Laparoscopic Total Colectomy & Ileoanal Pullthrough

Tubes and drains

You may have many tubes and drains. Remember that each one has a purpose and will be removed as soon as possible.

The abdominal incision has dissolvable sutures (stitches) and will have small white bandage-like strips across it. It will be covered with gauze and a clear plastic dressing. The first dressing put on in the operating room will be changed at least once before going home from the hospital. The small white bandages begin to fall off usually about 10 days after surgery. You should leave them on for as long as they will stay.

• Two Jackson Pratt (JP) drains will be put though your skin into your abdomen during surgery to drain fluid from your pelvis to decrease the risk of infection. These clear thin drainage tubes will be attached to a soft squeezable bulb about the size and shape of a lemon that has a plug type closure (like a beach ball cap). The squeeze bulb on the end of the drain tube creates a gentle suction that helps to get the fluid out of your abdomen faster. Your nurse will open this cap a few times a day to empty and measure the drainage into a measuring cup. The drainage in the beginning will be red, and should change to pink then colorless as you heal. The first JP drain is usually removed four to five days after surgery. The second one is often removed the following day. There is a gauze dressing around the tube site which your nurse will change once a day and whenever it becomes wet with drainage.
• A drain called a Penrose drain is also placed during surgery and comes out from your anus. It helps empty any mucous or bloody drainage from the ileal pouch to prevent it from becoming over distended. It is usually removed five days after your surgery. The pouch will continue to produce small amounts of mucus daily or every few days. For the first few weeks after surgery, it may be tinged with blood. At some point you may have an urge to have a bowel movement. You may need to sit on the toilet and gently push mucus from the anus. The amount of mucus and frequency of discharge varies. The drainage usually does not have an odor.

The skin around your anus may become irritated after any of the surgical procedures, but the irritation is most common after the first stage when then ileostomy is closed. The mucosa or lining of the bowel secretes a slippery mucus to lubricate the passage of stool.. Before the ileostomy is closed, mucus from the unused lower portion of the colon (i.e. the rectal remnant) or the "J-pouch" depending upon which stage of surgery you have had, may seep from the anus and be hard to control. This is temporary and once the ileostomy is closed, the mucus mixes with the stool and is easier to control.

Using soft toilet paper and keeping the area clean and dry is very important. Initially, some people feel more comfortable wearing a liner in their underwear to avoid moisture on their underwear. The treatment for rectal drainage is to protect the surrounding skin. Your nurses will recommend skin care powders, creams or ointments that will help.

• A Nasogatric tube (NGT)is used to help keep your stomach empty, rest your bowel while it heals, and prevent nausea and vomiting. It will be removed when your stomach and intestine begin to function normally. Your nurses and doctors will place a stethoscope on your stomach several times a day to listen for bowel sounds.
• An epidural catheter is a small tube which may be placed in your back. Pain medication may be given through the catheter.
• A PCA Pump refers to Patient Controlled Analgesia Pump. This has a button that you push to give yourself pain medication.
• A Foley catheter is placed into your bladder while you are in surgery. This tube drains urine and empties your bladder. While the epidural or PCA pump is in place, you may not feel the sensation of a full bladder and your bladder will not empty normally. This is usually removed 6-8 hours after you begin taking pain medication by mouth.
• An intravenous (IV) catheter is inserted into a blood vessel in your arm to give your fluids and medicines until you are able to drink and eat.
• Sequential compression devices (SCDs) sometimes called "Pneumoboots" are sleeves that are placed around your legs during the operation. These sleeves are attached to a pump that gently squeezes and then relaxes. These are to help with the blood circulation and prevent any blood closts from forming in your veins. They will be removed several times a day to wash your legs and check your skin. They stay on your legs the first few days after surgery until you are getting up 2-3 times a day and walking around.
• You will be shown how to use an incentive spirometer also called a "blow bottle". This will help inflate you lungs fully and prevent you from taking shallow breaths. Using the incentive spirometer will decrease the risk of pneumonia.