Hemi-colectomy

A hemicolectomy is an operation to remove part of the large bowel (colon/intestine) because
either it is not working properly or it is diseased.

Either side of your colon can be removed depending upon the location of the disease ie. a right
or left hemi colectomy, you will be advised where your disease is located.





The two ends of the bowel are joined together by sutures or clips. There is a risk of a temporary stoma if the left side of the colon is removed. Your surgeon will discuss this with you before surgery.
Occasionally, the transverse part of the bowel may be removed (the middle section of your large bowel which lies across the abdomen). This is also known as an extended hemicolectomy.

The Operation

You will have a general anaesthetic, and will be asleep for the whole operation. A cut is made in the skin in the middle lower part of your abdomen 25cm (10 inches) long. The right side of the colon and the lowest part of the small bowel are freed. The diseased bowel is taken out. The cut ends of the small bowel and of the middle of the colon are joined together. The cut is then closed up.
You will not end up with a colostomy or need to wear a bag to collect the bowel waste. You should plan to leave hospital about 10 days after the operation.

Before The Operation

Stop smoking and get your weight down if you are overweight. 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).
You may be required to take bowel preparation to clear the bowel prior to your admission. Please follow the instructions carefully. If you come into hospital the day of your surgery, you must fast for 6 hours prior to your operation.
Check that 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 pre-admission clinics, where you visit for an hour or two, a week or so before the operation, for these checks.

After - In Hospital

You may 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 perhaps a drainage tube nearby, connected to another plastic bag. 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. 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 4 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. You can wash the area as soon as the dressing has been removed. Soap and tap water are entirely adequate. Salted water is not necessary. You can shower or bath as often as you want.
You will be given an appointment to visit the Outpatient Department for a check up about one month after leaving hospital. The results from the laboratory about your colon will be ready by then. The nurses will advise about sick notes, certificates, etc.
 

After - At Home


You are likely to feel very tired and need rests 2-3 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, ie. after about 3 weeks.
You can restart sexual relations within 2-3 weeks when the wound is comfortable enough. You should be able to return to a light job after about 6 weeks and any heavy job within 12 weeks.

Possible Complications

Complications are unusual but are rapidly recognised by the nursing and surgical staff. If you think that all is not well, ask the nurses or doctors. You will be given injectable medication and stockings to avoid blood clots occurring in the leg. If pain or swelling occurs in either leg please alert nursing and medical staff immediately.
Chest infections may arise, particularly in smokers. Co-operation with the physiotherapists to clear the air passages is important in preventing the condition. Do not smoke. Occasionally the bowel is slow to start working again. This may take a week or more. Your food and water intake will continue through your vein tubing.
Sometimes there is some discharge from the drain near the wound. This stops given time. Sometimes the join in the bowel may leak. The doctor will talk to you about this. Wound infection is sometimes seen. This settles down with antibiotics in a week or two. Aches and twinges may be felt in the wound for up to 6 months. Occasionally there are numb patches in the skin around the wound which get better after 2-3 months. Because of loss of some of the bowel you may need vitamin replacement. This will be discussed with you.

Nursing Considerations

Nursing Priorities

1. Promote healing and adequate nutritional intake.
2. Prevent complications.
3. Provide information about surgical procedure/prognosis, treatment needs, and concerns.
Discharge Goals

1. Nutritional intake adequate for individual needs.
2. Complications prevented/minimized.
3. Surgical procedure/prognosis, therapeutic regimen, and long-term needs understood.
4. Plan in place to meet needs after discharge.
1.NURSING DIAGNOSIS: risk for imbalanced Nutrition: less than body requirements
Risk factors may include

Restriction of fluids and food
Change in digestive process/absorption of nutrients
DESIRED OUTCOMES/EVALUATION CRITERIA—CLIENT WILL:
Nutritional Status (NOC)

Maintain stable weight/demonstrate progressive weight gain toward goal with normalization of laboratory values.
Be free of signs of malnutrition.
2. NURSING DIAGNOSIS: deficient Knowledge [Learning Need] regarding procedure, prognosis, treatment, self-care, and discharge needs
May be related to

Lack of exposure/recall
Information misinterpretation
Unfamiliarity with information resources
Possibly evidenced by

Questions, statement of misconception
Inaccurate follow-through of instruction
Development of preventable complications
DESIRED OUTCOMES/EVALUATION CRITERIA—CLIENT WILL:
Knowledge: Disease Process (NOC)
Verbalize understanding of procedure, disease process/prognosis.
Verbalize understanding of functional changes.
Knowledge: Treatment Regimen (NOC)

Identify necessary interventions/behaviors to maintain appropriate weight.
Correctly perform necessary procedures, explaining reasons for actions.
POTENTIAL CONSIDERATIONS following acute hospitalization (dependent on client’s age, physical condition/presence of complications, personal resources, and life responsibilities)

risk for Imbalanced Nutrition—less than body requirements—change in digestive process/absorption of nutrients, early satiety, gastric irritation.
Fatigue—decreased energy production, states of discomfort, increased energy requirements to perform activities of daily living (ADLs).

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