Ileus | SCL Health

An ileus is usually not a severe condition, but it can be very uncomfortable. In most cases, time and TLC will resolve your ileus and lessen your symptoms, but in severe cases you need immediate medical attention.

An ileus is a condition in which the small intestine doesn’t work normally. Normally, the muscles of the small intestines squeeze to move air, fluid, and food through it. But in an ileus, the small intestine is not able to move the air, fluid and food along, due to the muscles not working properly and the intestines being slow. This causes the air and food to get backed up in the digestive tract, which causes abdominal distension, or bloating, and abdominal pain.

An ileus can happen in children and adults.

Causes of an ileus

Different things can cause an ileus, including:

• Surgery – Especially abdominal surgery, for any reason; surgery is the most common cause of ileus. This is due to manipulation of the intestines and exposure to the open air. This causes the intestines to go to sleep for up to several days after surgery.
• Infections – Infections of the intestine or inside of the abdomen.
• Injury – An injury to the abdomen, or blood within the abdominal cavity like you would experience in a trauma situation.
• Medications – Certain medicines, such as strong pain medicines (narcotics such as Vicodin, percocet, etc.) and other medications such as antidepressants or other psychiatric medications can cause the intestines to slow down.
• Blood flow – Not enough blood flow to the intestines.
• Other – Conditions that affect the body’s muscles and nerves

Symptoms of an ileus

The most common symptoms are:

• Abdominal pain
• Abdominal swelling and bloating (called abdominal distension)
• Nausea and vomiting
• Not being able to have a bowel movement or pass gas

These symptoms can lasts several days, depending on the cause for the ileus.

Testing for an ileus

Your doctor or nurse will ask about your symptoms and do an examination. To find out what’s causing your ileus, he or she will probably do blood tests and imaging tests. The imaging tests can include an X-ray, CT scan, or a series of X-rays called a “GI series.” For the CT scan and GI series, you may need to drink a liquid called “contrast” beforehand. The contrast will show up in your intestines on the CT scan or X-rays, and will give the doctors a more accurate picture of your digestive tract, to help determine what is causing the ileus.

Treatment for an ileus

Treatment depends on your symptoms and what’s causing your ileus. All people with an ileus are treated in the hospital.

To treat your symptoms and help you feel better, your doctor may do one or more of the following:

• Give you fluids and nutrition through an IV (a small tube that goes into your vein), this will prevent you from becoming dehydrated
• Put a thin tube called a “nasogastric tube” in your nose, down your esophagus, and into your stomach – The tube can suck up the fluid and air in your stomach, which will help to decompress the bowel. This will make your stomach feel better and help keep you from vomiting.

If recent surgery caused your ileus, you might not need any other treatment. That’s because an ileus that happens after surgery usually gets better on its own in a few days. Unfortunately, there is really no good way to get rid of an ileus after surgery, it just takes time. The body decides how much time it takes, and there are not really any treatment methods to speed up the time it takes to resolve. Getting up out of bed and walking around several times per day can help to get your bowel function back to normal after surgery.

If a medication has caused your ileus, your doctor will likely stop that medicine. He or she will also treat any other condition causing your ileus, if the condition can be treated.

People with an ileus do not usually need surgery. Usually it will get better on its own once the cause for the ileus has been resolved; but they might need surgery if their condition is severe.

Facilitating Return of Bowel Function after Colorectal Surgery: Alvimopan and Gum Chewing

Clin Colon Rectal Surg. 2013 Sep; 26(3): 186–190.

Deborah Keller

¹Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio

Sharon L. Stein

¹Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio

¹Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio

Address for correspondence Sharon L. Stein, MD, FACS Division of Colorectal Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, LKS 5047, Cleveland, OH 44106, [email protected] article has been cited by other articles in PMC.

Abstract

Postoperative ileus is common after colorectal surgery, and has a huge impact on hospital LOS. With the impeding cost crisis in the United States, safely reducing length of stay is essential. Chewing gum and pharmacological treatment with alvimopan are safe, simple tools to reduce postoperative ileus and its associated costs. Future research will determine if integrating these tools with laparoscopic procedures and enhanced recovery pathways is a best practice in colorectal surgery.

Keywords: postoperative ileus, alvimopan, chewing gum, health care utilization, enhanced recovery pathways

Objectives: On completion of this article, the reader should be able to summarize the etiology and costs of postoperative ileus, and the evidence for the use of alvimopan and chewing gum for postoperative ileus.

One of the major impediments in recovery from colorectal surgery is the return of bowel function. Approximately 25% of patients experience postoperative ileus (POI) following colorectal surgery.¹ In addition to patient discomfort and dissatisfaction, delay in bowel motility is a major factor in prolonging length of stay (LOS) and health care costs. ² The development of POI is associated with a 29% increase in hospital days with costs exceeding $1.75 billion in the United States.³

The development of standardized fast-track protocols or enhanced recovery pathways has optimized the return of bowel function. Minimizing the use of systemic narcotics, early refeeding, and the elimination of standard nasogastric tubes each play a role in facilitating patient care, and are covered elsewhere within this issue of Clinics in Colon and Rectal Surgery. Treatment and prevention of ileus also includes the use of pharmacological and gastric-stimulating agents; this will be reviewed within this article.

Postoperative Ileus: Definition and Etiology

Postoperative ileus is defined as the cessation of coordinated bowel motility preventing tolerance of oral intake. In general, a delay lasting greater than 3 days after laparoscopic surgery or greater than 5 days after open surgery is considered a delayed POI. ³ The pathophysiology of ileus has been well studied, but remains incompletely understood. The gastrointestinal (GI) tract is controlled by a combination of neurologic, hormonal, inflammatory, and extrinsic factors that determine timing of return of bowel function.^4,5,6 Many of these factors are listed in .

Table 1

Neurologic, hormonal, inflammatory, and extrinsic factors contributing to postoperative ileus

Neurologic factors

Sympathetic innervation: Inhibitory  Parasympathetic innervation: Stimulatory  Intrinsic neurologic factors: Migrating motor complexes return function to the small bowel after surgery

Local inflammatory mediators

Macrophage and neutrophil infiltration release inflammatory mediators that contribute to ileus: Vasoactive intestinal peptide Nitric oxide Substance P Calcitonin gene-related peptide Corticotropin-releasing factor Cyclooxygenase 2 (COX-2)

Anesthesia

Inhaled anesthetics often decrease gastric emptying.  Epidurals: May block afferent and efferent inhibitory reflexes  Narcotics: Increase nonpropulsive waves in colon

Surgical factors

• Longer surgery, increased bowel manipulation and open surgeries may increase intestinal edema and negative effects of ileus  • Blood loss: Inhibits intestinal recovery  • Edema: Inhibits intestinal recovery

The parasympathetic nervous system has a stimulatory effect on the intestinal tract, and is generally balanced by inhibitory signals from the sympathetic nervous system. The stress of surgery and direct bowel manipulation cause a surge in sympathetic stimulation, overriding parasympathetic stimulation and slowing bowel function.⁷ The effects of this are most pronounced in the colon, where it may take 2 to 3 days for normal peristalsis to return in the postoperative period. ⁸ The small intestines are heavily innervated by intrinsic enteric stimulation, also known as migrating motor complexes (MMC).^4,6 Because sympathetic stimulation does not inhibit MMC’s, small bowel function returns more rapidly, in 1 to 2 days after surgery.^4,9 Interestingly, abdominal cases are not the only type of surgery prone to cause ileus—orthopedic and extremity surgery also cause sympathetic stimulation and delay in bowel motility without direct intestinal manipulation.¹⁰

Hormonal and local inflammatory factors both play a vital role in ileus. Bowel manipulation, edema, and blood loss cause migration of neutrophils, damage to tight junctions, and release of inflammatory and paracrine mediators. These local factors modify the local inflammatory milieu and cause inhibitory input to the cholinergic neurons, decreasing gastric activity.^11,12 Antagonistic activity to vasoactive peptide and substance P has been shown to improve postoperative bowel recovery. ^13,14 Corticotropin-releasing factor and calcitonin gene-related peptid have each been shown to induce delays in gastric emptying and GI ileus.^12,15 Nitric oxide is released from local cells postoperatively causing inhibition of GI motility; experiments have demonstrated improved intestinal motility when production of nitric oxide is blocked.¹⁶

Anesthetic agents may also affect the return of bowel function. Some inhalational anesthetics such as halothane slow gastric motility, while nitrous has promotility properties.¹⁷ Exogenous narcotics bind to receptors within the GI tract and slow motility.¹⁸ Perioperative epidural anesthesia is believed to create a sympathetic blockade that may decrease the effects of stress on POI.¹⁹

Surgical factors also contribute to ileus in the postoperative period. Laparoscopy, with smaller incision size, magnitude of sympathetic activation, and decreased bowel manipulation may lessen the duration and prevalence of ileus. ⁴ Others have found that metabolic disarray, blood loss, or hypoalbuminemia may correlate with higher frequency of ileus.²⁰

Pharmacologic Agents

Multiple pharmacologic agents have been trialed in attempts to reduce or eliminate the incidence of POI. Trials of β blockade of adrenergic receptors aimed at reducing sympathetic stimulation were performed as early as 1983.²¹ Neostigmine, an acetylcholine inhibitor, and cisapride, a serotonin receptor antagonist, were also trialed. Results were mixed and side-effect profiles, including abdominal cramping and significant cardiovascular events, limited their utility and clinical use.^22,23 Metoclopramide has also been used. Although it reduces the risks of nausea and vomiting, it has not been found to reduce duration or frequency of POI.²⁴

Alvimopan is the most promising of selective mu opioid receptors to reach the market. The size and composition of alvimopan (Entereg^®, Adolor and GlaxoSmithKline, Exton, PA) prevents the molecule from crossing the blood-brain barrier and therefore provides opioid antagonism within the GI tract, while allowing for continued central nervous system effects of the pain medication. ²⁵ Studies have demonstrated that side effects are similar to placebo with nausea and vomiting the most common side effects.²⁶

The first double-blind prospective results on postoperative use of alvimopan were published by Taguchi in 2001.²⁷ Seventy-eight patients underwent total abdominal hysterectomy (TAH) or open colon resection and were randomized to receive alvimopan or placebo. The treatment group experienced a significant decrease in time to passage of first flatus, first bowel movement, and discharge. A multicenter, randomized double-blind trial validated results with reduced time to solid food, flatus, or bowel movement: 86.2 hours in the alvimopan group versus 100.3 in placebo.²⁸ Alvimopan was also noted to accelerate time to discharge order.²⁹ A comprehensive meta-analysis encompassing five studies and over 1,500 patients found alvimopan accelerated time to return of bowel function and reduced the postoperative LOS by 2 to 15 hours (4/5 studies). ³⁰

Data from Ludwig et al demonstrated that the number needed to treat (NNT) to realize clinical benefits is small. In a pooled analysis, only seven patients required treatment to achieve significantly accelerated bowel recovery and discharge order.³¹ There has been a single report that demonstrated a nonsignificant reduction in mean time to tolerate solid food, first flatus, or bowel movements; benefits were noted only for patients who received postoperative patient-controlled analgesia.³²

The benefits of alvimopan on patients undergoing laparoscopic surgery are less clear. Patients who undergo laparoscopic colectomy have been noted to have less pain, lower opioid requirements, and a shorter recovery time at baseline.³³ One multiarm study demonstrated a significant decrease in LOS for the open/hand assisted laparoscopic surgery patients treated with alvimopan (5.6 ± 2.5 vs. 6.8 ± 3.3 d, p = .009), but no difference in POI (p = 1. 00) or LOS (p = .305) in the laparoscopic group.³⁴ A more recent case series noted benefits of alvimopan in elective uncomplicated laparoscopic colectomy.³⁵ In this case series, the addition of alvimopan to an enhanced recovery protocol significantly decreased LOS (1.55 d, p < .0001) and incidence of POI (2% vs. 20%; p < .0001).

Alvimopan may have a significant cost impact through reduction in LOS. A cost analysis of alvimopan in the North American studies found the mean hospital LOS to be one full day shorter with a mean savings of $879 to $977 per patient when patients received an average of 8.9 doses.³⁶ Further analysis of prospective and retrospective data demonstrated a reduction in postoperative LOS of 1.2 days in the alvimopan group (p = 0.01), with an even larger difference (3.2 d) observed in elderly patients.³⁷ In this trial, a mean cost savings of $531 per laparoscopic patient and $997 per open patient was noted. Using a mathematical formula, Gaines found that a reduction of 24 hours was needed for costs savings if patient receive six or fewer doses of alvimopan, and for patients receiving more than six doses the LOS needs to be 2 days to decrease total hospital costs.³⁸

Based on the GI recovery benefits of alvimopan, its use can be recommended in patients undergoing open surgery, with a slight reduction in overall hospital costs, but a significant reduction in LOS. For laparoscopic surgery, both cost and clinical benefits require further evaluation and study to determine benefits.

Gum Chewing

Chewing gum following elective intestinal resection was first proposed in the literature in 2002 as a mechanism for sham feeding and gastric stimulation.³⁹ Sham feedings have been noted to promote the cephalic phase of digestion through vagal cholinergic stimulation and the release of GI hormones in the upper GI tract.^40,41 Gum chewing provides an inexpensive, convenient, and physiological method to stimulate these pathways,⁴² while avoiding complications of food intolerance associated with food intake. ⁴³ Chewing gum preoperatively and in the direct postoperative phase may ameliorate POI and enhance postoperative recovery.⁴⁴

Asao et al first described an earlier return of flatus (1.1 d, p < 0.01), time to defecation (2.7 d, p < 0.01) and time to discharge (1 d, not significant) in 19 patients randomized to chew gum after laparoscopic colectomy.³⁹ Although this study was poorly powered, a larger, randomized multicenter trial supported the data; patients who chewed gum four times daily after laparoscopic surgery had shorter duration of ileus (2.6 vs. 3.3 d, p = 0.0047), and hospital stay (4.0 vs. 5.3 d, p = 0.029) compared with controls (45). A trial of open sigmoid colectomy noted statistically decreased time to flatus (65.4 vs. 80.2 h, p = 0.05), defecation (63.2 vs. 89.4 h, p = 0.04), and LOS (4.3 vs. 6.8 d, p = 0.01) in 34 patients randomized to gum chewing.⁴⁵

Data from other studies is less compelling. Matros found no significant decrease in passage of flatus or reduction of ileus in 66 patients randomized to gum chewing after open colectomy.⁴⁶ A second randomized trial of 38 patients undergoing open surgery and found nonsignificant reductions in time to flatus (p = 0.56), first bowel movement (p = 0.38), and LOS (p = 0.75).⁴⁷ Bahena-Aponte also found that although oral tolerance and the time to first defecation occurred significantly faster in the gum-chewing group (p = 0.05), the duration of hospital stay was not significantly different among treated and nontreated patients.⁴⁸ Most recently, a randomized trial by Zaghyan et al demonstrated no difference in time to tolerating diet, flatus, bowel movement, or LOS in 114 patients who were placed on early enteric feeding and randomized to gum chewing or control. In addition, patients who chewed gum were noted to have more bloating, indigestion, and eructation.⁴⁹

A systematic review by Chan et al found with combined standard postoperative care and gum chewing, patients had significantly earlier time to pass flatus (24. 3% earlier, p = 0.0006), time to bowel movement (32.7% earlier, p = 0.0002), and time to discharge (17.6% earlier, p < 0.00001) than controls.⁵⁰ A later systematic review found chewing gum consistently reduced time to passage of flatus and stool, but results were mixed in reduced hospital LOS (one of three trials).⁵¹ Later meta-analyses on gum chewing confirmed these results,^{52,53,54,55,56,57} demonstrating a statistically significant reduction in time to flatus and defecation, but only two studies demonstrated a significant effect on the hospital stay.^54,58

Difficulties in these studies include small sample sizes, nonblinded trials, and variation in techniques. Some studies include use of open and laparoscopic surgery, use of epidurals, and enhanced recovery protocols, complicating data analysis. In general, studies of laparoscopic surgery, without use of epidurals have demonstrated the greatest effect in reducing POI. ^39,45,59 In addition, although most studies used sugar-free gum, the most recent study by Zaghyan et al may be complicated by the use of sugared chewing gum and the loss of the cathartic effects of sorbitol or sugar-free additives.⁶⁰

Although the evidence may not be overwhelming, the risks and costs of gum chewing are minimal. The financial costs of gum chewing are estimated to be minimal: Schuster’s 2006 analysis demonstrated costs of $.04 per stick of gum three times daily for 5 days⁴⁵ in comparison to the estimated $1,500 daily cost of a hospital room. Although theoretical complications such as aspiration may exist, only one study demonstrated increased GI distress in patients randomized to chewing gum. There is no physiological evidence that gum chewing increases the volume or acidity of gastric secretions or that swallowing gum increases the risk of aspiration; on the contrary, there is evidence that gum chewing promotes GI motility and physiological gastric emptying. ⁶¹

In conclusion, chewing sugarless gum preoperatively and in the direct postoperative phase is a simple, inexpensive tool to stimulate bowel motility and reduce ileus after colorectal surgery. Further, it has the potential impact to reduce health care expenditures with routine implementation. With the potential for substantial cost savings, larger-scale, blinded, randomized controlled trials are warranted.

References

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Mechanism behind bowel paralysis after surgery revealed — ScienceDaily

In the days following abdominal surgery, patients’ intestinal contents pass more slowly or not at all. New research at KU Leuven (University of Leuven), Belgium, has now shown that this phenomenon — known as post-operative ileus or bowel paralysis — is not caused by the cells previously identified as the main players. Quite the opposite, in fact: the cells even help restore bowel function. The findings are very important for further research into post-operative patient treatment.

After undergoing abdominal surgery, patients have to stay in hospital for several days because the procedure causes post-operative ileus or bowel paralysis. As a result, the patients cannot tolerate food or empty their bowels. This leads to personal discomfort and prolongs the hospital stay, which in turn increases the economic cost.

Scientists have long been looking for ways to prevent bowel paralysis or to speed up bowel function recovery. The assumption has always been that monocytes, a specific type of white blood cells, were most to blame for the bowel paralysis. Professor Gianluca Matteoli and Professor Guy Boeckxstaens from the TARGID unit at KU Leuven have now shown that the opposite is true.

“Abdominal surgery always leads to a subtle inflammation of the intestinal muscle. This inflammation mostly consists of monocytes,” says Professor Matteoli. “We did research on mice that were genetically modified to make it impossible for monocytes to leave the bloodstream and enter the intestinal muscle. We expected that this would enable us to prevent bowel paralysis. To our surprise, however, the mice still developed bowel paralysis, and their recovery was even slower than expected.”

Further research confirmed that monocytes have a positive impact on bowel function recovery. “We noticed that monocytes initially contribute to inflammation. After a while, however, they start removing the damaged tissue — they clean it up, so to speak. After that, their function drastically changes and they even help to restore proper bowel functioning,” Professor Boeckxstaens continues. “If we can speed up this switch from cleaning up to restoring, we may also increase the pace of the patient’s recovery.”

Story Source:

Materials provided by KU Leuven. Note: Content may be edited for style and length.

Tips to Deal With Constipation After Surgery

SOURCES:

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Advice Following Bowel Surgery

Introduction

Surgery on the bowel is a major physiological insult to your body and as such is no wonder you will not feel ‘yourself’ immediately after it.   It typically takes between 2 and 6-weeks to fully recover after a bowel operation.  The exact time depends on the type of surgery performed, your individual characteristics, other medical problems you may have, your ‘outlook’ on recovery and whether or not you have any complications after surgery. The following describes what typically may be expected after bowel surgery:

Pain

Following discharge from hospital, after bowel surgery, it is normal to experience some abdominal discomfort from either the wound or windy pain from the bowel itself.  This will gradually improve over several weeks.  You should continue taking the pain relieving drugs, which have been prescribed for you at the hospital, until you feel comfortable.  If you need further supplies or your pain is not adequately controlled or your pain is getting worse you should see your GP.

Simple measures such as supporting your abdomen with a cushion when coughing or whilst wearing a seat belt will avoid putting strain on your wound and make you more comfortable.

Wound

You may have had your staples/stitches removed before you were discharged home from hospital.  If your staples/stitches are still in place, the nursing staff on the ward will refer you to your District Nurse or Practice Nurse who will remove these 7-12 days following surgery.  In some patients the would is closed with stitches under the skin which dissolve away on their own.  The would will be covered with paper steri-strips, which you should leave in place until they fall off on their own.

If your would has not completely healed and there is a dressing in place, you must keep this clean and dry to reduce the risk of infection.  Your District/Practice Nurse will advise you further.

You will have some bruising from the operation but the can vary in degree (red and blue turning yellow).  Do not be alarmed as this is quite normal and it will improve over time.

If your would becomes red, inflamed, and painful or has any discharge from it, this could indicate an infection.   You should contact your GP/Practice Nurse or your colorectal nurse specialist at the hospital who will be able to recommend the appropriate treatment.

Eating and Drinking

It may take a while before you get your normal appetite back.  Instead of eating three meals a day it may be easier to have small and more frequent meals as you did whilst in hospital (see Enhanced Recovery Programme leaflet).  After having an operation on your bowel, you should aim to gradually return to a normal balanced diet, including fruit, vegetables, whole-wheat cereals and bread, in order to maintain a healthy lifestyle.

Some people notice that certain foods upset the normal action of their bowel.  Fruit and vegetables may give you loose stools, increased wind and bloating, this is usually temporary, and if it affects you, it may be sensible to start on foods which are low in fibre, gradually increasing your fibre intake over the next few weeks.  There are no set rules on which types of foods to avoid – everybody is different!

Bowel Function

Following bowel surgery your bowel habit may continue to be unpredictable.   You may find that your bowel motion is looser, more frequent and/or urgent.  It is important to drink plenty of fluids if you have diarrhoea to prevent dehydration.  Occasionally people may experience constipation.  It is normal to expect a lot of wind, sometimes associated with abdominal discomfort.  This will gradually settle down over 2-3 months, although some people find that their bowel function never returns to its previous pattern.

Bowel problems often improve by simple measures such as looking at what you eat.  Once again, you should speak to your Surgeon, GP, or Colorectal Nurse Specialist, who will be able to advise on diet and medication available to control these symptoms.

Bowel obstruction – following surgery, adhesions (scar tissue) form in the abdomen, which may cause a blockage to the bowel.  If this occurs you may experience severe windy pain with an inability to pass wind or stool, abdominal bloating and vomiting.  You should contact your GP or the emergency doctor for advice if the symptoms do not settle within a few hours.

Excessive wind or bloating – you should reduce the amount of fibre for a week or so and then try re-introducing a single item of high fibre food at a time.  Fizzy drinks will cause more wind, nausea and bloating, so are best avoided.  Alcohol is fine in moderation, but beer and lager can produce wind as with fizzy drinks. 

Rest and Exercise

It is normal to feel tired and weak for up to three months after major surgery.  This will gradually improve and you will become stronger each day.  It is important that you rest when needed, however, this does not mean that you should confine yourself to bed.

Good nutrition in the form of a well balanced diet is essential.  Having sufficient food and fluids to drink will help to keep your energy levels up and prevent feelings of weakness.

You should avoid heavy lifting, for example only do the equivalent of light housework.  Start by taking a gentle walk each day, perhaps around the house or garden and gradually increase as you feel able.  Remember it is best to take rest periods when needed.  Short frequent periods of activity help you to avoid over exertion.  

If you normally take part in sport or exercise, you will probably be able to start these after your follow up appointment with you Surgeon.  You can discuss whether you are fit enough to start participating in sport or more vigorous exercise.  Most people will have returned to their normal level of fitness 3 months after their surgery. 

Hygiene

If your wound has healed you can shower and bathe as normal, but make sure you can get in and out of the bath safely.  If you anticipate and problems the Occupational Therapist at the hospital will be able to advise you on the availability of bathing aids.

Driving

You should wait at least 2 weeks before starting to drive again.  This will depend on your ability to perform an emergency stop without causing discomfort to your abdomen and how comfortable it is to wear a seat belt.  It is advisable to check your insurance policy to ensure you are covered after you have had an operation.

Sexual Activities

Feeling tired and weak after an operation or illness naturally affects your sex drive.  As you gradually start to feel well again and your energy levels return to normal so should you sex drive.  It is important for you and your partner to discuss your feelings openly.

Sexual intercourse can be resumed as soon as you feel comfortable, generally about 2-4 weeks after surgery.  Occasionally, following surgery or radiotherapy to the rectum or lower colon, nerve and blood vessel damage can occur either as a result of pre-operative treatment itself or the subsequent surgery.  In men this may cause ejaculatory problems or result in difficulty and/or maintaining an erection.  In women, discomfort or vaginal dryness may occur.

These problems are usually temporary, due to inflammation and swelling after surgery, but in some instances may be permanent.  If you do experience problems of this mature, please discuss it with your Surgeon or Colorectal Nurse Specialist, as specialist help is available.

Returning to Work

It is advisable to take a minimum of 2-4 weeks off work.  The nature of your occupation and the surgery you have had performed will determine how soon you can return to work.  It may be wise to go back part time until you have regained your strength.  At your follow up appointment with your Surgeon you can discuss when you are going to be fit enough to return to work.

Travel Abroad

It is safe for you to travel abroad when you feel ready, but it is advisable to wait to be seen for your follow up appointment with your Surgeon.

When applying to travel abroad you should be sure you are not travelling against medical advice; you may require a letter from your GP.  It is best to check the insurance policy for ‘pre-existing medical conditions,’ which need to be declared for the policy to be valid.

Follow Up

You will be seen in the outpatient department of the hospital 6-weeks (or earlier) after your surgery.  Any outstanding results will be discussed with you at this time. If you have had your operation for cancer you will be referred to an Oncologist (cancer specialist), they will then discuss with you any further treatment that may be necessary.

Who Can Help?

During your hospital stay you will have met the Colorectal Nurse Specialist who is available to provide information and give support to you and you family.  Please remember that following your discharge home from hospital the Colorectal Nurse Specialist is still available to support you.  If at any point you have any queries or concerns please telephone them.  

Additional Support Available

Cancer Bacup

0808 800 1234
www.cancerbacup.org.uk

National Association Crohns & Ulcerative Colitis

01727 830038
www.nacc.org.uk

Beating Bowel Cancer

020 8892 5256
www.beatingbowelcancer.org

British Colostomy Association

0800 328 4257
www.bcass.org.uk

Ileostomy and Internal Pouch Support Group

0800 018 4724
www.ileostomypouch.demon.co.uk

Rectal Cancer Surgery | Side Effects of Rectal Surgery

Surgery is usually the main treatment for rectal cancer. Radiation and chemotherapy are often given before or after surgery. The type of surgery used depends on the stage (extent) of the cancer, where it is, and the goal of the surgery.

Before doing surgery, the doctor will need to know how close the tumor is to the anus. This will help decide what type of surgery is done. It can also impact outcomes if the cancer has spread to the ring-like muscles around the anus (anal sphincter) that keep stool from coming out until they relax during a bowel movement.

Polypectomy and local excision

Some early rectal cancers and most polyps can be removed during a colonoscopy. This is a procedure that uses a long flexible tube with a small video camera on the end that’s put into the person’s anus and threaded into the rectum. These surgeries can be done during a colonoscopy:

• For a polypectomy, the cancer is removed as part of the polyp, which is cut at its base (the part that looks like the stem of a mushroom). This is usually done by passing a wire loop through the colonoscope to cut the polyp from the wall of the rectum with an electric current.
• A local excision is a slightly more involved procedure. Tools are used through the colonoscope to remove small cancers on the inside lining of the rectum along with a small amount of surrounding healthy tissue on the wall of rectum.

When cancer or polyps are taken out this way, the doctor doesn’t have to cut into the abdomen (belly) from the outside. The goal of these surgeries is to remove the cancer or polyp in one piece. If some cancer is left behind or if, based on lab tests, the tumor is thought to have a chance to spread, a more complex type of rectal surgery (see below) might be the next step.  

Transanal excision (TAE)

This surgery can be used to remove some early stage I rectal cancers that are relatively small and not too far from the anus. As with polypectomy and local excision, TAE is done with instruments that are put into the rectum through the anus. The skin over the abdomen (belly) isn’t cut. It’s usually done with local anesthesia (numbing medicine) – the patient is not asleep during the operation.

In this operation, the surgeon cuts through all layers of the rectal wall to take out the cancer as well as some surrounding normal rectal tissue. The hole in the rectal wall is then closed.

Lymph nodes are not removed during this surgery, so radiation with or without chemotherapy might be recommended after surgery if the cancer has grown deep into the rectum, was not removed completely, or has signs of spread into the lymph system or blood vessels. Sometimes, instead of chemo and radiation, a more extensive surgery, such as low anterior resection (LAR) or abdominoperineal resection (APR) (discussed below), might be recommended and then followed with chemo and radiation.

Transanal endoscopic microsurgery (TEM)

This operation can sometimes be used for early stage I cancers that are higher in the rectum and can’t be reached using the standard transanal resection (see above). A specially designed magnifying scope is put through the anus and into the rectum. This allows the surgeon to do a transanal resection with great precision and accuracy. This operation requires special equipment and surgeons with special training and experience, so it’s only done at certain cancer centers.

Low anterior resection (LAR)

Some stage I rectal cancers and most stage II or III cancers in the upper part of the rectum (close to where it connects with the colon) can be removed by low anterior resection (LAR). In this operation, the part of the rectum containing the tumor is removed. The lower part of the colon is then attached to the remaining part of the rectum (either right away or sometime later) so that the patient moves their bowels in the usual way.

A low anterior resection is done with general anesthesia (where the patient is put into a deep sleep). The surgeon makes several small incisions (cuts) in the abdomen. The cancer and a margin (edge or rim) of normal tissue around the cancer is removed, along with nearby lymph nodes and other tissues around the rectum.

The colon is then reattached to the remaining rectum so that a permanent colostomy is not needed. (A colostomy is needed when, instead of reconnecting the colon and rectum, the top end of the colon is attached to an opening made in the skin of the abdomen. Stool then comes out this opening.)

If radiation and chemotherapy have been given before surgery, it’s common for a short-term ileostomy to be made. (This is where the end of the ileum, the last part of the small intestine, is connected to a hole in the skin of the abdomen.) This gives the rectum time to heal before stool moves through it again. In most cases, the ileostomy can be reversed (the intestines reconnected) about 8 weeks later.

Most patients spend several days in the hospital after the LAR, depending on how the surgery was done and their overall health. It could take 3 to 6 weeks to recover at home.

Proctectomy with colo-anal anastomosis

Some stage I and most stage II and III rectal cancers in the middle and lower third of the rectum require removing the entire rectum (called a proctectomy). The rectum has to be removed so that a total mesorectal excision (TME) can be done to remove all of the lymph nodes near the rectum. The colon is then connected to the anus (called a colo-anal anastomosis) so that the patient will pass stool in the usual way.

Sometimes when a colo-anal anastomosis is done, a small pouch is made by doubling back a short piece of colon (called a colonic J-pouch) or by enlarging a segment of the colon (called coloplasty). This small reservoir or pouch of colon provides storage for stool, like the rectum did before surgery. When special techniques are needed to avoid a permanent colostomy, the patient may need a short-term ileostomy (where the end of the ileum, the last part of the small intestine, is connected to a hole in the abdominal skin) for about 8 weeks while the bowel heals. A second operation is then done to reconnect the intestines and close the ileostomy opening.

General anesthesia (where the patient is put into a deep sleep) is used for this operation. Most patients spend several days in the hospital after surgery, depending on how it was done and their overall health. It could take 3 to 6 weeks to recover at home.

Abdominoperineal resection (APR)

This operation is more involved than the LAR. It can be used to treat some stage I cancers and many stage II or III cancers in the lower part of the rectum (the part close to the anus). It’s often needed if the cancer is growing into the sphincter muscle (the muscle that keeps the anus closed and prevents stool leakage) or the nearby muscles that help control urine flow
(called levator muscles).

Here, the surgeon makes a cut or incision (or several small incisions) in the skin of the abdomen, and another in the skin around the anus. This allows the surgeon to remove the rectum, the anus, and the tissues around it, including the sphincter muscle. Because the anus is removed, a permanent colostomy is needed (the end of the colon is connected to a hole in the skin over the abdomen) to allow stool to pass.

General anesthesia (where the patient is put into a deep sleep) is used for this operation. Most people spend several days in the hospital after an APR, depending on how the surgery is done and their overall health. Recovery time at home may be 3 to 6 weeks.

Pelvic exenteration

If the rectal cancer is growing into nearby organs, a pelvic exenteration may be recommended. This is a major operation. The surgeon will remove the rectum as well as any nearby organs that the cancer has reached, such as the bladder, prostate (in men), or uterus (in women).

A colostomy is needed after pelvic exenteration. If the bladder is removed, a urostomy is needed, too. (This is an opening in skin of the abdomen where urine leaves the body and is held in a pouch that sticks to the skin.) It can take many months to fully recover from this complicated surgery.

Diverting colostomy

Some patients have rectal cancer that has spread and is also blocking the rectum. In this case, surgery may be done to relieve the blockage without removing the part of the rectum containing the cancer. Instead, the colon is cut above the cancer and attached to a stoma (an opening in the skin of the abdomen) to allow stool to come out. This is called a diverting colostomy. It can often help the patient recover enough to start other treatments (such as chemotherapy).

Surgery for rectal cancer spread

If rectal cancer has spread and formed just one or a few tumors in the lungs or liver (and nowhere else), surgery might be used to remove it. In most cases, this is only done if the cancer in the rectum is also being removed (or was already removed). Depending on the extent of the cancer, this might help the patient live longer, or it could even cure the cancer. Deciding if surgery is an option to remove areas of cancer spread depends on their size, number, and location.

Possible side effects of rectal surgery

Possible risks and side effects of surgery depend on several factors, including the extent of the operation and a person’s general health before surgery. Problems during or shortly after the operation can include bleeding from the surgery, infections at the surgery site, and blood clots in the legs. 

When you wake up after surgery, you will have some pain and will need pain medicines for a few days. For the first couple of days, you may not be able to eat or you may be allowed limited liquids, as the rectum needs some time to recover. Most people are able to eat solid food again in a few days.

Rarely, the new connections between the ends of the colon may not hold together and may leak. This can quickly cause severe belly pain, fever, and the belly to feel very hard. A smaller leak may cause you to not pass stool, have no desire to eat, and not do well or recover after surgery. A leak can lead to infection, and more surgery may be needed to fix it. It’s also possible that the incision (cut) in the abdomen (belly) might open up, becoming an open wound that may need special care as it heals.

After the surgery, you might develop scar tissue in your abdomen (belly) that can cause organs or tissues to stick together. These are called adhesions. Normally your intestines freely slide around inside your belly. In rare cases, adhesions can cause the bowels to twist up and can even block the bowel. This causes pain and swelling in the belly that’s often worse after eating. Further surgery may be needed to remove the scar tissue.

Colostomy or ileostomy

Some people need a temporary or permanent colostomy (or ileostomy) after surgery. This may take some time to get used to and may require some lifestyle adjustments. If you have a colostomy or ileostomy, you will need to learn how and where to order the proper supplies and to manage it. Specially trained ostomy nurses or enterostomal therapists can help you. They’ll usually see you in the hospital before your operation to discuss the ostomy and to mark a site for the opening. After your surgery they may come to your house or an outpatient setting to give you more training. There may also be ostomy support groups you can be part of. This is a good way to learn from others with first-hand experience in managing this part of the treatment.

For more information, see Colostomy Guide and Ileostomy Guide.

Sexual function and fertility

Rectal surgery has been linked to sexual problems and quality of life issues in both men and women.
Talk to your doctor about how your body will look and work after surgery. Ask how surgery will impact your sex life. You and your partner should know what you can expect, for example:

• If you are a man, an AP resection (APR) may stop your erections or your ability to reach an orgasm. In other cases, your pleasure at orgasm may become less intense. Normal aging may cause some of these changes, but they may be made worse by the surgery.
  An APR can also affect fertility. Talk with your doctor if you think you want to father a child in the future. There may still be ways to do this.
• If you are a woman, rectal surgery (except pelvic exenteration) usually doesn’t cause any loss of sexual function. Abdominal adhesions (scar tissue) may sometimes cause pain or discomfort during sex. If your uterus is removed, you won’t be able to get pregnant.

If you have a colostomy, it can have an impact on body image and sexual comfort level in both men and women. While it may require some adjustments, it should not keep you from having an enjoyable sex life.

For more about sexuality and fertility, see Fertility and Sexual Side Effects.

Appendectomy | Johns Hopkins Medicine

An appendectomy is surgery to remove the appendix when it is infected. This condition is called appendicitis. Appendectomy is a common emergency surgery.

The appendix is a thin pouch that is attached to the large intestine. It sits in the lower right part of your belly. If you have appendicitis, your appendix must be removed right away. If not treated, your appendix can burst. This is a medical emergency.

There are 2 types of surgery to remove the appendix. The standard method is an open appendectomy. A newer, less invasive method is a laparoscopic appendectomy.

• Open appendectomy. A cut or incision about 2 to 4 inches long is made in the lower right-hand side of your belly or abdomen. The appendix is taken out through the incision.

• Laparoscopic appendectomy. This method is less invasive. That means it’s done without a large incision. Instead, from 1 to 3 tiny cuts are made. A long, thin tube called a laparoscope is put into one of the incisions. It has a tiny video camera and surgical tools. The surgeon looks at a TV monitor to see inside your abdomen and guide the tools. The appendix is removed through one of the incisions.

During a laparoscopic surgery, your provider may decide that an open appendectomy is needed.

If your appendix has burst and infection has spread, you may need an open appendectomy.

A laparoscopic appendectomy may cause less pain and scarring than an open appendectomy. For either type of surgery, the scar is often hard to see once it has healed.

Both types of surgery have low risk of complications. A laparoscopic appendectomy has a shorter hospital stay, shorter recovery time, and lower infection rates.

Recently, some studies have suggested that intravenous antibiotics alone could cure appendicitis without the need for appendectomy. These results remain controversial and appendectomy remains the standard of care.

Why might I need an appendectomy?

You may need an appendectomy to remove your appendix if you show symptoms of appendicitis.

Appendicitis is a medical emergency. It is when your appendix becomes sore, swollen, and infected.

If you have appendicitis, there is a serious risk your appendix may burst or rupture. This can happen as soon as 48 to 72 hours after you have symptoms. It can cause a severe, life-threatening infection called peritonitis in your belly.

If you have appendicitis symptoms, seek medical care right away.

What are the risks of an appendectomy?

Some possible complications of an appendectomy include:

You may have other risks that are unique to you. Be sure to discuss any concerns with your healthcare provider before surgery.

How do I get ready for an appendectomy?

• Your healthcare provider will explain the surgery to you. Ask any questions you may have.

• You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully and ask questions if anything is not clear.

• Your provider will ask questions about your past health. He or she will also give you a physical exam. This is to make sure you are in good health before you have surgery. You may also need blood tests and other diagnostic tests.

• You must not eat or drink anything for 8 hours before the surgery. This often means no food or drink after midnight.

• Make sure your provider has a list of all medicines (prescribed and over-the-counter) and all herbs, vitamins, and supplements that you are taking.

• You may be given a medicine to help you relax (a sedative) before the surgery.

Tell your healthcare provider if you:

• Are pregnant or think you may be pregnant

• Are allergic to or sensitive to latex, medicines, tape, or anesthesia medicines (local and general)

• Have a history of bleeding disorders or are taking any blood-thinning (anticoagulant) medicines, aspirin, or other medicines that affect blood clotting. You may have to stop taking these medicines before surgery.

Your healthcare provider may have other instructions for you based on your medical condition.

What happens during an appendectomy?

In most cases an appendectomy is an emergency surgery and will require a hospital stay. You will have either an open appendectomy or a laparoscopic appendectomy. This will depend on your condition and your healthcare provider’s practices.

An appendectomy is done while you are given medicines to put you into a deep sleep (under general anesthesia).

Generally, the appendectomy follows this process:

• You will be asked to remove any jewelry or other objects that might get in the way during surgery.

• You will be asked to remove your clothing and will be given a gown to wear.

• An IV (intravenous) line will be put in your arm or hand.

• You will be placed on the operating table on your back.

• If there is a lot of hair at the surgical site, it may be clipped off.

• A tube will be put down your throat to help you breathe. The anesthesiologist will check your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

Open appendectomy

• A cut or incision will be made in the lower right part of your belly.

• Your abdominal muscles will be separated and the abdominal area will be opened.

• Your appendix will be tied off with stitches and removed.

• If your appendix has burst or ruptured, your abdomen will be washed out with salt water (saline).

• The lining of your abdomen and your abdominal muscles will be closed with stitches. A small tube may be put in the incision to drain out fluids.

Laparoscopic appendectomy

• A tiny incision will be made for the tube (laparoscope). More cuts may be made so that other tools can be used during surgery.

• Carbon dioxide gas will be used to swell up your abdomen so that your appendix and other organs can be easily seen.

• The laparoscope will be put in and your appendix will be found.

• Your appendix will be tied off with stitches and removed through an incision.

• When the surgery is done, the laparoscope and tools will be removed. The carbon dioxide will be let out through the cuts. A small tube may be placed in the cut to drain out fluids.

Procedure completion, both methods

• Your appendix will be sent to a lab to be tested.

• Your cuts will be closed with stitches or surgical staples.

• A sterile bandage or dressing will be used to cover the wounds.

What happens after an appendectomy?

In the hospital

After surgery, you will be taken to the recovery room. Your healthcare team will watch your vital signs, such as your heart rate and breathing. Your recovery will depend on the type of surgery that was done and the type of anesthesia you had. Once your blood pressure, pulse, and breathing are stable and you are awake and alert, you will be taken to your hospital room.

A laparoscopic appendectomy may be done on an outpatient basis. In this case, you may be discharged and sent home from the recovery room.

You will have pain medicine as needed. This may be by prescription or from a nurse. Or you may give it to yourself through a device connected to your IV (intravenous) line.

You may have a thin plastic tube that goes through your nose into your stomach. This is used to remove stomach fluids and air that you swallow. The tube will be taken out when your bowels are working normally. You will not be able to eat or drink until the tube is removed.

You will be asked to get out of bed a few hours after a laparoscopic surgery or by the next day after an open surgery.

You may be allowed to drink liquids a few hours after surgery. You may slowly be able to add more solid foods.

You will set up a follow-up visit with your healthcare provider. This is often 2 to 3 weeks after surgery.

At home

When you are home, you must keep the incision clean and dry. Your doctor will give you instructions on how to bathe. Any stitches or surgical staples used will be removed at a follow-up office visit. If adhesive strips were used, they should be kept dry. They will often fall off in a few days.

The incision and your abdominal muscles may ache, often after long periods of standing. Take a pain medicine as recommended by your provider. Aspirin or other pain medicines may raise your risk of bleeding. Only take medicines that your provider has approved.

If you had a laparoscopy, you may feel pain from the carbon dioxide gas that is still in your belly. This pain may last for a few days. You should feel a bit better each day.

Your provider will likely want you to walk and move around a bit. But avoid any tiring activity. Your provider will tell you when you can return to work and your normal activities.

Call your healthcare provider if you have any of the following:

• Fever or chills

• Redness, swelling, bleeding, or other drainage from the incision site

• More pain around the incision site

• Vomiting

• Loss of appetite or unable to eat or drink anything

• Constant coughing, trouble breathing, or shortness of breath

• Belly pain, cramping, or swelling

• No bowel movement for 2 days or longer

• Watery diarrhea for more than 3 days

90,000 Sedation (medication sleep) – CMT Clinic

Benefits of undergoing colonoscopy and gastroscopy while sleeping:

If the patient wishes, EGD and colonoscopy are carried out in a state of drug sleep. Under the supervision of an experienced anesthesiologist, the patient receives light sedation. Medication sleep is not anesthesia , it is much easier to tolerate, after it there is no lethargy or lethargy, as well as problems with orientation.After the end of the procedure, a gentle awakening is felt without any discomfort. After 25-30 minutes, the patient can drive the vehicle himself.

Benefits of medication sleep:

• Patient painlessness and comfort

Carrying out the procedure while sleeping helps to reduce the level of anxiety and fear in the patient and avoid pain.

Sleep colonoscopy allows you to examine the entire large intestine.During the diagnosis, it is possible to remove polyps, stop bleeding in the intestines and carry out other manipulations, saving the patient from additional intervention and surgery.

• Accurate diagnostics

During routine endoscopy without sedation, the physician has to work in a nervous environment. The doctor is forced to rush, as the patient may be painful or unpleasant. Gastroscopy under sedation allows you to conduct the examination calmly, without haste, which reduces the percentage of diagnostic errors.

• Reducing the time of the procedure

Studies have shown that sleep colonoscopy takes 15-25% less time on average than a procedure without sedation. Also, several endoscopic examinations can be performed simultaneously during one sedation session.

• Reducing the likelihood of complications

Sleep relaxes the patient’s intestines, which almost completely eliminates the possibility of perforation and other damage to the intestine during colonoscopy under sedation.

Colonoscopy under general anesthesia, preparation and contraindications for research – MEDSI

Contents

Colonoscopy is a popular diagnostic method used to detect bowel disease . The procedure is quite painful and causes severe discomfort. For this reason, patients often refuse to be examined, which makes it difficult to make an accurate diagnosis and delays the appointment of therapy.Not surprisingly, colonoscopy under general anesthesia has become increasingly popular in recent years. Such an examination does not give any obvious unpleasant sensations, but at the same time it is distinguished by sufficient accuracy and safety.

Diagnostic features

Colonoscopy with anesthesia – a technique that avoids a number of unpleasant sensations. Like the standard one, it is performed using a special probe inserted into the anus. The probe is attached to the tube and complemented by a microscopic video camera to record all internal changes.Modern equipment allows the doctor to examine the entire surface of the mucous membrane of the large intestine, as well as the rectum, blind, sigmoid and colon.

Additionally, within the framework of the survey, you can perform :

• Removal of polyps
• Biopsy: taking tissue samples for further histology
• Elimination of detected neoplasms

The main purpose of diagnostics is to detect a wide range of diseases and pathological conditions in the early stages of development (including before the onset of symptoms).This allows to reduce all risks to the patient’s health and life and to prescribe adequate treatment in a timely manner.

The main advantages of both standard colonoscopy and the one performed with anesthesia include :

• Pronounced therapeutic effect. The technique is not only aimed at diagnostics, but also allows performing simple surgical interventions
• Possibilities for quickly determining the localization of damaged tissues and the stage of development of pathology
• Accurate diagnosis.During the diagnosis, the doctor can examine most of the intestinal cavity
• Method availability. Diagnostics is carried out today in many medical institutions. You can do both colonoscopy and EGD at once under general anesthesia. This not only saves time, but also provides accurate information about the work of the upper and lower gastrointestinal tract

The examination is carried out using several options for anesthesia.

• Local .In this case, the anesthetic drug is applied directly to the endoscope, as it moves forward, the agent comes into contact with the intestinal walls and slightly reduces pain. With local anesthesia, the patient is awake and may experience discomfort. Therefore, this procedure is not suitable for everyone
• Medication sleep (sedation ) . To achieve a pronounced analgesic effect, special modern drugs are used that are sufficiently effective with optimal safety indicators.When using such means, the patient retains the ability to move and respond to the doctor’s requests. At the same time, awakening from the state of drug-induced sleep usually goes quite easily
• General anesthesia. With this anesthesia, the patient is unconscious and does not experience any discomfort at all. At the same time, when using drugs, the risks of damage to the intestinal walls increase. In addition, rehabilitation takes more than a day. It is forbidden to administer general anesthesia to patients with serious diseases of the lungs and bronchi, as well as with heart failure and other pathologies

Thus, sedation is the best option.Colonoscopy with anesthesia in St. Petersburg is carried out in MEDSI in a state of medication sleep.

Indications for diagnostics

An examination (both under anesthesia and without it) is prescribed for the following symptoms :

• Regular stool disorders: diarrhea and constipation
• Pain during bowel movements
• Appearance of blood and mucus impurities in feces
• Bloating
• Recurrent or persistent pain in the lower abdomen
• Decreased appetite (especially if it is accompanied by general weakness)
• Periodic temperature rise

Also, to do a colonoscopy under anesthesia, the doctor can advise in case of hemorrhoids, sudden weight loss, the presence of cancer cells in the blood.Often, an examination is prescribed to clarify the diagnosis after an ultrasound scan, computed tomography and other diagnostic procedures.

Direct indications for the use of anesthesia during the examination include :

• The presence of inflammatory and destructive processes in the intestine, which include colitis and enteritis, as well as peptic ulcer disease. This is due to the fact that with such pathologies the intestinal walls have damaged surfaces, contact with which the endoscope can provoke a sharp and pronounced pain
• Patient’s age up to 12 years .Without effective pain relief, the child will not be able to fully relax the muscles, and prolonged pain syndrome can negatively affect the psychological state of the little patient
• Adhesive formations in the intestine , formed as a result of traumatic effects (including surgery) or hereditary predisposition. Air movement in the intestines during the study can also provoke severe pain
• Psychological imbalance of the patient , pathological fear of any medical procedures and low pain threshold

Colonoscopy of the intestines under anesthesia at MEDSI in St. Petersburg is also performed at the personal request of the patient.

Potential risks and complications

The methods of anesthesia developed today can significantly reduce and even completely eliminate pain syndrome, but there are certain risks and complications of the procedure. For this reason, experts strongly advise patients to spend at least a few hours in the hospital after completing the diagnosis.

Important! A preliminary consultation with a doctor helps to avoid negative consequences.The specialist can assess the degree of occurrence of some of the risks and complications.

Common consequences of the procedure include :

• Allergic reactions to the drugs used
• Nausea and vomiting (especially during or after eating)
• Increased body temperature and blood pressure indicators
• Exacerbation of diseases of internal organs
• Pain in the abdomen, back, sides

In some cases, complications such as problems with defecation and spotting from the anus, damage to the walls of the intestines and spleen, and infectious diseases are detected.These consequences usually occur when the procedure is performed incorrectly. That is why it is very important to take a responsible approach to the issue of choosing a clinic in which diagnostics will be performed.

Contraindications

Colonoscopy under general anesthesia is not performed for the following diseases and conditions :

• Chronic bronchitis and bronchial asthma
• Peritonitis
• Inflammation of the peritoneum
• Pregnancy
• Hemophilia and other blood clotting pathologies
• Postoperative period
• Ulcerative and ischemic colitis in late stage

General anesthesia is strictly prohibited for mitral stenosis, after strokes and in heart failure.

In children, examination under anesthesia is not carried out for such pathologies as exhaustion, lung disease, progressive rickets, upper respiratory tract infections, lyoderma.

Important! Indications and contraindications for colonoscopy in St. Petersburg in our clinics are determined exclusively by a doctor.

Advantages of holding in MEDSI

• Experienced Doctors . Our endoscopists are constantly improving their qualifications and can perform a wide range of examinations with high accuracy and minimal discomfort for the patient
• Innovative equipment and modern technologies .Examination rooms are equipped with expert class equipment from well-known foreign manufacturers
• Safe and effective research . When conducting colonoscopy under anesthesia, innovative formulations are used. They completely eliminate discomfort and allow examinations even for patients with high sensitivity. We provide maximum comfort and take care of the absence of pain and other unpleasant sensations in patients, we strive to reduce psychological discomfort (embarrassment, fear, etc.)
• Availability of modern wards for preparation for diagnosis and recovery after it . They are equipped with comfortable beds, appliances, and a bathroom. The patient is in the most comfortable conditions and can fully prepare for the study and recover from it

If you want to make an appointment for an intestinal colonoscopy under anesthesia at our clinic in St. Petersburg, to find out the cost of the study, call +7 (812) 336-33-33.

Anesthesia

Even the most knowledgeable patient is worried and asks a similar question: will it not hurt me during and immediately after the operation, when the anesthesia “goes away”? The answer in this case may sound like this: thanks to the achievements of anesthesiology (a branch of medical science that studies various types of anesthesia and anesthesia), any, even the most complex and extensive operation will be painless, safe and comfortable for the patient.

ANESTHESIA – a condition in which, against the background of loss or preservation of consciousness, sensations are partially or completely lost, and therefore there is no pain. In a common sense, anesthesia is one or another way of relieving a patient from pain during surgery.

The purpose of anesthetic management of surgical interventions is to adequately protect the body from operational stress.

What types of pain relief exist in modern medicine?

Anesthesia or anesthesia can be general or local.

Local anesthesia. It consists in the introduction with a syringe into the area of ​​the operation being performed or into the area of ​​peripheral nerves that control the pain sensitivity of the operation area, a special substance, a local anesthetic, which temporarily turns off pain sensitivity. Local anesthesia can be infiltration (injection of anesthetic directly into the incision and surgical manipulation area), conduction (blockade of peripheral nerves and plexuses, epidural and subarachnoid anesthesia (at the level of the spinal cord) – the introduction of anesthetic into the area of ​​large nerves, which provide pain sensitivity in the operation area, however, they themselves are outside this zone).During the operation under local anesthesia, the patient is awake.

General anesthesia or anesthesia consists in temporarily turning off the central zones of pain sensitivity and the transmission of pain impulses in the brain or spinal cord.

Anesthesia is intravenous and intubation.

During intravenous anesthesia, a drug is injected into the patient’s vein, which causes the centers of pain sensitivity of the brain to turn off and at the same time turns off the patient’s consciousness, while maintaining, as a rule, spontaneous breathing.

Intubation anesthesia consists in preliminary temporary shutdown at the level of the brain of the central pain sensitivity and consciousness of the patient, temporary paralysis of the muscles followed by intubation (introduction of a breathing tube into the trachea) and the implementation of artificial ventilation (artificial respiration) using special respiratory equipment for the entire duration of the operation … This type of anesthesia is used in major operations where it is required that the patient’s muscles be relaxed and involuntary or voluntary movements would not interfere with the surgeon and would be completely excluded.

A special place among the methods of general anesthesia is occupied by spinal (epidural) anesthesia, which consists in the introduction of local anesthetics of various durations into the spinal canal, which leads to a temporary shutdown of pain and tactile sensitivity, as well as motor function below the injection site. Spinal anesthesia is usually supplemented with so-called intravenous sedation (medication sleep) and the patient is asleep during the operation.

Combined anesthesia is a broad concept that implies the sequential or simultaneous use of various types of anesthesia (inhalational anesthesia with local anesthesia), which makes it possible to enhance pain relief.

Recommendations for preparation for anesthesia

• Restriction on food and drink intake. It is forbidden to eat or drink anything for a certain period of time before anesthesia (average 8 hours).
• Restrictions on medication. If the patient is taking any medication on a regular basis (for diabetes or heart disease), check with the anesthesiologist if these medications can be taken on the day before and on the day of the procedure.Some drugs can interact with anesthetics and other drugs used for anesthesia.
• Applying some mental relaxation techniques (focusing on optimistic and positive thoughts, relaxing and releasing tension by focusing on a pleasant experience or a calming place, meditation).

Immediately before the operation, the patient undergoes premedication – a complex drug preparation for anesthesia (sleeping pills are given at night, narcotic analgesics 40 minutes before the operation).

Objectives of premedication: to eliminate feelings of anxiety, fear and excitement; to enhance the effectiveness of the forthcoming anesthesia; to prevent unwanted side effects of anesthesia.

What are the features of the patient’s exit from various types of anesthesia and the immediate postoperative period?

Very often patients are interested in what will happen to them and how will they feel when the anesthesia wears off? Of course, this also depends on the type of anesthesia used, and on the type and volume of the operation, as well as on the general condition and individual characteristics of the patient’s pain sensitivity.After the cessation of the effect of local anesthesia, patients, as a rule, experience minor pain in the area of ​​the operating wound (the site of the operating injury cannot but hurt). Pain reliever is usually sufficient to relieve these pains.

After intravenous and intubation anesthesia, patients feel like after a good and deep sleep, sometimes they remember bizarre dreams, occasionally experience a headache, nausea, and in rare cases vomiting. After intubation anesthesia, there is a sore throat and a feeling of discomfort in the throat, which is associated with the presence of a breathing tube there during the operation.In the first hours after the operation, all patients are under the close supervision of the medical staff of the anesthesiological service (anesthesiologist, nurse-anesthetist). Only when the patient fully regains consciousness is he transferred to a regular ward.

REMEMBER THAT A QUALIFIED ANESTHETIC SUPPORT AND COMPLETE POSTOPERATIVE REHABILITATION ARE THE MOST IMPORTANT COMPONENTS OF SURGICAL TREATMENT!

Prevention of sleep disorders

Sleep disorders

Insomnia is one of the unpleasant companions of late age.This is most often called the inability to fall asleep or maintain a state of sleep.

According to statistics, about 45% of people experience insomnia at least once a year. Most of them complain of deep depression and, as a result, lack of sleep or difficulty falling asleep. Sometimes insomnia is caused by somatic diseases, such as: diseases of the brain, diseases of the cardiovascular system, diseases with pain syndromes, etc. Psychological causes of insomnia are most often anxiety, quarrels in the family, conflicts at work.

One of the causes of insomnia is an elementary lack of the correct daily regimen.

Sleep disturbance leads to the fact that during the day a person feels overwhelmed, drowsy, and at night he cannot fall asleep. And ultimately, if insomnia can arise from stress, then it must be remembered that with prolonged sleep disturbance, stress from insomnia itself can arise.

Consider factors of insomnia such as overwork, stress, chronic fatigue and neurosis.

One of the causes of neurosis may be suspiciousness. If such patients are asked what thoughts haunt them all day and interfere with sleep at night, they answer that they are afraid that they make mistakes at work, despite the fact that there seems to be no objective evidence to support this version.

Once, with a group of patients suffering from insomnia, scientists conducted an experiment: they calculated how much real time these people sleep. It turned out that the objective data was very different from what seemed to the patients.As a rule, patients were sure that they slept no more than 3-4 hours, and fell asleep for at least an hour. In fact, most of them slept for at least 5 hours, and fell asleep within 15 minutes, as they went to bed! It should be noted that 20-30 minutes for falling asleep is a physiological norm. Despite the discrepancy between objective data and subjective ideas of a person, it is the perception of the person himself that plays an important role in the formation of ideas about his health or ill health.

The prevention of insomnia is an active lifestyle in the daytime, sufficient physical physical activity, regular exercise – the most important factors in a healthy lifestyle. Exercises aimed at relieving tension, relaxation (muscle relaxation, calming thoughts) are also recommended. However, if, despite the implementation of all the recommendations, sleep remains disturbed for a long time, and this has a negative effect on the well-being of the elderly person, it is advisable to seek the advice of a doctor (psychotherapist or psychiatrist).

To identify the causes of sleep disorders, experts advise keeping a “Sleep Diary”. This will help the doctor collect data, study the disease, and only then can he prescribe treatment for the patient.

To find out what caused the insomnia, you need to fill out such a diary for at least a week. What should be recorded in a sleep diary?

The following points should be noted in the diary:

1. Date
2. Time when we went to bed in the evening
3. What did you take to sleep?
4. How long did it take to fall asleep?
5. How many times did you wake up at night?
6. How long after waking up did you manage to fall asleep?
7. Time for morning awakening?

In the evening, on the eve of going to bed, you answer the following questions :

1. When and how many cups of coffee or caffeinated drinks were drunk during the day.
2. When and how much alcohol was drunk
3. What medications were taken during the whole day
4. Were there any stresses (what?)
5. Did I have to take a nap during the day and for what period of time.

Thus, it turns out that the diary will consist of two parts, one of which you fill in in the morning, and the other – in the evening.

By answering the above questions daily, you can collect accurate information about each individual’s sleep disorder.Moreover, by keeping a diary, you yourself will begin to understand a lot.

In case of complaints of insomnia for a long time, you can sign up for a consultation psychiatrist or psychotherapist , which will help determine the causes and suggest further treatment tactics.

You can sign up by calling the registry (812) 575-27-63 or through the form on the main page of the site .

(The article uses information from sources on psychological education, methodological literature, Internet resources, recommendations of specialists. References to thematic resources and References are given in a special section)

COMPLEX OF FOOD ADDITIVES | orto.lv

How to help the body in the postoperative period?

FOOD ADDITIVES COMPLEX

It often seems to us purely psychologically that the operation is the most difficult thing to overcome in the process of recovery.But in reality, it is much more difficult to accept the recovery period after surgery – when the process is slower than we would like and the person feels weak and limited: not the way he imagined it.

Because of anxiety and excitement, we sleep worse, we feel tired, because the body spends a lot of energy on healing, it happens that we catch a cold – although we did not go out into the street. All this gives us discomfort:
we want the recovery period to pass as quickly as possible – and again we can start living a full life and move as usual.

Experienced specialists of ORTO Clinic understand all this very well and are looking for ways to make it easier to endure the postoperative weeks and help the body to effectively cope with the stress caused by surgery. Doctors ORTO Clinic in cooperation with Riga University. P. Stradins investigated and determined in which areas our body needs additional support in the postoperative period:

• Rapid tissue regeneration and healing
• Good sleep
• Stress Reduction
• Strengthening immunity
• Maintaining optimal intestinal microflora while taking antibiotics
• Full blood circulation and oxygen saturation
• Reduction of muscle atrophy during postoperative movement restrictions

In order to get back on your feet after surgery, it is important to be outdoors and be physically active (preferably under the supervision of an experienced physiotherapist), as well as to have a high-quality, varied diet.And in addition, you can help the body by supporting it with biologically active substances and vitamins that have a positive effect on all processes that are important for quick recovery after surgery.

In cooperation with the Latvian drug manufacturer LotosPharma, ORTO Klīnika has developed a special ORTO package, which includes dietary supplements required before and after surgery. They will help the body recover easier and faster.

Recommended set of food additives includes:

• Artroveron – Glucosamine, Hyaluronic Acid, Omega-3, Chondroitin and Collagen
• Solvitale – Vitamin D and Fatty Acids
• Good sleep – valerian, passionflower, hops and melatonin
• MagneMix – magnesium
• C Vit prolong – C vitamin and currant
• VenaVein – Horse Chestnut Seed Extract, Hesperidin and Diosmin
• LactoFar – chamomile and yeast
• PerioOp – Cow’s Milk Protein Concentrate, Whey Protein Isolate, Inulin

Considering that after some operations the recovery period can take up to six months, we offer the ORTO food supplement package for one month and three months.

Set price per month – 90 euros

Price of a set for three months – 150 euros

90,000 Recovery after cesarean section | Kaplan Medical Center

Caesarean section is a surgical intervention, a full-fledged abdominal operation using anesthesia. The pace of recovery after cesarean depends on compliance with the basic rules of behavior. The most important recommendation is to try to get out of bed as soon as possible to prevent the onset of so-called “venous thrombosis”, which is considered a relatively common complication after this operation.
Once the operation is over, you will be escorted to the intensive care unit where you will spend about 2 hours without your child. The policy of the Kaplan Medical Center is not to separate the mother and the baby for a long time, therefore, in the absence of contraindications on the part of the mother and the child, feeding is allowed as soon as the woman comes to her senses after the operation. Our staff will help to attach the baby (skin-to-skin contact) so that he does not freeze and will help to establish feeding if there are no contraindications for the mother and the baby.After that, the woman and the baby are transferred to the postpartum ward, where they will spend about 4 days. About six hours after surgery, the catheter will be removed from your bladder and you can get out of bed and sit in a chair. The next day, after a doctor’s examination and dressing, you can take a shower, walk around the room and, of course, take care of your baby. The development of lactation after a cesarean section is almost the same as in women who gave birth naturally. It is most convenient to feed the baby lying on its side in the first days after the cesarean section.This position will have the least effect on the postoperative suture. In the future, it is possible to feed the baby in a sitting or standing position.

What are the main problems during the postoperative recovery period?

Pain : As with any surgery, you experience pain, but there are several ways to relieve the condition. Pain caused by uterine contraction is a normal postpartum condition. But you must definitely inform the medical staff about this and, if necessary, you will be prescribed pain relievers.As with incision pain.
Nausea : Many people suffer from nausea – this is a normal reaction of the body. Be sure to inform the medical staff and you will be given an intravenous prophylactic drug.
Thirst and hunger : Do not eat for the first few hours after surgery. Drinking is allowed, but only water or tea. Sugary drinks and carbonated drinks are prohibited to prevent the formation of gases. Subsequently, the load on the gastrointestinal tract in the postoperative period should be increased gradually.On the second day, you can eat boiled meat, cereals, low-fat broth. Starting from the third day, the mother can already afford more nutritious food, taking into account breastfeeding.
Bleeding : As with any woman after childbirth, you will have vaginal bleeding, which is a consequence of the usual postpartum uterine changes. You should monitor the amount and color of the discharge, and if the bleeding increases or changes color (usually brownish-pinkish discharge), notify the medical staff immediately.
Constipation : These postoperative manifestations are indeed unpleasant, but natural. Such symptoms are observed within two to three days. To avoid this, use safe remedies for constipation – glycerin suppositories or microclysters. But in any case, you should consult with medical personnel.

Treatment of colon diverticulosis – surgery for diverticulosis at the Clinical Hospital on Yauza

Diverticular disease of the colon is the formation of small protrusions on its walls.In a chronic condition, it can be asymptomatic. However, it is often complicated by inflammatory processes that develop due to stagnation of feces. As a result, the risk of phlegmon, peritonitis and perforation of the intestinal wall increases significantly. In the Clinical Hospital on Yauza, operations are performed for colon diverticulosis, and methods of conservative treatment are selected.

When is Diverticular Colon Disease Surgery Needed

Usually, when a disease is detected, conservative treatment is prescribed.It consists in the appointment of a special diet and special drugs to prevent the development of inflammatory processes. However, drug therapy does not lead to complete recovery. Diverticula do not disappear. Treatment is aimed at preventing complications from occurring.

The operation for intestinal diverticulosis gives a more pronounced therapeutic effect. Diverticula are directly removed surgically.

Clinical Practice Guidelines for Colon Diverticulosis Surgery

According to statistics, the disease appears rather rarely in young people.Diverticulosis usually develops in 5% of patients under 40 years of age. As the body ages, the risks increase, and by the age of 55, already 30% of people have this pathology.

Since in the early stages of development, the disease may be asymptomatic, it is most often detected during routine examinations. Surgery in old age should be carried out with caution. Therefore, it is preferable to solve the problem through minimally invasive methods. These include laparoscopic surgery for diverticulosis.

Diagnostics and treatment of pathology in the clinic on Yauza

The clinic is equipped with modern equipment that allows detecting the development of pathology at an early stage. The main method for diagnosing diverticulosis is colonoscopy.

In the Yauza hospital, it is possible to carry out the procedure with minimal discomfort for the patient. For this, at the request of the patient, all manipulations are performed under sedation (in a state of drug sleep).

If necessary, laparoscopic surgery is performed for colon diverticulosis.The experience of doctors and innovative equipment make the excision minimally invasive. The excellent resolution of the video equipment enables the surgeon to obtain a clear and detailed image. As a result, the impact is carried out pointwise, without injuring healthy tissues.

The period after surgery for diverticulosis

The clinic on Yauza is equipped with its own comfortable hospital. After surgery, patients recover in comfortable wards under constant medical supervision.

Since the operation is minimally invasive, the postoperative period does not exceed 3-5 days. After its expiration, the patient goes home, having received detailed doctor’s advice on the diet after diverticulosis surgery and further treatment.

Advantages of laparoscopic surgery for colon diverticulosis in the clinic on Yauza

The clinic on Yauza is an integrated approach to treatment. Here, patients can receive all the necessary medical services. Before the operation and during the recovery period, patients are under the supervision of a surgeon and doctors of other specialties, if necessary.

The latest diagnostic methods make it possible to detect the disease at the initial stages, which contributes to easier and more effective therapy. The experience of our specialists and the use of innovative techniques allows us to successfully treat diverticulosis at any stage.