How to Prepare for a Proctectomy

Preparing for a proctectomy involves first learning what it is. Most commonly, this surgery is chosen to treat colon or rectal cancers, but can also be used to treat people with advanced inflammatory bowel diseases such as Crohn's or ulcerative colitis.

The last six or so inches of your colon is called your rectum. Unlike the rest of the colon, the rectum has a reservoir-like pouch for stool and the anal opening (the anus), where stool is expelled from your body. Chances are you've never heard the term "proctectomy" unless you or a loved one need to have this surgery, where the entire rectum is removed.

Types of Proctectomy Surgeries

There are many different types of surgeries for colon cancer where your rectum is removed. Your surgeon uses the stage, grade, location, and size of your cancer to determine the best surgical options in your case. If the tumors are isolated to the rectum alone, your surgeon may encourage a proctectomy via the anus, which is called a transanal proctectomy.

If you require a portion of your colon removed, have suspected lymph node involvement, or have local areas of metastasis that need removal, you may get the proctectomy as part of a surgery called a low abdominoperineal resection. In this surgery, the healthcare provider opens up your abdomen so that he or she can visualize and remove several portions of bowel and surrounding tissues (such as lymph nodes) to provide you with clear cancer margins and an improved outcome. Almost all low abdominoperineal resections end with an anal closure, which will require a permanent ostomy for stool removal.

Can You Still Move My Bowels Normally?

Unless your proctectomy included an anal closing, you should be able to move your bowels as always following the surgery. Depending on what portion of your colon was removed alongside your rectum, the surgeon has a few different options to help restore your normal bowel habits. Following your proctectomy, he or she can take the remaining portion of your colon and surgically connect it to your anus. This surgery is called a coloanal anastomosis which allows you to continue moving your bowels as you always did. During the surgery, the final portion of your colon is surgically altered to create a new reservoir for stool collection that mimics your old rectum.

Surgical Preparation

Your healthcare provider will prescribe a bowel preparation regimen prior to your surgery. Since the surgeon will be cutting into your rectum, and possibly your colon, the bowels must be cleaned of all stool and waste prior to the surgery. You may also be required to take antibiotics to help decrease your risk of post-operative infection. Likewise, be sure to discuss any prescription and over-the-counter medications you are taking as some may need to be stopped. If you take medications to help thin your blood, you will need to discuss the risks of stopping these medications for the surgery with your cardiologist, or the practitioner that prescribes them.

The day prior to the surgery, the surgeon will ask you to stop eating and drinking at a certain time. If you smoke or use chewing tobacco you will need to stop this as well.

Hospitalization and Recovery

Your hospitalization and recovery period depends upon what type of proctectomy surgery you have. The average hospital stay is between four and seven days (barring complications) and your recovery at home could take up to six weeks. During your discharge from the hospital, your surgeon will provide education on your post-operative restrictions that could include physical limitations, such as lifting or abstaining from sex, to dietary restrictions until you are fully recovered. You might even have a temporary ostomy for a few months while your colon heals, or you could be going home with a permanent ostomy if your anus was surgically closed.

You may want to consider making a few pre-arrangements at home to make things easier upon your return from the hospital. For instance, establish which family members or friends will be available to help you out with groceries or other domestic chores. Other factors to consider while you are recovering at home include:

• Who will care for your children, dependents or pets?
• If you have a multistory home, can you move your bed to a lower level until you are able to safely negotiate the stairs?
• Position all of your necessities near your bed or couch in the home. Something as simple as running up the stairs to grab a charge cord may seem insurmountable when you first arrive home.
• Make sure you have plenty of medication available if you take routine prescriptions. Get your refills before you enter the hospital for surgery. Likewise, if your surgeons send you home with painkillers, get the prescription filled and ready on your way home from the hospital.
• Make sure that you have plenty of easy meals available, even if that means cooking and freezing some meals in advance.

Proctectomy Risks

Removal of the rectum is a major surgery. The risks are magnified if you have a pre-existing medical condition, such as diabetes. Prior to signing your consent for the surgery, the anesthesiologist and your surgeon will review these risks with you that might include:

• Bleeding (during or after the procedure)
• Infection
• Sexual difficulties (erectile dysfunction, vaginal dryness)
• Problems with elimination (urination or moving your bowels)

Be sure to ask questions if you do not understand any part of the preparation, surgery, recovery or potential complications prior to your surgical date.