Preparing for Bowel Surgery

Preparing for bowel surgery includes principles from our Enhanced Recovery After Surgery (ERAS) program. This is a package of protocols used to help achieve the best outcomes after bowel surgery. This package includes:

  • Special instructions for eating and drinking prior to surgery

  • A bowel preparation and antibiotics prior to undergoing bowel surgery

  • A bundle of pain control and anti-nausea medications after surgery

  • A regimen of activity after surgery to get you up and moving and speed your recovery after surgery

  • A number of special dietary and nutritional measures to stimulate your bowels so that they regain their function quickly after surgery

Whenever appropriate, we try to use minimally invasive approaches to bowel surgery. This is also called laparoscopic surgery. This technique employs a number of small incisions using long, thin instruments to manipulate and free structures inside the abdomen and complete your surgery.

Why Laparoscopic (Minimally Invasive) Surgery?

Laparoscopic surgery, when safe and possible, results in less pain, lower infection rates, less slowing of the bowels, and less complications than traditional open surgery with a large incision. While laparoscopic surgery is not always safe or possible because of scarring from previous surgery, infection, or other technical factors, we try to use a laparoscopic (minimally invasive) approach whenever possible.

Eating and Drinking Prior to Surgery, Bowel Preparation, and Antibiotics

In the days leading up to your bowel surgery you will be asked to change your diet, complete a bowel preparation (bowel cleanse), and to pick up some specialized antibiotics from the pharmacy. The bowel is packed full of bacteria and bowel surgery has higher rates of infection when compared to other kinds of surgery that do not require us to cut into or open areas that do not contain bacteria (for example hernia surgery).

To help decrease infection rates around the time of your bowel surgery, you will be asked to complete a bowel cleanse and take antibiotics by mouth. This helps to decrease the amount of bacteria in your bowel at the time of surgery, and studies have shown this helps to decrease infection rates after surgery.

BLOOD THINNERS & SURGERY

You must alert your surgeon during your consultation if you are taking blood thinners. There are a number of reasons why your physician might have prescribed a blood thinner including heart disease or stroke, stents in blood vessels in the heart or elsewhere in the body, a history of blood clots, or a blood clotting disorder.

Blood thinners typically need to be stopped a few days prior to surgery and this will be coordinated by your surgeon who will involve any other specialists whose advice is required.

Blood thinners most commonly come in pill form and include medications like:

  • Warfarin (Coumadin)

  • Clopidogrel (Plavix)

  • Ticagrelor (Brillinta)

  • Apixaban (Eliquis)

  • Rivaroxaban (Xarelto)

  • Dabigatran (Pradaxa)

  • Edoxaban (Lixiana)

Be sure to alert your surgeon if you are currently taking any blood thinners.

Pain Control After Bowel Surgery

Pain control after bowel surgery can be more challenging than pain control after other kinds of surgery. This is because you may be unable to eat regularly at first, your bowels may not be moving food and fluids along the GI tract regularly, and you may experience nausea or vomiting. In some cases, pills alone might not be enough to control your pain.

A combination of regular anti nausea medications and intravenous (IV) and oral medications (pills) are used for pain control after bowel surgery.

The goal of pain control after bowel surgery is not to bring your pain level to zero, but to keep your pain at a manageable level that allows you to participate actively in your recovery. Important activities after surgery include:

  • deep breathing and coughing to clear any mucous or phlegm from the airways

  • incentive spirometry (a lung capacity meter that measures how large of a breath you can take in and how well you are expanding your lungs after surgery)

  • sitting up in a chair instead of laying in bed

  • going for at least 3 walks per day

During surgery it is typical practice to inject freezing (local anesthetic) to interrupt the pain signals to the nerves in the abdominal wall, however this freezing typically wears off after 12-24 hours.