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MBChB PhD FRCS

FAQs

Consultant Laparoscopic Colorectal and General Surgeon

Laparoscopic colorectal surgery

Colorectal surgery enhanced recovery programmes

Getting mobile as part of a colorectal surgery enhanced recovery programmeMajor centres for colorectal surgery have been using colorectal surgery enhanced recovery programmes (ERAS), also called fast-track surgery, for several years now. The first was developed by Henrik Kehlet, a Danish surgeon in 1997. These programmes aim to improve and optimise many steps in the treatment, surgery and rehabilitation and to maximise patient recovery at every stage.

Colorectal surgery enhanced recovery programmes start before surgery

Preparation is important with both physical and mental preparation. It is crucial that you and your family get good information about the enhanced recovery programme that you will follow after surgery. It is best to go through this carefully and ask questions so that you know what to expect.

Increasingly, ERAS specialist nurses will provide pre-surgery educational programmes to prepare patients. Emphasis is placed on early mobilisation and nutrition, with more of the recovery happening in the comfort of your own home, away from the risk of hospital-acquired infections.

You will also have all the usual pre-operative checks for blood pressure, lung and heart function, and routine blood tests.

Patients benefit from a shorter hospital stay

“When we use colorectal surgery enhanced recovery programmes, most patients will only need to stay in hospital for five to seven nights, even for major colorectal surgery. This may be a little longer for patients who need open colorectal surgery or stomas.”

Mr Jonathan Wilson supports and encourages the use of colorectal surgery enhanced recovery programmes with his NHS and private patients.

Getting mobile

Experience and clinical studies have shown that people having colorectal surgery who become mobile again within the first 24 hours, and start to eat and drink as soon as possible, recover faster. This is the case for both open surgery and laparoscopic bowel surgery. Gone are the days when patients were traditionally on ‘bed rest’ for weeks, and only allowed to start drinking and eating when there were signs of bowel function returning (up to one week after surgery).

On the day of surgery

You will be told to fast from the midnight before surgery. Some people will need a bowel preparation (strong oral laxatives) to clear out the colon, but this is not always necessary nowadays. Some centres offer a drink rich in carbohydrates to take just before surgery as this speeds recovery.

Unless your operation is very late in the day, you will be encouraged to get out of bed and walk around a little on the same day that you have surgery.

The first days of recovery

Eating and drinking

As soon as you are able to eat and drink, you should. You will be offered effective pain relief and anti-nausea medication as needed. Strong pain relief is generally used only in the first two days, but then your pain is monitored regularly as you move on to oral painkillers. Eating little and often can help, as can drinking high protein, high calorie drinks.

The next day, you will be encouraged to walk more and be out of bed for a few hours. This helps get your bowels moving again, and it reduces the risk of blood clots in your legs. Unless you are attached to lots of equipment (e.g. an epidural or urinary catheter) you will also be encouraged to dress in your ordinary clothes, rather than a gown or night clothes. This helps you to feel as if you are getting better and that you are progressing towards going home. Psychology is crucial in the post-operative period.

Stoma care

If you have to have an ileostomy or colostomy (stoma) as part of your surgery, where the small bowel or colon is brought out on to the skin’s surface and the bowel waste (stool) empties into a bag attached to your abdomen, your hospital will usually have a dedicated stoma nurse to train you in how to take care of your stoma and provide psychological support.

Your training for an ERAS educational programme begins before surgery and continues on the ward afterwards. The specialist nurse will also be available for advice after you are discharged. Some stomas are only temporary, but some may be permanent and it is important to learn how to accept it as part of your everyday routine.

Going home

You will need someone to collect you and then look after you when you get home, but you should continue your programme of mobility and regular eating. You will be given various liaison numbers to call in case of problems, so that you can ring for advice and support.