Laparoscopic Bowel Surgery
Many bowel operations are now possible using laparoscopic or keyhole techniques and an Enhanced Recovery Program (see definitions section).
Patients with diseased sections of bowel from bowel cancer, diverticular disease or inflammatory bowel disease like Crohn’s disease or ulcerative colitis can have the diseased bowel excised through very small incisions. Laparoscopic bowel surgery can help assist with stoma formation or stoma reversal and reversal of Hartmanns operation.
Laparoscopic bowel surgery is much less traumatic than traditional open surgery and therefore has the benefits of quicker return to normal function and less pain. Hospital stay can be reduced from 7-10 days down to 4 days and the convalescence period can be reduced from 8-12 weeks down to 2 weeks. This not only brings important benefits to patients but can bring cost savings to local health economies and so it is becoming popular with both patients and health providers.
One problem with open traditional bowel surgery performed through a large incision is that patients are prone to adhesions which can trap the bowel and cause bowel obstruction. They are also prone to weakened abdominal muscles and hernias. This is not only a problem for patients but is also very costly for local health economies paying for subsequent treatment. Laparoscopic bowel surgery reduces post-operative hernias and adhesions.
Laparoscopic bowel surgery is technically challenging and it is not appropriate for all patients. Laparoscopic colorectal surgery is particularly difficult in very obese patients, in patients with multiple previous operations and adhesions, and in patients with large masses in the abdomen.
That said, laparoscopic or keyhole bowel surgery is now benefiting many patients requiring bowel surgery throughout the world.
Patients may be required to take strong laxatives to cleanse the bowel on the day before surgery. The average hospital length of stay after keyhole bowel surgery is 4 to 5 days. Patients are allowed to eat and drink straight after their operation but they are given control of this themselves and they are encouraged to listen to their bodies. If they feel hungry or thirsty then they can eat or drink. If they feel sick or nauseous then they should abstain from eating and drinking. Patients are actively encouraged to mobilise and they should have a cough and move all four limbs in the bed at least every hour apart from when they are asleep. Patients are usually kept in hospital until they have had one bowel action. The first bowel action after keyhole bowel surgery can be a bit of a fanfare and patients should not be alarmed if they have a sudden rush of diarrhoea. It is much better out than in! Although this can be unpleasant, this is often a good sign that the surgery has been successful and patients should be reassured that their surgically shortened bowels will quickly get back to a more normal bowel habit. Patients with persistently loose motions can take simple anti-diarrhoeal medicines such as loperamide.
After the operation patients should not do any heavy lifting or heavy exercise for two weeks but light duties and walking are encouraged. Patients should try to keep their wounds dry for 48 hours to enable a scab to form over the wound which is the best type of dressing. Patients can wash and shower as normal after surgery but they should replace any wet dressings with dry ones in the first 48 hours. After 48 hours a formal dressing should not be required. After two weeks most keyhole surgery patients will be able to resume all normal activities. If patients have had to have open surgery through a large incision then they may well have to stay in hospital for several days longer and their recovery time at home is lengthened up to eight weeks. There is no strict rule on getting back to driving but you should be happy that you can do an emergency stop and slam down the brakes if a young child were to suddenly run in front of your car. For many patients this means not driving for at least one week after surgery. Hospital clinic follow up is usually arranged for 3 weeks after hospital discharge.