Proctectomy surgery for inflammatory bowel disease electricity and circuits class 6 questions

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For patients with ulcerative colitis who either don’t want to undergo j-pouch surgery or aren’t able to have that surgery because of problems in the perianal area, a proctocolectomy with permanent ileostomy is also an option. For a minority of people with ulcerative colitis, the rectum still has inflammation, and removing it would give the best chance of improving quality of life.

Proctectomy surgery is major surgery and there are various techniques that might be used. The colorectal surgeon who is completing the surgery will decide on how the surgery will be done, and patients will want to talk over the particulars at the pre-surgical appointments. Every surgical team and hospital will have a preferred way of completing the surgery and deciding how long patients will stay in the hospital afterward and the management of aftercare.

In all cases, this surgery is done under general anesthesia and will require a hospital stay of at least a few days. Pain management will be an important part of recovery both in the hospital and at home. As with most surgeries, getting up and out of bed and walking as soon as hospital staff recommends is vital to healing.

After proctectomy surgery, patients will go home with a new ileostomy, if one was not in place before the surgery. An enterostomal therapy nurse will help with understanding how to care for a new stoma and how to change an ostomy appliance. There will also be stitches in place in the bottom where the anus was closed up, and that area may need special care and cleaning for a time until it is fully healed. The surgical team will give instructions on any other concerns before a patient is released from the hospital. Changes in Diet

Patients may be on bowel rest (not eating foods) until the small intestine "wakes up" from surgery and starts making noise that a healthcare professional can hear through a stethoscope on the abdomen. The next step is usually eating clear liquids such as gelatin and broth, and gradually adding more types of foods until you’re eating a diet of solid food again.

Patients often go home on a modified diet for several weeks until the colorectal surgeon says a normal diet can be resumed. After that, there may be a few foods that the surgeon and the gastroenterologist recommend be avoided (things like popcorn or nuts) because any type of abdominal surgery carries a risk of later having a bowel obstruction. This risk of obstructions will vary greatly from person to person, so diet is best discussed with the surgeon and other members of the healthcare team. Potential Complications of a Proctectomy

Perianal wounds: The most common complication of proctectomy surgery for Crohn’s disease is that of having an unhealed wound in the perianal area. In some cases, people with Crohn’s disease who need a proctectomy have gotten pretty sick and may be in poorer physical shape than they and their physicians would want prior to surgery.

Having abscesses or fistulas in the perianal area is also a risk factor for having complications in that area after surgery. Poor nutrition or vitamin deficiencies, being a smoker, and having obesity can also contribute to having wounds heal poorly after surgery. In the majority of cases a nonhealing wound is treated conservatively with wound care techniques but in a minority of cases, another surgery might be needed.

Sexual function: Concerns about sexual function are also common with this type of surgery. Fortunately, erectile dysfunction in men after proctectomy is low, and estimated to be at between two and four percent. Even better news is that one long-term follow-up study showed that 90 percent of people who had proctectomy surgery are satisfied with their sexual health.

Some patients do report that sexual function is worse, and the rate is estimated to be between 25 and 30 percent. Patients who find that sexual function is not what they would like it to be will want to address this topic with the surgeon and/or a gastroenterologist. Help is available for the issues related to sexual health and the most vital piece to getting the concerns addressed is in bringing it to the attention of your healthcare team.

Medications: Some patients may be concerned about how the current medications they’re taking can affect recovery. One study showed that people with Crohn’s disease who are receiving biologic therapy don’t have any higher risk of having problems with wound healing than those that aren’t taking a biologic therapy at the time. A Word From Verywell

Talking about the surgery with a colorectal surgeon and a gastroenterologist often helps in putting many risk factors in perspective. The good news is that majority of people with IBD who have proctectomy surgery heal up well and go on to feel better and to enjoy their lives more.

Kunitake H, Hodin R, Shellito PC, et al. " Perioperative treatment with infliximab in patients with Crohn’s disease and ulcerative colitis is not associated with an increased rate of postoperative complications." J Gastrointest Surg. 2008 Oct; 12(10):1730-6; discussion 1736-7.