Colorectal (bowel) cancer – Part 3

What will happen to me before and when I come into hospital for my operation (laparoscopic surgery) Enhanced Recovery Programme.

What is the Enhanced Recovery Programme?

The Enhanced Recovery Programme is a new way of preparing you for your operation with a quicker recovery period afterwards. For it to work, you have to be willing to follow each step of the detailed programme which has you eating, drinking and walking much earlier than usual.

If you agree to take part in this programme it is very important you understand that you must comply (follow) with every step. Your family and friends will also need to understand the programme so they can support and help you.

What will happen at my pre-assessment clinic appointment?

You will be seen by a pre-assessment nurse and / or doctor. The aim of pre-assessment is to check your general health and carry out simple tests to make sure you are fit to have your operation. It is important you tell us about any problems you may have with your health, for example, high blood pressure or angina.

You will be asked a lot of questions about your health and have some tests, for example blood samples may be taken or an electrocardiogram – ECG (heart tracing) may be done. You may have to go to other departments in the hospital for certain tests.

You will be told how long you can expect to be in hospital and stay off work.

What if I need help to get to my appointment because of my health?

Due to your medical condition or mobility problems, if you feel you need transport, you will need to contact the appropriate number below:

• GP surgery within the Tees area:

Patient Transport Information Services
Telephone: 0191 2648870
Monday – Friday, 9.00am – 5.00pm

• GP surgery within the East Durham area:

Travel Response Centre
Telephone: 03000 269 999
Monday – Friday, 8.30am – 5.00pm

You will be asked a number of questions to see if you are eligible to have transport provided for you. You will need to apply at least 2 – 3 weeks before your admission date to arrange transport.

There is also a Volunteer Driver Scheme, bookable through the Social Resource Centre in Ferryhill. You can contact the centre on 01740 658880. There is a charge for this service which will depend on the length of your journey.

More detailed leaflets about these services are available at your GP surgery or hospital.

If you are registered with a GP outside the Tees or East Durham areas, you will need to contact your GP to arrange transport.

If transport is arranged for you and your admission date or time changes or you no longer need it, please let the service know as soon as possible.

What will happen when I come into hospital?

You may need to come into the hospital the day before your operation or on the day of your surgery.

If you come in the day before your operation, you will go on the ward where one of the nurses who will care for you will welcome you to the ward and show you to your bed. He or she will check your details, taken at the pre-assessment clinic, to make sure nothing has changed.

If you come in on the day of your operation, you will go to the Access Lounge and one of the nurses who will care for you will come to the ward and show you to your bed. He or she will check your details (taken at the pre-assessment clinic) to make sure nothing has changed.

You will also be seen by one of your doctors who will check you understand your planned operation and answer any questions you may have. When you fully understand the operation you are about to have, you will be asked to sign a consent form, if this has not already been done.

Your anaesthetist will visit you to discuss which type of anaesthetic is best for you and answer any questions you may have. You will normally have a general anaesthetic. You will have been given a leaflet (‘You and your anaesthetic’) explaining about anaesthetics in more detail.

You will be told the time of your operation and when to stop eating and drinking.

Please tell a nurse if you have difficulty sleeping as you can be given medication to help.

How long will I need to stay in hospital after my operation?

The length of your stay will depend on what type of operation you have had and how quickly you recover. You should expect to be in hospital for at least 3 – 7 days.

Your specialist nurse and one of your doctors will see you regularly to keep you informed of your progress, answer any questions you may have and let you know when you will be well enough to go home.

What are the visiting times?

University Hospital of North Tees

7 days a week, 2.00pm – 4.00pm
7 days a week, 6.30pm – 8.00pm

If these visiting times are not suitable, please discuss this with the nurse in charge of your ward, who will try to offer other times.

If your family or friends would like to make enquiries about your progress while you are in hospital, it would help if you could ask only one member of your family or a friend to contact the ward after 11.00am. They can then pass the information to the rest of your family and friends.

Most beds in our hospitals have a bedside unit called Hospedia, which has a telephone you can use to keep in touch with your relatives, carers and friends. Hospedia also has a television, radio and internet.

If at any time you wish to discuss your care and treatment with a doctor, please ask one of your nurses, who will arrange this. Relatives will need your agreement before staff are able to discuss your case in detail with them.

What will happen to prepare me for my operation?

On the day before your operation you:

• can eat and drink normally

• will be asked to drink 4 special drinks which are high in carbohydrates the night before your operation. These drinks are a lemon flavoured energy drink. It is important that you have these drinks as they will help your recovery after your operation.

If your bowel needs to be prepared before your operation you will be told what to expect during your outpatient appointment.

After you are admitted to hospital you will be:

• measured and fitted with a pair of special elastic stockings to help reduce the risk of a DVT. These should be worn at all times unless you are told otherwise. Your nurse will help you to put on the stockings, if needed.

• given an injection of Heparin into your abdomen or arm either before or after your operation. This helps reduce the risk of DVT or PE by thinning your blood. (See risks and possible complications in Part 2 of this booklet.)

This injection will be given to you every day while you are in hospital. This will continue for up to 4 weeks at home. You or a family member can learn how to do this or you can attend your practice nurse at your GP surgery.

On the day of your operation:

You will be asked to drink another 2 special lemon flavoured, high carbohydrate drinks before 6.00am. About 2 hours before your operation, you may be given an enema (fluid passed into your rectum) to make sure the lower end of your bowel is empty.

Before your operation you will be asked to remove any nail varnish, make-up and jewellery, including body piercings.

Wedding rings can be left on but will be covered with tape. Your nurse will ask you to have a shower to make sure your skin is clean and reduce the risk of infection. Body lotions, deodorants or perfumes should not be used. You will be asked to put on a theatre gown.

If you wear glasses, contact lenses, false teeth or hearing aids, you will be asked to remove these after you arrive in the operating department (theatre).

Why am I asked not to eat or drink before my operation?

You must not eat anything for 6 – 8 hours and must not drink anything for 2 hours before your operation. This is very important. You must follow the instructions. Nothing means nothing at all, including water, sweets and chewing gum. Eating sweets or chewing gum increases the amount of fluid in your stomach.

If you forget and do eat or drink, you must tell your doctor or nurse, as your operation may need to be postponed for your safety. This is because when you are unconscious, if your stomach contains food or fluid you may be sick and it could get into your lungs, affect your breathing and cause an infection.

Getting ready to go to theatre

Just before the time of your operation, you will be taken to the operating department. A nurse will go with you and transfer your care to a theatre nurse. If you have any worries or concerns tell the staff; they are there to help and support you.

A theatre nurse will check your details again before taking you into the anaesthetic room where you will meet your anaesthetist again. Your details will be checked for a final time then your anaesthetist will give you your anaesthetic before you are taken into the operating theatre and will stay with you during your operation.

Before and during your operation:

• A fine needle will be used to insert a cannula (thin plastic tube) into a vein in the back of your hand or arm so your anaesthetist can inject the anaesthetic drugs. Sometimes, when the drugs are injected they may feel cold and sting a little bit.

• An intravenous drip (fluids into your vein) will be attached to your cannula during your operation.

• You may be asked to breathe oxygen through a face mask, before you are given your anaesthetic.

• Your blood pressure will be monitored (checked) throughout your operation.

• Your pulse will be taken and recorded.

• The amount of oxygen in your blood will be measured by attaching a special clip on to your finger. This does not hurt.

• Your heart rate will be monitored by placing sticky pads on your chest. These are attached to some leads to show a tracing of your heart on a monitor. This is called an ECG.

• You may be given Patient Controlled Analgesia (PCA – painkilling drugs through a catheter (fine tube) which is inserted into your vein). (See leaflet, ‘Pain relief after surgery’.)

• You will be given your general anaesthetic.

This is routine and is nothing to worry about.

What will happen during my operation?

You will usually be given a general anaesthetic (a state of carefully controlled and supervised unconsciousness (deep sleep) that means you are unable to feel any pain).

After you are anaesthetised, your surgeon will make at least 3 – 4 small incisions (cuts) about 1 – 3cm (½ – 1 inch) long in your abdomen. A laparoscope (a special thin tube) is then passed into your abdomen.

The laparoscope has a bright light and camera at the end which passes pictures to a monitor which allows your surgeon to see your bowel and other organs inside your abdomen.

Air will be pumped into your abdomen to allow your surgeon to get a better view. He or she will then carry out your operation using special instruments passed down the laparoscope and through the other small incisions.

One of the small incisions may need to be a little larger, about 5 – 8cm (2 – 3 inches) to allow your surgeon to remove part of your bowel. If needed, your surgeon will form a stoma during your operation; this will have been discussed with you before your operation.

The air is then removed from your abdomen and your surgeon will close the incisions, usually using sutures (stitches) that dissolve over time. He or she may also use clips that will need to be removed. Your surgeon will tell you how long your operation may take to complete. This can vary between 1½ – 4 hours.

If your surgeon is unable to complete your operation using a laparoscope, he or she may need to convert to an open operation through a much larger incision.

What will happen after my operation?

After your operation, you will be taken to the recovery room of the operating department. Specially trained staff will look after you until you are ready to return to your ward. Most people do not remember waking up in the recovery room or returning to their ward.

The nurses in the operating department will transfer your care back to your ward nurses. One of your nurses will collect you from the operating department and you will be taken back to your ward on a trolley.

How will I feel after my operation?

You will be made comfortable on your bed. Apart from nurses checking your pulse, blood pressure, pain level and wound regularly, you will be allowed to rest.

You will be quite drowsy when you first wake up. Sleep is good for your recovery, so get as much as you can.

The PCA should control your pain and you can press the button on the PCA to get more pain relief as you feel you need it. If you still have any pain, tell your nurse who then will arrange for you to have extra painkillers.

You may continue to have oxygen through a face mask or nasal (nose) tube for as long as needed to keep the oxygen in your body at the right level.

If at any time you feel sick, please let one of your nurses know and you will be given medication to relieve it.

After your operation you must not get out of bed until your nurse says you can. You will be given your ‘nurse call’ buzzer to use should you need anything.

As you become more alert, you will notice several tubes in your body. These will include:

• An intravenous drip (intravenous infusion): Special fluids will be given to you through your intravenous drip to replace your body fluids until you are able to eat and drink again. The drip will usually be removed the day after your operation or as soon as you are drinking enough fluids.

• A naso-gastric tube: While you are under the anaesthetic, you may have a tube which will be gently passed up your nose and down into your stomach. This helps to drain off your digestive juices from your stomach. If they were to build up they would make you feel sick and you may vomit. The tube is usually removed after your operation.

• A catheter: While you are in theatre, a catheter (narrow flexible tube) is inserted into your bladder to drain your urine into a collection bag. This means you will not have to go to the toilet to pass urine straight after your operation, making you more comfortable and it lets your doctors and nurses know how much urine you pass.

The catheter is usually removed 1 – 2 days after your operation. Sometimes patients have problems passing urine on their own at first. A new catheter may be put in until the problem settles.

• A drain: While you are in theatre a drain may be put through your skin into your operation site. This is to drain away any excess fluid or blood which may have collected during your operation. This is removed once it is safe to do so.

Will I be in pain after my operation?

After any operation, some discomfort, soreness or pain is to be expected, so good pain relief is important.

It helps you feel better and makes it easier for you to move around, take deep breaths and cough. This reduces the risk of any complications that could occur after your operation, such as chest infection or a DVT, possibly leading to a PE.

Before your operation, you will have been given a leaflet (Pain relief in hospital) which explains the types of pain relief available in our hospitals. Your anaesthetist and nurse will discuss with you the type of pain relief they think will suit you best.

You will also be given a more detailed leaflet about the pain control you will receive. To make sure your pain is well controlled, your nurses will check your pain regularly by using a pain score. You will be asked to describe your pain level each time by using the following scale:

Pain score

0 = No pain, 1 – 3 = Mild, 4 – 6 = Moderate, 7 – 9 = severe,

10 = worst possible.

With the help of painkilling medication, we would expect your pain level to be controlled between 0 (none) and 6 (moderate). You must tell your doctor or nurse if the painkillers are not controlling your pain, as other types of painkillers can be given.

When can I start eating and drinking again?

A few hours after your operation, you can have drinks and, if you wish, food. It is important that you eat and drink early after your operation and we will encourage you to have normal food and drinks, and if prescribed by your doctor, more of the special drinks mentioned earlier.

Wound care

Your wound will be kept covered with dressings to prevent infection and only changed when needed. Your dressings are covered with protective film so you can shower or bathe as normal.

You will have either sutures (stitches) or clips to close your wound. These will be removed about 10 – 12 days after your operation. Some sutures dissolve over time and do not need to be removed; you will be told what type of sutures you have. A district nurse may be arranged to take them out or you may be asked to come to the Colorectal Unit to have them removed.

How can I help myself to recover in the early days after my operation?

You will be expected to:

• Start your deep breathing and leg exercises. You will be given a leaflet at pre-assessment explaining how to do these exercises.

• Spend 2 hours out of bed about 6 hours after your operation. Your nurses will help you to get out of bed.

• Spend at least 8 hours out of bed every day while you are in hospital.

• Walk about 60 metres (65 yards) 4 – 6 times every day, starting from the day after your operation. By being out of bed in a more upright position and by walking regularly, your lungs will work better and help to reduce the risk of developing a chest infection.

Exercise increases the amount of oxygen carried around your body which helps the healing process.

• Wear your day clothes, the day after your operation, as this can help you feel more positive about your recovery.

• Drink special high protein drinks each day after your operation, if prescribed by your doctor.

Please remember to tell us about everything you eat and drink and when you open your bowels and pass urine. You will be encouraged to write some of this information on the charts yourself and complete your patient diary.

Many different things will be checked during your recovery.

These include:

• Your fluid intake. (The amount of fluids you receive, for example, through your intravenous drip and fluids you drink).

• The amount and type of food you eat.

• Your fluid output. (The amount of urine you pass).

• Your bowel movements (poos)

• The level of pain you are feeling

• The number of walks and how far you walk each day

• How long you spend out of bed each day.

What will happen when I am discharged from hospital?

Plans for your discharge from hospital will be discussed with you before any decisions are made. See leaflet ‘Planning your Discharge from Hospital’.

When you are ready to go home, you will be given a copy of your discharge plan which gives details of any arrangements made for you, for example, if you need to see your GP’s practice or district nurse to have stitches removed or dressings changed.

A copy will also be sent to your GP. Any medications you need to take will be explained to you.

Please ask your nurse if you need a ‘Fit’ note.

You must continue with the Enhanced Recovery Programme and all information will be provided to assist you.

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]