Anterior Resection

Anterior Resection of Rectum

The bowel is a tube of intestine which runs from the stomach to the back passage. The lower half of the bowel is called the colon. The colon runs from the right side of the waist line, up to the right ribs, loops across the upper part of the belly and passes down the left side. There it runs backwards into the pelvis as the back passage, where it is called the rectum. In your case, the problem lies in the left side of the colon or upper rectum. The left side of the colon and upper rectum is taken out, and the ends are joined up whenever possible.

The Operation

You will have a general anaesthetic, and will be asleep for the whole operation. A cut is made in the skin to the left of the tummy button about 40 cm (15 inches) long. The left side of the colon loop and the upper rectum are freed from the inside of the tummy. The diseased part is cut out and usually the ends are joined together. Sometimes it is safer if the ends are not joined together. Then the bowel waste is channelled through the bowel which opens in the front of your tummy (a colostomy), and you need to wear a bag. Usually the ends are joined up at a later date. Sometimes the ends are joined up at the first operation, but a short term colostomy is made as well. This keeps the bowel waste away from the join while it is healing up. You should plan to leave hospital 2 weeks after the operation. Very rarely, if the problem area is in the lower part of the rectum, at operation, the back passage may need to be removed as well. You would be warned about this before the operation.

Any Alternatives

Simply waiting and seeing is not a good plan. The trouble you are having with the bowel will simply get worse and may well lead to very serious problems. Tablets and medicines will not be helpful, neither will x-ray and laser treatment. Keyhole operations are still quite rare.

Before the operation

Stop smoking and get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to hospital, take you home, and look after you for the first week after the operation. Bring all your tablets and medicines with you to hospital. On the ward, you may be checked for past illnesses and may have special tests, ready for the operation. You will be asked to fill in an operation consent form. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.

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After - In Hospital

You will probably have a fine plastic tube coming out of your nose and connected to another plastic bag to drain your stomach. Swallowing may be a little uncomfortable. You will have a dressing on your wound and a drainage tube nearby, connected to another plastic bag. You may have a colostomy. The wound is painful and you will be given injections and, later, tablets to control this. Ask for more if the pain is still unpleasant. You will be expected to get out of bed the day after operation despite the discomfort. You will not do the wound any harm, and the exercise is very helpful for you.

The second day after operation you should be able to spend an hour or two out of bed. By the end of four days you should have little pain. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. Do not make important decisions during that time. You will probably have a fine drainage tube in the penis or front passage to drain the urine from the bladder until you are able to get out of bed easily. You should be eating and drinking normally after about four days. The wound has a dressing which may show some staining with old blood in the first 24 hours. There may be stitches or clips in the skin. Sometimes 7 or 8 stitches are put across the wound to add strength. Stitches and clips are removed after about 8 days. The drain tube is removed after 4 days or so. If you have a colostomy, special nurses will show you how to manage it. You will be given an appointment to visit the Out Patient Department for a check up about one month after you leave hospital. You will know the results of the examination of the bowel by then. The nurses will advise about sick notes, certificates etc.

After - At Home

You are likely to feel very tired and need rests 2 or 3 times a day for a month or more. You will gradually improve so that by the time 3 months has passed you will be able to return completely to your usual level of activity. You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about 3 weeks. You can restart sexual relations within 2 or 3 weeks when the wound is comfortable enough. Sometimes the operation will upset the nerves which control sex in the male. The surgeon can discuss this with you. You should be able to return to a light job after about 6 weeks and any heavy job within 12 weeks.

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