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Crohn's Disease Forum » Surgery » What happens before a small bowel resection?


12-03-2013, 03:39 AM   #1
YJ120
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What happens before a small bowel resection?

Hi all,

I'm pencilled in (hoping it becomes definite!) for a small bowel resection on 11th December, following being ill for a while and an MRI showing a stricture in my terminal ileum approx 7cm.

I haven't had my pre-op yet and am still waiting for a date.

My reason for posting is to find out what happens before the op? There's lots of info about the op and after the op, but I've no info on before. I've met my surgeon who's told me he is hoping to do the surgery laparoscopically, but as with all surgeries they don't know the full extent until they can see it and they may end up doing open surgery.

Could anyone be kind enough to advise what happened before being taken to theatre?

Fast?
Bowel prep, if so when do they give you this?
Do any nurses/doctors/specialists see you before the op?
Are you hooked up to any drips etc?
Are you marked up for a stoma in case you end up needing one?
Are family ok to be with you before op and wait for you to come round?
And any other info if there is any.

Thanks very much Yvette x
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Hospitalised & Diagnosed Nov 10 - Crohns Disease.
Started on Predisone after discharge from hospital for a few months.
Been on Mesalazine 4g a day since. Tried Azathioprine & 6MP, didn't work. Been on Budesonide in between due to flares.

MRI showed stricture on 24/09/13. TI resection done on 11/12/13
More tests colonoscopy on 28/3/14
12-03-2013, 04:05 AM   #2
Jennifer
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This site mentions the procedure fairly well along with instructions for before the procedure: http://www.nlm.nih.gov/medlineplus/e...cle/002943.htm

Before I had my resection I was kept in the hospital for about 5 days on a liquid diet and had to prep the night before (2 gallons of some nasty clear liquid I couldn't get down so I had an NG tube put in to help me get it down). If you do get an NG tube put in for any reason, make sure you go to the bathroom the second you feel like you need to go otherwise the liquid eventually backs up and bad things happen. More often then not I hear members mentioning no prep before surgery now days (my resection was 14 years ago). I spoke with my GI and the surgeon the night before surgery and the day of (they worked in the same hospital). I did have an IV the entire time I was in the hospital.

The day before surgery I had to sign a document that stated that a stoma was a possibility when I woke up from surgery. If I didn't sign it then they would not do the surgery. However I did see a member mention once that they signed a paper saying that if a stoma was a possibility then to close them back up and not do the surgery (the surgeon did think they needed a stoma so the member was sown back up with nothing done inside).

My parents hung around until I was taken back for the surgery (they were in my room) and they were allowed in the recovery room after some time but I don't remember any of that because I didn't actually wake up until the nurse shook my awake after I was already back in my room.

I was told that I would get a catheter but I woke up without one. That's not common practice now so you'll likely wake up with one (which I'm told isn't bad, I've never had one though).

If I think of anything else I'll let you know.
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Diagnosis: Crohn's in 1991 at age 9
Surgeries: 1 Small Bowel Resection in 1999; Central IV in 1991-92
Meds for CD: 6MP 50mg
Things I take: Tenormin 25mg (PVCs and Tachycardia), Junel, Tylenol 3, Omeprazole 20mg 2/day, Klonopin 1mg 2/day (anxiety), Restoril 15mg (insomnia), Claritin 20mg
Currently in: REMISSION Thought it was a flare but it's just scar tissue from my resection. Dealing with a stricture. Remission from my resection, 17 years and counting.
12-03-2013, 04:12 AM   #3
YJ120
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Thanks very much, that's great info and appreciate the link
12-03-2013, 04:24 AM   #4
DustyKat
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Fast?
Matt fasted from midnight the night before.

Bowel prep, if so when do they give you this?
He did not have bowel prep.

Do any nurses/doctors/specialists see you before the op?
Two days before surgery he had a pre op work up at a clinic attached to the hospital. It took 4 hours and he saw/had:
ECG
Chest X-Ray
Bloods
Registration (admissions officer)
Nurse
Clinic nurse
Case manager
Anaesthetist
Surgical registrar

Are you hooked up to any drips etc?
He didn’t have anything before theatre.

Are you marked up for a stoma in case you end up needing one?
When he went for his pre op work up it is then that he would have seen the stoma nurse if they thought he would likely end up with one. Had he seen the Stoma nurse he would have been marked up then.

Are family ok to be with you before op and wait for you to come round?
I went with Matt into the theatre area and waited in the “holding bay” with him until they took him into the actual theatre.
They told me the ward and room number he would be going to post op so I waited there for him. Under normal circumstances you wouldn’t go into recovery unless there was a problem or it was a young child that may need settling when they are first coming around. This may vary from place to place though.

And any other info if there is any.
Everything, paperwork wise, was done at the pre op clinic so we just turned up at operating theatres reception, presented at the desk and then waited for our turn. He was given pre op wash prep at the pre op clinic and showered at home with it the morning of the op.
When his name was called they took him into a room and did his obs, put ID bands on and confirmed some info with him, he was then taken through to another area where he changed into a gown, disposable pants and TED stockings. He had his belongings with him and they were tagged and put in a locker. We then went through into the holding area, there were about 8 beds there, and he was put on a bed. The anaesthetic registrar came out and had a chat with him and then we just waited there until they wheeled him into theatre.

Matt’s surgery was done in a large city hospital.

My daughter was undiagnosed at the time of her emergency surgery so it was done at our local rural district hospital which is VERY small in comparison. Being an emergency there was no pre op work up and I just walked beside her bed to theatre doors and she went straight in. I waited outside the theatres and then sat with her in recovery as she was quite distressed coming out of the anaesthetic. Again this was unexpected surgery and done in a small rural hospital so things work a little differently.

Hope that helps and good luck!

Dusty. xxx
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12-03-2013, 04:28 AM   #5
YJ120
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Thanks Dustycat, that's very informative and useful. Much appreciated
12-03-2013, 11:32 AM   #6
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Fast?
Bowel prep, if so when do they give you this?
Do any nurses/doctors/specialists see you before the op?
Are you hooked up to any drips etc?
Are you marked up for a stoma in case you end up needing one?
Are family ok to be with you before op and wait for you to come round?
And any other info if there is any.

Thanks very much Yvette x
I haven't had a small bowel resection, so can only comment on surgery in general.

On the NHS, surgeries get cancelled at the last minute and the order in which the surgeon plans to operate on different patients gets changed at the last minute too. I've had surgeries where there has been no waiting at all, some where I've waited all day, and one where it was cancelled and I was sent home again, and it was rescheduled for a few of weeks later. You have to just go with it and make sure you're prepared for a possible cancellation.

I've had all kinds of different bowel prep before bowel surgeries, except I've never had to take a laxative at home the day before like you do for colonoscopies. I've been given enemas at the hospital, but most of my surgeries there's been no prep at all, other than not eating on the day of the surgery.

The surgeon and anaesthetist (who you've usually met at a pre-op appointment) see you before the surgery. When I was having a planned ileostomy, I saw a stoma nurse too. And you see loads of nurses who tell you where to go when, when to put a gown on, maybe give you pain meds prior to surgery, etc., etc.

I've usually only been hooked up to things after coming round when the surgery's been done. Be prepared that you might have lots of drips, catheters, IVs, etc., etc. coming out of you when you wake up.

When I had a total colectomy I was not marked for a stoma, even though I'd been told it was a possibility. (When I went for my ileostomy, I obviously was marked for a stoma. Apparently I have the perfect stomach for a stoma - the flatter the better, as it allows them to see where your muscles are and get it in the right place. )

You're usually allowed one family member or friend who can stay with you right up until the time you go to theatre, and that person will also be allowed to wait while you're in surgery, or someone will call them when you're out. Once you're taken off the recovery ward to another ward your friend/family member will be told where you are (wards often change due to the unpredictable nature of how many beds are available) and can be with you as you start to fully come round from the anaesthetic.

Have you had your pre-op assessment yet? That's usually done a few weeks before the surgery, and you might have more than one appointment if you need to see different people - e.g. I've seen the pre-op nurse, anaesthetist, stoma nurse, etc. At the NHS hospital I have surgery they try and fit them all on the same day, though I've also been called back to have more appointments prior to the surgery date.
12-03-2013, 11:39 AM   #7
YJ120
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Hi unxmas,

Thanks very much, that's very informative.

I've spoke to the hospital today and they said I'm now booked in for next Wednesday (eeek!!) but I'll bear in mind that this may change.

I'm relieved and scared at the same time lol!
12-03-2013, 11:43 AM   #8
YJ120
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Just re-read that and I missed a paragraph first time! Not had my pre-op yet, when I spoke to hospital today they said my pre-op appt would be included in the letter.

Thanks again
12-03-2013, 12:14 PM   #9
Astra
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Good Luck Yvette, I'm due for surgery too, but they said after Christmas xxx
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12-03-2013, 12:17 PM   #10
YJ120
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Thanks Astra, hope you're feeling a bit better x
12-03-2013, 01:01 PM   #11
emmaaaargh
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Fast?
I fasted from midnight onwards - my operation was somewhere around 8am.

Bowel prep, if so when do they give you this?
I was given two enemas, one at midnight and one at 6am.

Do any nurses/doctors/specialists see you before the op?
I was visited by the surgeon to explain the procedure to me and for me to sign the consent form.

Are you hooked up to any drips etc?
I didn't have anything inserted until I was already under, so no. When I woke up, I had cannulae in my hand and foot (??? They never ended up using the foot one, though) and an NG tube to remove excess bile.

Are you marked up for a stoma in case you end up needing one?
I wasn't marked up for a stoma at all. I think the thought would have terrified me back then - I didn't even consider it.

Are family ok to be with you before op and wait for you to come round?
My parents came with me almost to the theatre - as far as they were allowed- and I *think* they were allowed into recovery just as I was waking up, but had to leave after that. Not too certain, as at that point I was only staying awake for two-minute intervals.

I hope your surgery goes well! Mine was a blessing and I entered a two-year remission after it. Best two years I've ever had Good luck!
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12-03-2013, 01:04 PM   #12
YJ120
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Thanks very much Emma your comments really help.
12-04-2013, 05:27 AM   #13
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Just re-read that and I missed a paragraph first time! Not had my pre-op yet, when I spoke to hospital today they said my pre-op appt would be included in the letter.

Thanks again
You didn't miss it - I edited the post to correct some spelling mistakes and added a bit in.
12-04-2013, 05:43 AM   #14
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Ah! Lol! Thanks
12-04-2013, 09:24 AM   #15
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Fast?
I fasted from midnight onwards too but my op wasn't until midday ish so I was allowed water until 8am.

Bowel prep, if so when do they give you this?
I wasnt actually given any, isn't it weird how everyone different?

Do any nurses/doctors/specialists see you before the op?
I saw a surgeon and an anaesthetist and some doctors just to discuss risks and all that.

Are you hooked up to any drips etc?
Before the op I just had a IV in to give me the sleep drugs but when I woke up I had three IVs, one was arterial, an NG to remove bile, a drain (a tube in your stomach) and a catheter. WARNING: Before the op I was NOT warned about the NG, drain or catheter so please ask before you go under! I was furious they didn't warn me, I have a thing with Ng tubes and I hated the catheter.

Are you marked up for a stoma in case you end up needing one?
I was meant to be, but the stoma nurse was busy all morning so I wasn't. Luckily they found a good place though for mine, I'm happy with it

Are family ok to be with you before op and wait for you to come round?
I'm a child so its probably different, but my dad came and watched me be put to sleep then both parents came to recovery and unfortunately something wasn't good (I was too sleepy to be told what happened) and I stayed in recovery for a few hours deciding if I should go to the intensive care unit or not. I ended up just returning to the ward.

I would just keep calm, they gave me a button afterwards that I could press whenever I liked (each press 5 mins apart) that gave me morphine, so dont worry about the pain after too much, they are very good, plus the morphine button was helpful for my drain removal and Ng, but they had to take it away an hour before my catheter removal.

Just ask about a catheter drain or Ng as mine were nasty surprises, I wasn't warned >: (

Good luck with your op and remember to take it easy, you know your body best!xx
12-04-2013, 10:49 AM   #16
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Before the op I just had a IV in to give me the sleep drugs but when I woke up I had three IVs, one was arterial, an NG to remove bile, a drain (a tube in your stomach) and a catheter. WARNING: Before the op I was NOT warned about the NG, drain or catheter so please ask before you go under! I was furious they didn't warn me, I have a thing with Ng tubes and I hated the catheter.
Often they don't know what tubes you'll need prior to beginning the surgery. Still, you should have been told that these things were at least a possibility!

I would just keep calm, they gave me a button afterwards that I could press whenever I liked (each press 5 mins apart) that gave me morphine, so dont worry about the pain after too much, they are very good, plus the morphine button was helpful for my drain removal and Ng, but they had to take it away an hour before my catheter removal.
Just a quick warning - after most of my bowel surgeries I've not been allowed any morphine, because opiates slow down the digestive system and can increase the chance of blockages. (For the same reason, I wasn't allowed codeine either.) It must depend on the specifics of the surgery and whether you're at risk for blockages. So don't count on morphine being available. But going without opiates involves less pain than a blockage.
12-04-2013, 11:41 AM   #17
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Often they don't know what tubes you'll need prior to beginning the surgery. Still, you should have been told that these things were at least a possibility!



Just a quick warning - after most of my bowel surgeries I've not been allowed any morphine, because opiates slow down the digestive system and can increase the chance of blockages. (For the same reason, I wasn't allowed codeine either.) It must depend on the specifics of the surgery and whether you're at risk for blockages. So don't count on morphine being available. But going without opiates involves less pain than a blockage.
Yeah no warnings of a possibility for me!

And sorry I didn't realise not everyone gets morphine xxy
12-04-2013, 01:15 PM   #18
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Thanks Ki, that's brill and is very up to date info seen as your surgery was last week I will definitely ask about the tubes etc

Thanks unxmas too.

They mentioned an epidural when I met my surgeon, anyone any experience of this?

Yvette
12-05-2013, 09:43 PM   #19
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i had my op in september and the epidural for me was the best thing since sliced bread, was scared when i was told what it was, but thought what the hell, was wheeled down to theatre and the aneasthetist said ok lean forward a bit and ill have a quick look, could feel her fingers touching my back and thats was all, 10 seconfs later she said thats it all done, and thats the last i remember before waking up in the care ward, it really numbs the pain of the operated area, you really notice the difference when they take it out after 4-5 days
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12-06-2013, 09:11 AM   #20
YJ120
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Hi Gmm,

Thanks for feeding back on the epidural. Is it put into the spine?

All -
My surgery is now confirmed for Wednesday, got to be there at 7.30am, so hoping I'm having the op in the morning, then I'm not worrying all day! lol! I've got my pre-op Tuesday afternoon. Scared and relieved at the same time - lol!
12-06-2013, 11:21 AM   #21
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to be honest im not sure lol, something tells me it isnt actually in the spine but near it, i didnt want to know at the time lol, but id certainly have it again, we're all scared of an op but once the first 3 days or so after are done with it really gets easier,if its a re join just stick to realy sloppy foods for a while even if they tell you you can have normal stuff good luck and all the best for the op
12-06-2013, 12:44 PM   #22
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Thanks gmm. I am going to opt for the epidural, I've had 2 lumbar punctures before so it can't be as bad as them lol! Thanks for your support too
12-06-2013, 02:26 PM   #23
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Thanks gmm. I am going to opt for the epidural, I've had 2 lumbar punctures before so it can't be as bad as them lol! Thanks for your support too
You found lumbar punctures bad? I didn't mind at all - and I had a junior doctor doing mine who messed it up three times - which meant having to inject more anaesthetic three times - before getting his superior to do it (she did it first time ). The anaesthetic stung a little and I remember it caused weird sensations in my legs, but was not really painful.
12-06-2013, 02:33 PM   #24
YJ120
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Hi unxmas,

No didn't find them bad, just uncomfy especially when they hit a nerve and my leg shot up on it's on! Lol! Snap the second one I had a trainee who'd never done it before and after a few attempts the doctor had to do it!
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