Colorectal Surgery Leaflet: Anterior Resection

Anterior Resection: This type of surgery is recommended if your bowel cancer or polyp is in the upper and middle part of the rectum. The surgeon removes the part of the bowel that contains the cancer or polyp and rejoins the two open ends of the bowel.

Leaflet Details

Patient Information

Contents

• BEFORE YOUR SURGERY
• SURGERY
• Risks and Complications
• DIFFERENT TYPES OF STOMAS
• Ileostomies
• Colostomies
• Risks and Complications
• POST-OPERATIVE
• WHEN WILL I GO HOME?
• Useful Contact Numbers

BEFORE YOUR SURGERY

Before we book you for surgery, you will see one of our bowel surgeons at a face-to-face appointment and you will have the surgery and associated risks explained.

Don’t worry if you can’t think about all the questions at that time as you will see one of our Specialist Nurses and you will be able to speak with a doctor again if you need to.

You will have a few more appointments after this one before we can declare you fit for surgery.

You will have a general assessment done by our Pre-Operative Nurses. You will have bloods taken, vital signs (blood pressure, temperature, heart rate, oxygen, height and weight and an ECG) checked and your medical and social history will be formally documented.

At this stage you will be given strong laxatives to clear your bowels (unless if your consultant and/or the team advise otherwise), antibiotics to take on the day before your surgery (to help preventing wound infection), Preload® (carbohydrate drinks) and if you are not diabetic, we will also give you some high energy drinks called Fortisip®.

If you have pre-existing medical conditions which may make you at higher risk for surgery, we may recommend a pre-habilitation program to help reducing this risk.

You may also be advised to see one of our anesthetists pre-operatively and have further tests done.

SURGERY

This type of surgery is recommended if your bowel cancer or polyp is in the upper and middle part of the rectum. The surgeon removes the part of the bowel that contains the cancer or polyp and rejoins the two open ends of the bowel. Often, this join needs to be protected and the surgeon may have to create a temporary stoma (loop ileostomy). Occasionally, the bowel is not joined together, and a permanent stoma (end colostomy) is formed.

Risks and Complications Associated with this type of surgery

Bleeding, infection, wound problems, DVT (clot in leg), lung problems (e.g. clot in lung, infection), cardiac problems (e.g. heart attack), stroke, chest infection / complications, kidney problems (e.g. kidney failure), anastomotic leak (2-5%), recurrence of disease, damage to other organs/structures (e.g. ureter, spleen, bowel, blood vessels), ischaemic bowel, conversion to open procedure (if you are having keyhole surgery), need for blood transfusion, sexual / bladder dysfunction, Low Anterior Resection Syndrome (LARS), Incisional hernia, complications associated with stoma, need for further procedures, sepsis, risk of acquiring COVID-19, risk of life (mortality, this varies according with patient difference comorbidities).

DIFFERENT TYPES OF STOMAS

Before your operation you may have an appointment with our Stoma Care Team. They will explain the different stomas and materials to you in more detail, and they will draw an X on your abdomen to mark a site where the possible stoma will be brought to surface.

Ileostomy

Loop ileostomy

In this type of stoma, a loop of the small bowel is brough to the surface. A loop stoma will have two openings and bowel content will come out of the upstream opening. This is typically a temporary measure to protect a surgical join in the bowel.

Colostomy

A colostomy is usually sited on the left-hand side of your abdomen. Stools in this type of stoma are expected to be solid.

There are two main types of colostomies:

End Colostomy

Part of your large bowel is removed, and the end part of your bowel is brought to the surface of your abdomen. This type of stoma can be temporary (parts of your bowel need to rest before being joined together) or permanent (when it is too risky or not possible to re-join the two parts of the intestine).

Loop Colostomy

In this type of stoma, your bowel is brought to the surface of your abdomen and held in place by a stoma rod (Our Stoma Care Nurses and Doctors will let you know when this will be removed). A loop stoma will have two openings and bowel content will come out of the upstream opening. This is typically a temporary measure to protect a surgical join in the bowel.

If you have a stoma, you will be followed on the ward and at home by our Stoma Care Nurses.

Risks and Complications associated with formation of stoma:

Bleeding, infection, high output stoma, parastomal hernia, stoma prolapse, skin excoriation, stoma retraction, stenosis, necrosis / ischaemia (lack of blood supply), kidney problems (e.g. kidney failure), electrolyte imbalances needing infusions, need for further surgery on the stoma due to complications.

Post-operative

After your surgery, you will see our team and our Enhanced Recovery Pathway Nurse on the ward. Every day the team develops a plan / goal for your day, and we will work with you to help you recover as quickly and safe as possible.

When will I go home?

You will go home once you are hemodynamically stable (your blood pressure, heart rate, temperature and bloods are within normal values); you are able to mobilize safely; your pain is controlled; and you are eating and drinking adequately. If you have a stoma, it needs to be active, and you or your carer need to be able to look after it independently.

Virtual Ward Enrolment

You may be enrolled in our Virtual Ward when you are discharged from hospital. This means you would go home the day after your surgery with a monitoring kit to check your observations, along with a detailed follow-up plan.

If this is suitable for you, a member of the team will discuss it with you in more detail.

Contacts