How do I get treatment

For London Colorectal please telephone:

  • +44 (0) 20 7403 6061

For Gastroenterology please call:

  • +44 (0) 20 7234 2292

 

Patient Advice following an Abdomino-Perineal Excision

An Abdominal-Perineal Excision (AP Excision) is usually performed due to a low rectal cancer . This is where the lower part of the colon, rectum and sphincter muscles are removed. This results in a permanent end Colostomy. After the rectum has been removed a muscle flap will have been created or the perineal wound will have been sutured depending on what is felt best by your surgeon.

Bowel Function

The output from the stoma immediately after surgery can be loose however it depends on how much of the colon (large bowel) has been resected. Once your body settles down and you begin to manage to return to a normal diet the stool should become formed. On average your stoma will produce a motion once a day, however every individual is different. Certain foods and drinks can influence the output.However please see leaflet entitled Formation of a Colostomy to give you more guidance.

Medications

It is not unusual to still have some discomfort/pain after you have been discharged and you will have been discharged with some pain relief medication. It is important to carry on taking these as prescribed and gradually wean yourself off them. Your body will tell you if are over doing things or if you require more pain relief. Contact your GP or specialist if pain becomes worse.

Diet

Ensure you try and eat a sensible diet with plenty of fluids, fresh fruit and vegetables. Following bowel surgery it may take a few weeks for your appetite to return. It is important to ensure you drink plenty of fluids and try taking regular, smaller portions of food. After formation of your Colostomy you will continue to digest and absorb all nutrients normally in your small bowel. The length of the large bowel, resected during surgery (if any) will affect the amount of water and salts that are absorbed in your colon. The more large bowel you have had removed, the looser the colostomy output will be. The long term dietary expectation for a person who has a Colostomy is generally a healthy one. Most people with a colostomy can have, within reason, any food and drinks. Constipation can be an issue; however this can be prevented or resolved with dietary measures and laxatives (if required). It is important to remember that everyone is different and reacts differently to particular foods so this information is only a guide. It would advicable to keep a food diary and identify any foods that cause you any problems. It doesn't mean that you have to rule all the foods out that cause any problems i.e. looser stools, excessive wind etc but it will allow you to manage it better.

Sutures and Wound care.

Your wound will have been closed with either Dermabond, abdominal clips or sutures.

If you have Dermabond to your wound, this will take a few weeks to disappear. Ensure that you don't rub at the wound in order to remove the glue like substance. This acts like a water proof protection to your wound.

If you have abdominal clips in place, these remain in place for 10-14 days. If you have gone home before the removal date, it can be arranged for you to attend your practice nurse or for you to return to LBH Outpatients Dept in order to have clips removed.

If you have sutures in place, these usually stay in place for 7-10 days. Again if you have been discharged prior to this it can be arranged for you to have them removed as above.

Your wound is best left exposed unless there is a reason for a dressing still to be required. The nurse will advise you on dressing changes prior to discharge home. If it is felt that District Nurse/ Practice Nurse input is required then a referral will be sent prior to you leaving hospital.
If your wound becomes inflamed, swollen or painful or if there is evidence of the wound weeping, this could be a sign of a wound infection; you may also have signs of fever. If you have any of these signs or symptoms please ensure you contact your GP or Consultant as antibiotics may be required.

Bathing/Showering

You can bath and shower as normal once you are at home, however ensure that you don't rub yourself across the wound area with or without perfumed lotion/potions. Bubble bath or highly scented soaps etc can cause irritation to the wound. Ensure you dry yourself well, patting your wound sites gently. Do not use talcum powder as this can cause irritation.

Driving

It is recommended not to drive a car during the early weeks (up to 4 weeks) following surgery. Before stating to drive again you should test to see that you are happy to perform an emergency stop. It is important that you contact your insurance company to ensure that your insurance covers you to drive after surgery of this nature. Even as a passenger you are at risk as the seat belt crosses over the very area you are trying to protect. It would be advisable that you place a thin cushion or towel between yourself and the seat belt to act as protection in the initial weeks until you feel more secure.

Exercise

Ensure you allow yourself recovery time following the initial surgery. You will feel tired for the first few weeks which is only natural. You should ensure you avoid activities that could cause undue abdominal discomfort and risk of developing a hernia around the stoma for the first 4-6weeks post operatively. Remember to listen to your own body and not to over do it. The physiotherapist will advise you on recommended exercises. Walking is a good place to start with exercising and can be gently built up. It is important to talk to your consultant or specialist nurse regarding contact sports or heavy lifting. If you have had a formation of an Ileostomy this should not prevent you from exercising or from being as physically active as you were before your surgery.

Household Duties

As your abdominal muscles start to heal after surgery they will be very weak and even everyday movements can cause possible pressure and the possibility of a hernia. The sort of movements that can cause the most discomfort following surgery are bending, stretching and lifting. It is important that family and friends help out if possible as you should try not to do any heavy lifting for approximately 6 weeks. It is not unusual to feel tired and insecure when you first go home. It can be quite frustrating relying upon others to help with everyday activities however it is important to allow time for healing.

Sexual Relationships

After surgery, while you are recovering and learning to adapt, you may not experience any sexual feelings for days, weeks or even months. It is important that you don't expect too much of yourself, ensure you are patient and kind to yourself and your partner. Once you have rested, healed and become more reassured, your sexual desires will return. Your surgeon will have explained the small possibility of problems following lower pelvic surgery, however these are usually temporary. It is important that you talk to your partner and allow yourself time to recover.

Returning to Work

The time at which you can return to work depends on the type of surgery you have had and what your job entails. It is important that you feel completely better and stronger in yourself. It is worth discussing with your employer as to whether working part time initially may be advisable.

Follow up Appointment

You will be advised to make an appointment with your Consultant through his secretary after you have been discharged. This will usually be within the first 2 weeks. However, you will be advised if this should be any different. You will be seen by the stoma nurse after you have been discharged home.