procedure
It is important to choose a surgeon who has advanced training in laparoscopic techniques. Complications of a minimally invasive procedure can include bleeding, a leak where the colon was reconnected, injury to or perforation of organs (such as the small intestine, ureter, or bladder), injury to blood vessels, a blood clot in the lung, trocar injuries, or infection.
It is possible that a surgeon might need to convert from a minimally invasive procedure to an open surgery during the operation. This decision is made by the surgeon and is based on what is best for the patient.
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What to Ask
The decision to have surgery for colon disease can often be stressful. Patients interested in MIP for colon disease should find a surgeon who is experienced in MIP for colon disease. When meeting with the surgeon, the patient should bring a friend or family member to take part in the discussion with the surgeon, to help take notes, and to ask questions.
Patients can use the list of questions below in talking with the surgeon about which surgery option is best and about whether he or she is qualified to perform MIP:
- Do you perform minimally invasive or laparoscopic colon surgery?
- Are you board-certified? Which board? Which state?
(Surgeons should be certified by a national surgical board approved by the American Board of Medical Specialties.)
- How many colon cases do you treat annually?
(The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) recommends prerequisite experience should include performing at least 20 laparoscopic colorectal resections for benign colon disease or metastatic colon cancer before using the technique to treat curable cancer.)
- Have you received advanced training in minimally invasive surgical techniques?
- How many minimally invasive colon disease surgeries have you performed overall?
- What have you seen in terms of patient outcomes with this procedure?
- Who assists you with this surgery (residents, surgical physician assistants, surgeons)?
- What is the most common complication you have encountered with this procedure?
- Am I a candidate for a minimally invasive colon procedure?
- What are the benefits of minimally invasive colon surgery?
- What are the risks associated with this procedure?
- What will my recovery time be like following this procedure?
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