What You Need to Know Before Getting Colorectal Surgery

Dr. Jeffery Snow, M.D. has been a senior partner at Surgery Specialists of South Broward for 17 years and was named one of America’s top surgeons three years in a row. His compassionate approach to care involves educating patients and walking them through every step of the process to ensure a comfortable and successful procedure. This article reviews what patients should understand before undergoing colorectal surgery.

Getting colorectal surgery can be intimidating, but the more you know, the more you’ll be prepared. Understanding the pre-op process is essential, both for your health and for your peace of mind. In this article, we’ll review the main pre-operative rules and considerations for colorectal surgeries so you can be fully prepared for your procedure.

Pre-Surgical Consultations and Preliminary Testing

If you have been diagnosed with a colorectal issue that requires (or may require) surgery, the first step is to get pre-surgery consultation. This usually is scheduled between six weeks to a month prior to the planned procedure. The purpose of the appointment is to ensure that you fully understand:

• The proposed surgery
• Why it is needed
• The pros and cons of the specific procedure
• How the surgery is performed
• Presurgical preparations and medications

In addition to explaining the details of the proposed operation, your doctor will require you to undergo a variety of tests, which may include:

• X-rays
• An electrocardiogram (EKG)
• An ultrasound
• Urine and blood testing

Understanding all of this information is important, as you may want to take the time before the planned surgery to weigh the benefits and risks of the procedure. You may also want to get a second or third opinion on the surgery, as well as attempting to determine whether there may be any non-surgical or less invasive alternatives to the planned operation.

At this point, it may be a good idea to identify a health care proxy, which is usually a
spouse, partner, family member, or close friend who can make medical decisions for you if you cannot communicate with your healthcare provider post-surgery. Make sure to bring all proxy documents to the hospital or surgery center before your procedure.

Pre-Op Medication Considerations for Colorectal Surgery

There are a variety of medications and supplements which could cause serious issues during your procedure. Your doctor will typically advise you about medication restrictions during your pre-operative consultation. However, if they do not, you should make sure to check with both your surgeon and the prescribing doctor at the latest 14 days prior to your procedure.

Medication restrictions can vary widely between patients and types of procedures, but in general, medication restrictions are advised as followed:

Avoid 1 Week Before Surgery

Medications to Avoid:

• Gout Medications (Colchicine, Indomethacin)
• Aspirin and Ibuprofen (Advil, Motrin)
• NSAIDS (Relafen, Aleve)

Supplements to Avoid:

• Chondroitin
• Glucosamine
• Herbal supplements including:
  • St. John’s Wort
  • Vitamin E
  • Garlic
  • Ginseng
  • Black Cohosh

Avoid Five Days Before Surgery

• Plavix (may need to be stopped earlier upon market recommendation)
• Coumadin (speak to a doctor prior to stopping this medication)

Avoid Two Days Before Surgery

• Metformin/Glucophage (must speak to your diabetes doctor before stopping insulin and other diabetes medications)
• Alcohol

Avoid Day of Surgery

• Aldactone, Hydrocholrothiazide
• Diuretics/water pills (Lasix/ furosemide,
• Spironolactone
• Diovan HCT

Take Day of Surgery

• Heart medications
• Blood pressure medications
• A sip of water to accompany your medication

Pre-Op Diet Considerations for Colorectal Surgery

1. Remember, no alcoholic beverages two days before surgery
2. Begin a diet of clear liquids 6:00 on the day prior to surgery
3. Begin dry fasting (no foods or liquids) 10:00 PM on the night prior to your procedure (except for approved/required medications; take these with a small sip of water)

A clear liquid diet can consist of the following:

Beverages

• Water
• Gatorade
• Coffee and tea/ (no creamers permitted)
• Fruit juice (strained without pulp)
• Sodas/Kool-AID

Soups

• Beef broth/bouillon-based soup
• Chicken soup
• Vegetable soup

Desserts

• Jello (no toppings allowed)
• Popsicles
• Hard candies

Avoid ice cream, sherbert, custard, and other similar deserts. Make sure to avoid any foods colored red or purple.

Bowel Preparation for Colorectal Surgery

In addition to following each of the restrictions above, you will need to fully clean and clear out your bowels prior to surgery. This is typically done via drinking a solution referred to as a colon lavage. This can be prescribed by your doctor, and generally comes in the form of power that must be mixed with water before taking it.

1. Mix your colon lavage solution: Stop drinking fluids entirely for one to two hours, then follow the instructions precisely, or your colon lavage may not fully clean out your bowels. This can cause serious issues during surgery. Some people like to add lemon juice to the lavage or suck on hard candy for taste, as the solution can be difficult to stomach.
2. Start drinking your colon lavage at the correct time: People should generally being drinking the lavage between 10:00 AM. and 1:00 PM the day before your surgery. You should avoid drinking the lavage after 1:00 PM unless you have special instructions from your doctor.
3. Expect bowel movements: You might experience stomach pain, including cramps, as well as chills. Don’t worry, as these are a common side effect of the lavage. Bowel movements should start with thirty minutes to one hour.
4. Skipping cups: You may find that the lavage is too much to handle on your stomach. If you feel too ill, it’s okay to skip a cup, and take a short break, as long as you eventually drink all of the prescribed lavage in the allotted time frame.

What to Do The Day of Your Colorectal Procedure

On the day of your colorectal surgery, remember to:

• Avoid eating or drinking after 10 PM
• Avoid all alcohol two days prior to your procedure
• Avoid tight or uncomfortable clothing (dress for comfort)
• Take off any makeup and nail polish
• Take off all jewelry and body accessories
• Take off your contact lenses (bring a case for glasses)
• Take off dentures
• Brush teeth without swallowing water
• Bring a list of allergies and current medications

If you still have stool in your bowels, you will need to use a Fleet Phosphosoda enema between one to two hours prior to leaving for your surgery. You will know that your bowels are not clear when a movement is not fully clear or straw-colored liquid.

1. Remove the enema from the box and remove the green cap
2. Lie down on your left side with your right leg drawn up and your left leg straight.
3. Carefully place the lubricated bottle tip into your anus until it reaches the bottom of the narrow tip.
4. Squeeze out the contents of the enema.
5. Take the cap off of the bottle and fill it with warm water.
6. Continue to administer the enema in the same way until the amount of water held is at least doubled.
7. Hold the enema fluid for as long as possible (no longer than 5 minutes).
8. Expel the enema fluid in the toilet.

Recovering After Colorectal Surgery

Recovering after colorectal surgery is an entirely different process. Colorectal surgery recovery times may vary based on the procedure done, but hospitalization typically varies from 4-7 days. You may need to follow special protocols involving stitches or bandages, which may need to be removed or replaced by your doctor. Consult your doctor to learn more about recovering property from colorectal surgery.

If you have any questions please call our office: (954) 237-1123