Reviewed By Robert A. Cowles MD, Assistant Professor of Surgery, Columbia University College of Physi…cians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.more »
Definition
Total proctocolectomy and ileal-anal pouch surgery is the removal of the large intestine and most of the rectum. The surgery is done in one or two stages.
You will receive general anesthesia right before your surgery. This will make you unconscious and unable to feel pain.
During the first stage of surgery:
Your surgeon will make an incision (cut) in your belly. Then your surgeon will remove your large intestine.
Next your surgeon will remove your rectum. Your anus and anal sphincter (the muscle that opens your anus when you have a bowel movement) will be left in place.
Then your surgeon will make a pouch out of the last 1 1/2 feet of your small intestine. The pouch is sewn to your anus.
In the second stage of surgery, you will often have a small cut made in the wall of your belly for an ileostomy. It is usually placed in the lower right part of your belly. The ileum is brought up to this spot and sewn into the abdominal wall.
If you have an ileostomy, your surgeon will close it later in a shorter surgery.
Ask your doctor which drugs you should still take on the day of your surgery.
If you smoke, try to stop. Ask your doctor for help.
Always let your doctor know about any cold, flu, fever, herpes breakout, or other illnesses you may have before your surgery.
Eat high fiber foods and drink 6 to 8 glasses of water every day.
The day before your surgery:
Eat a light breakfast and lunch.
You may be asked to drink only clear liquids, such as broth, clear juice, and water, after noontime.
Do NOT drink anything after midnight, including water. Sometimes you will not be able to drink anything for up to 12 hours before surgery.
Your doctor or nurse may ask you to use enemas or laxatives to clear out your intestines. They will give you instructions for this.
On the day of your surgery:
Take your drugs your doctor told you to take with a small sip of water.
Your doctor or nurse will tell you when to arrive at the hospital.
After the Procedure
You will be in the hospital for 3 to 7 days. By the second day, you will most likely be able to drink clear liquids. Your doctor or nurse will slowly add thicker fluids and then soft foods as your bowel begins to work again.
While you are in the hospital for the first stage of your surgery, your nurse and doctor will teach you how to care for your ileostomy.
Outlook (Prognosis)
Most people recovery fully. You will probably have 4 to 8 bowel movements a day after this surgery. You will need to adjust your lifestyle for this.
Most people who have a total abdominal colectomy recover fully. Most people are able to do most activities they were doing before their surgery. This includes most sports, travel, gardening, hiking, and other outdoor activities, and most types of work.
