Full Thickness Laparo-Endoscopic Excision of Colonic Polyps

What is the reason for this procedure?  

It has been highlighted that you have a colonic lesion that cannot be removed by colonoscopy. It has been recommended you have this lesion removed by a procedure called Laparo-Endoscopic Full Thickness Resection.  

Full Thickness Laparo-Endoscopic Excision is a technique for polyps that were unable to be removed within the endoscopy department and requires a combination of colonoscopy and a laparoscopy procedure.

This Full Thickness Laparo-Endoscopic Excision of the colon combines the use of a telescope (colonoscope) in the colon and a keyhole operation (laparoscopy).  Full Thickness refers to how much of the lining of the bowel is removed. In other procedures only the superficial layers (mucosa and submucosa) might be removed, while endoscopic full thickness resection procedure aims to remove deeper tissues to ensure complete lesion/tumour removal.

Preparing for endoscopic full thickness resection  

You will get information and medications to take following the guidelines of colonoscopy. It is important your bowel is empty and clean for this procedure. YOU MUST follow the instructions given in the leaflet of how to prepare for a colonoscopy.  

This procedure will be carried out by an endoscopist (this is a trained doctor or nurse who is trained to do endoscopies), which allows us to see inside the large intestine (colon). This is the most accurate way of looking inside your bowel.  

A colonoscope (a soft flexible tube about the thickness of the finger) is passed into your rectum and guided through the large intestine. This tube has a bright light and a camera at the end of it that passes back a picture of the inside of the bowel onto a monitor. The endoscopist is then able to detect where the lesion/tumour is located.  

The polyp (an abnormal clump of cells that grow inside the body) is then detected and removed. If the polyp is unable to be removed safely then a small part of the bowel where the polyp is located may be removed.  This is called a bowel resection. The bowel will either be joined back together again or a stoma (an opening in the body leading to the bowel or small intestine) will be created. This will be explained to you before surgery.

You might have markings made on your abdomen before surgery just in case a stoma is required so we can locate the correct site for this.  

Are there any risks or possible complications?  

These risks are applicable to any minor or major surgery: 

• Bleeding – Bleeding from the operation site can happen for up to 1 week.  If this bleeding continues and shows no signs of stopping you may need another operation to stop the bleeding.

• Perforation (hole) – The risk of perforation is higher with polyp removal. Sometimes an operation is required to repair this. A small section of the bowel might require to be removed. In some cases a stoma (opening where the end of the bowel is brought out on to the skin of your abdomen. This may be needed to allow your bowel to rest and heal).

• Risks associated with general anaesthetic – Your  anaesthetist (a doctor with special training in anaesthetics) will discuss this with you

• Deep Vein Thrombosis – DVT (blood clots in the leg veins) or Pulmonary Embolism – PE (blood clots in the lungs) Sometimes a clot forms in the deep veins of the leg after an operation. This can cause the leg to swell and become painful. If the blood clot in the vein becomes dislodged (moves) it can travel to the lung and cause a PE. A DVT or PE can be due to the effects of the surgery or reduced activity during your recovery. 
  
  All adult patients will have their risk of developing a blood clot assessed within 12 hours of admission. Patients who are being admitted for planned surgery may have their risk assessed at a pre-assessment visit.
  
  The nurse or doctor who carries out the risk assessment will discuss your risk factors with you and advice on treatment to reduce your risk. 
  
• Infection – Signs of an infection include generally feeling unwell, with a temperature or a very smelly discharge from your rectum that is not faecal. This can be treated with a course of antibiotics and you may need a longer stay in hospital.   

• Pain – You may experience pain following your operation in which case you will be given pain relief to take on discharge. Local anaesthetic may be given at the time of the operation to help for the first few hours following your operation. 

• Recurrence (happening again) – If this happens you may need further treatment or another operation.
  
• Wound healing – this may be a prolonged process and take time to heal.

• Anastomotic leak – this is where two parts of the bowel that have been joined have opened, causing a leak.  

Pre-assessment clinic  

What will happen at the pre-assessment clinic?  

Unless you have already attended after your outpatient appointment, you will be invited to attend the pre-assessment clinic around 2 weeks before your operation.

You will be asked about your general health. Your blood pressure, pulse and weight will be checked. Please remember to bring a fresh sample of your urine with you and all tablets, medicines, inhalers and creams that you are using.

Your nurse will tell you if you need to stop taking any of these before your operation. Samples of your blood will be taken and you may be sent for an X-ray and ECG (heart tracing).

Acute symptoms 

Antibiotics may be given if you show signs of an infection before surgery. Antibiotics treat a wide range of bacteria and help to give relief from infection and discomfort. Painkillers and inflammatory medications can be taken to help reduce pain.  

What do I need to do before the operation?  

Routine blood tests may have been done in pre-assessment, but if not they will be done before your operation. 

You will be given some anti-embolism stockings ‘TED stockings’ to wear before, during and after the operation, this is to help prevent blood clots forming in your legs. Patients often wear flowtron boots which are applied on the lower legs in surgery to help stimulate the flow of blood through the deep veins. These will be removed when you are awake and you can mobilise again safely. 

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

Your Nurse will tell you when you must stop eating or drinking before your procedure. This is very important.

If your stomach contains food or drink during your operation, this can get into your lungs, affect your breathing and cause an infection.

You must follow the instructions, but if you do forget you must tell your doctor or Nurse, as your procedure may need to be postponed for your safety.  

What will happen during my operation?  

Your theatre nurse will check your details again before taking you into the anaesthetic room.

In the anaesthetic room you will meet your anaesthetist again; a cannula (fine needle) will be placed in the back of your hand or arm so we can inject medications.  Sometimes, when medicines are injected they may feel cold and sting a little. 

An intravenous drip may be attached to your cannula. Your blood pressure will be measured.  Your pulse will be taken, and the amount of oxygen in your blood will be measured by attaching a special clip to your finger.

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 routine and nothing to worry about. 

The operation will be carried out under a general anaesthetic (a state of carefully controlled and supervised unconsciousness that means you are unable to feel any pain) or spinal anaesthetic (which may mean you are awake or asleep). Your anaesthetist will explain this in more detail before the surgery.

What will happen after the operation?  

You will be taken to the recovery room. Specially trained nursing staff will look after you until you are ready to return to your ward. 

If at any time you are in pain or feel sick, please let one of your nurses know and they will give you medication to help relieve it.  You will have an intravenous drip in your hand or arm through which you will receive fluids to prevent you from dehydrating until you are able to eat and drink normally again.

What to expect after the operation  

You may experience some discomfort following this procedure when the local anaesthetic wears off depending on the outcome of the operation. Analgesia and laxatives will be prescribed to take home. 

 For the next few weeks, to try and help with the healing process of the wound sites, avoid putting pressure on your wound, please follow these instructions; 

• No strenuous activity.   
• No lifting items over 11lbs (5kg) such as children or heavy bags of shopping.   
• Keep the area clean and dry.   
• Do not apply any creams or ointments, unless they have been prescribed by your surgeon. 

How long will I be in hospital?  

Every patient is different and recovers at different speeds. This can normally be done as a day case procedure if the polyp has been removed.  However, if a bowel resection has been carried out then you may be in hospital between 3 to 7 days.  If you have any medical conditions that need to be monitored post operatively then you may be asked to stay in hospital for 24 hours for observation.  

It is important to try and be mobile as soon as you feel safe to do so and hygiene is important to try and prevent any infection. You are able to take a shower the day after the procedure. 

Will I have any sutures (stitches) to be removed?

You will be given advice after the operation and instructions to follow if you require any sutures to be removed. 

How long will I need to be off work?  

This may depend upon the type of work you do. You should ask your Doctor or GP for advice.Your consultant will send a discharge letter to help advise your GP.

If you are taking any medication that makes you drowsy, you must not drive or operate machinery.  

You should try to avoid any lifting that may require straining. Most patients require 2 weeks off work, however every patient is different. You should only do what you feel able to do and give your body time to heal. 

If you require a ‘Fit note’ for work please let a member of staff know before you are discharged from hospital. 

What should I look out for at home?

When you go home, if you notice any of the following or are worried about the wound: 

Signs of: 

• Infection
• Redness
• Swelling
• Pain
• Heat
• High Temperature
• Bleeding from the wound site
• Pus or an unpleasant smell coming from the wound site.

You must contact the Surgical Decisions Unit if any of these symptoms occur in 7 days after discharge. After 7 days contact your GP.  

How can I help myself?  

You will probably be more comfortable wearing loose fitting cotton underwear. 

Avoid constipation or straining on the toilet. 

You should increase the amount of fibre in your diet gradually as a sudden increase can cause abdominal discomfort and wind. Below are a few examples of the foods you could introduce into your diet. 

• Wholemeal bread, pasta and rice 
• Beans
• Lentils 
• Vegetables and fruit 
• Nuts 
• Seeds 
• High fibre cereals 

When can I drive again?  

You can drive 2 weeks after the operation, however, if you do not feel ready to drive then wait until it is safe to carry out an emergency stop.  

You should check with your insurance company as policies may vary with individual companies. 

When can I play sport again?  

You should not go swimming until the area has healed and only do light sport activities. This will help in the healing process. 

Will I have a follow up appointment?   

You will have a follow up appointment after the operation to check the wound and healing process. This will be discussed on discharge as to when you are to attend as this will change from each patient depending on the extent of the surgery. If you haven’t received an appointment please call the outpatient department or the ward which you were discharged from, they will be able to check this for you.

Outpatient Department: 01642 383838

Contact numbers   

If you have any worries or concerns during the first 24 hours following your discharge from hospital, please phone the ward to which you were admitted.  

After 24 hours; please seek advice from your GP.  

North Tees and Hartlepool NHS Foundation Trust

North Tees Hospital

Ward 28  

Telephone: 01642 382828  

24 hours a day, 7 days a week  

Ward 31  

Telephone: 01642 382831  

24 hours a day, 7 days a week  

Day Case Unit  

Telephone: 01642 624168  

Monday to Friday 8am to 5pm  

Specialist Colorectal Nurses  

Telephone: 01642 624399  

Monday to Friday 9am to 4.30pm  

Hartlepool Hospital

Ward 9  

Telephone: 01429 382809  

24 hours, 7 days a week  

Day Case Unit  

Telephone: 01429 522949  

Monday to Friday 8am to 5pm  

Non-urgent messages can be left on the answering machine  

For Urgent advice within 1 week of discharge, please contact:  

Surgical Decision Unit 

24 hours a day, 7 days a week 

01642 617617 – ask switchboard to contact the SDU coordinator on extension 46430 or via Vocera. 

NHS 111 offers medical help and advice from fully trained advisors supported by experienced nurses and paramedics. Available over the phone 24 hours a day contact 111. 

NHS Choices provides online information and guidance on all aspects of health and health care, to help you make choices about your health. W: The NHS website – NHS (www.nhs.uk)

(This patient leaflet is attributed to St. Marks Hospital for Colorectal Diseases.)

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