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Laparoscopic Total Colectomy & Ileoanal Pullthrough

Laparoscopic Total Colectomy&Ileoanal Pullthrough

Digestive Tract Disorders

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Laparoscopic Total Colectomy&Ileoanal Pullthrough

At Home Care

At Home Care

Medications

If you took steroids before your surgery, you may be on what is called a "steroid taper" post-op. This is when the dose of the steroids is slowly decreased over the first few weeks post-op.

Review of Potential Complications

Before surgery, your doctor and nurses will have reviewed possible complications related to the surgery. Those complications include:

Small bowel obstruction (SBO): This is a blockage of digestive contents (stool) through the small bowel. This often is managed medically for a few days by placing and IV for hydration and an NGT to empty stomach contents and rest the bowel. If the blockage does not resolve or is complete with significant pain, surgery may be required.

Fluid and Electrolyte imbalances: During digestion, the colon absorbs fluids and some electrolytes (which are chemicals important to the function of many processes in the body). You no longer have the large bowel or colon to absorb water so you must increase the amount of fluids you drink. The ileostomy will put out a moderate amount of fluids in the stool and increases the risk of dehydration and electrolyte imbalance. Treatment of dehydration may require hospitalization.

Stenosis: This is a narrowing or development of scar tissue in the area where the J-pouch is surgically sewn and connected to the rectum. This is typically diagnosed when you are having symptoms of an obstruction or blockage. These symptoms may include: straining, anal pain, passage of frequent watery stools, urgency, sensation of incomplete emptying, and leakage. These areas of narrowing may need to be stretched to allow easy passage of stool. Sometimes your doctor can stretch the area by using a lubricated gloved finger, or you may require daily dilations with a special dilator.

Pouchitis: This is an inflammation of the internal reservoir or "pouch." Symptoms may include an increase in the number of stools, rectal bleeding, urgency (feeling like you have to have a bowel movement immediately), abdominal cramping, more liquid stools, incontinence (unable to hold stool in the body), fever, and feeling more tired than usual. No one knows what causes pouchitis. Because stool is stored in the J-pouch it may be due to the overgrowth of bacteria. There is no one definitive test to diagnose pouchitis. It is often diagnosed based on the symptoms you are having. An endoscopic examination of the pouch may be required to confirm the diagnosis. Pouchitis may occur as a single episode and respond well to a short course of antibiotic treatment. Occasionally, pouch irrigations may be advised using a catheter and water. Pouchitis rarely becomes chronic and require long-term antibiotic therapy or steroids. Corticosteroids may be given at that point, but usually the antibiotics are adequate to control all but the most stubborn cases of pouchitis.

Pelvic Infections: Antibiotics and/or drainage may manage the infection. An ultrasound scan or computerized tomography (CT) scan may be done to diagnose and/or guide placement of drains to drain fluid collections that may be seen. Sometimes, surgery is required to achieve drainage of fluid collections.

NEVER take a laxative. These are often given to clean out the large bowel which you no longer have. If you have concerns, contact your General Surgeon or GI doctor.

Be aware of different forms of medications you are prescribed. For example, time released or enteric-coated pills will not longer be effective. Consult your doctor or pharmacist before beginning a new medication.

Pelvic exercises called Kegels may be started a few weeks before your last surgery for ileostomy closure. The purpose is to strengthen the tone of your anal sphincter muscle. These are the muscles that help you control your bowel function and keep the stool (poop) inside your body and prevent "accidents."


	The Kegel Exercise Tighten your anal muscle as if you are trying to stop a bowel movement. It should feel like the same sensation when you stop your urine stream when voiding ("peeing"). Do not squeeze the buttock ("bottom") muscles. Hold to the count of ten while squeezing tightly then relax for a count of ten. Repeat these exercises 10 times for one full set. Try to do 4-5 sets a day. You can do them anytime in any position. Most people remember to do them whenever they go to the bathroom or when watching TV.

A nurse from a Visiting Nurse Agency (VNA) will be coming to your home to help review ostomy care instructions, and monitor your progress for any possible complications.

A Durable Medical Equipment (DME) company will deliver ostomy supplies to your home that have been ordered by the hospital. Your nurse will inform you of what the name and phone number of the company is.

"Back at home with my new stoma..."


					Children's Hospital Boston is the primary pediatric teaching hospital of Harvard Medical School

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