Anterior Resection
Patient Information
Colorectal Team
Incorporating hospital and community health services, teaching and research
This leaflet explains about the procedure known as an
Anterior Resection.
Before your operation
Before your operation you may have scans and x-rays to
assess the extent of the cancer. While waiting for your
operation it is important to prepare yourself physically. If
you can, continue eating a normal diet and take gentle
exercise. If you smoke, try and stop before your operation.
Before the operation you will be asked to sign a consent
form to say that you understand what the operation
involves.
Pre-admission clinic
You may have to attend the pre-admission clinic where
routine pre-operative tests take place e.g. blood tests,
chest x-ray, ECG (electrocardiograph – trace of your
heart); listening to your chest and checking your blood
pressure. This is to make sure your admission to hospital
is as smooth as possible. During this appointment you
may see the nurse specialist who will be able to answer
any of your questions.
Your admission to hospital
Your bowel will need to be clear before your operation.
You will be given some medicine to clear your bowel.
You will be given: 2 x Bisacodyl tablets and 2 x Picolax sachets
(powerful laxative drink) – to be taken the day
before the operation. Please read the instruction
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

leaflet you have been given carefully on how to take
the bowel preparation.
It is important to drink plenty of fluids while taking
the laxatives to prevent dehydration. Fluids allowed
include water, squash or tea/coffee (without milk)
You may continue to drink plain water (not fizzy) for
up to 2 hours before surgery.
Your Colorectal CNS or your Consultant will advise on
the appropriate bowel preparation before your
surgery.
If you have been given Energy Drinks (Nutricia Pre-Op),
drink them as soon as you wake up on the day of surgery
before you come to the hospital.
Do not eat sweets or chew gum on the day of the
surgery
Do not take your medications on the day of surgery. Bring
all your medication with you to the hospital and the
Doctors or nurses will advise you which medications to
take.
Your operation details
Anatomy of the bowel
http://www.bowel-control.co.uk/anatomy/index.htm
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The end of the large bowel (rectum) is attached to the anal
muscles which controls your bowels movements. The part
of your large bowel, near your bottom, will be removed
during this operation.
Anterior Resection
This operation will remove the lower part of the large
bowel. It involves the removal of the sigmoid colon and
part of the rectum. After removal of the diseased portion
the two free ends of bowel will be joined together to
restore intestinal continuity and to help the stool to pass
through as normal. This is called an anastamosis.
The sigmoid colon is mainly for the storage of waste
matter, thus removing this part has little effect on opening
of your bowels, although your stool may be a little softer.
You may also find that you open your bowels more
frequently than before because the capacity to hold
motions is smaller.
The operation may be done as a keyhole procedure with a
cut on the tummy or, as an open procedure with a larger
wound
Before
After
https://www.jhmicall.org/JHGI_Home.aspx?CurrentUDV=31
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There is a possibility that an ileostomy (stoma) may be
formed to allow the join to heal and prevent complications.
A stoma is an artificial opening through the wall of the
abdomen (tummy) to collect waste into a bag. A bag fits
over this to collect your stool and is completely disposable.
The bag will need to be changed on a daily basis.
Stoma is the Greek word for "mouth" or "opening".
This kind of stoma is usually temporary; if the growth in
the bowel is too low then it may have to be permanent.
You may need some further treatment after your
operation, in the form of chemotherapy. The piece of
bowel removed during surgery will be examined by the
pathology department; your further treatment will depend
on the basis of these results. It may take a few weeks
before the results of these tests are completed.
If an ileostomy is required, further treatment may slightly
delay the reversal of this. The stoma care nurse will help
and support you to manage your stoma and provide you
with any advice that you may need.
Having a stoma
Before your operation the stoma nurse or colorectal nurse
will mark the area on your abdomen where the stoma will
be placed. They will try to make sure that it is positioned
in the best place for you so it does not interfere with the
clothes you wear and to make it as discreet as possible.
The stoma is part of the bowel and is very pink and moist,
just like the inside of your mouth. At the beginning it will
be quite swollen, but it will shrink down in a few weeks to
about the size of a 50 pence piece (although this can vary
depending on the type of surgery you have had).
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The design of stoma bags has improved in recent years
and they are now completely disposable and very discrete.
No-one will know that you have a stoma unless you
choose to tell them. They come in various sizes to fit in
with your lifestyle; your stoma nurse will show you a
selection. Smaller bags can be worn under swimwear and
are unnoticeable. You do not need to change the type of
clothes you wear, although the stoma care nurse will be
able to advise you on certain clothes that can even further
disguise the fact you have a stoma bag.
There is no reason to change your lifestyle because you
have a stoma. You can still work, travel, eat out and enjoy
a good social life.
Laparoscopically assisted surgery
If possible your surgery may be performed using a
laparoscopic assisted approach. Laparoscopic colorectal
surgery also known as ‘keyhole surgery’ involves inserting
laparoscopic (‘keyhole’) instruments through a number of
small incisions in the abdomen (tummy).The instrument
has a camera attached which projects images on the TV
monitor to help with the dissection, removal of the
diseased portion and thereby performing the entire
surgery through a slightly smaller incision .
The main aim of having this type of surgery is to:
- Reduce hospital stay
- minimise hospital infection
- Quicker recovery
- Minimise scarring
- Reduce discomfort following surgery
Risks or complications of surgery
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Most operations are successful.
However, every
procedure has risks and potential complications. The risks
and complications that are most relevant to the operation
are listed below.
If there is anything you are unsure about you can discuss
this with your Doctor or Nurse.
Choosing not to have this operation will depend on your
diagnosis following investigations but will include the
continuation and worsening of the symptoms. The bowel is
likely to become obstructed leading to emergency hospital
admission and possible emergency surgery.
We have a specific complex pre-operative assessment
service for the elderly and anyone with other serious
medical conditions. At this clinic you will see a specialist
doctor, cardiologist, Intensive care doctors and specialist
allied health care professionals who work together to
assess and plan your care if you have an operation.
The risks and complications can be divided into three
areas:1.
2.
3.
Complications of the anaesthesia
General complications of any surgery
Specific complications of this operation
1. Complications of the anaesthesia
Your anaesthetist will discuss about the risks of an
anaesthetic.
2. General complications of any operation
Pain – this can occur with any operation. Post
operatively the pain team will regulate the pain relief to
fit your personal needs.
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Bleeding – this can occur during or after the surgery.
If this happens you may need a blood transfusion or
very occasionally another operation may be required. If
you have any religious or personal objections discuss
this with your doctor before the surgery.
Infection in the surgical wound – this would usually
be treated with antibiotics or occasionally further
surgery (risk: 3-7 in 100).
Unsightly scarring - this is more likely if the wound
has become infected.
A hernia – this can occur in the incision scar when the
deep muscles fail to heal or around the site of the
stoma. If the hernia appears as a bulge around the
incision line it is called an incisional hernia, if it occurs
as a bulge around the stoma it is called a parastomal
hernia. If this causes problems, you may need another
operation.
Blood clots – These can occur in the legs
(thrombosis) and can move to the lungs to cause
breathing problems. You will be asked to wear antithrombosis tights (long socks) and will be given blood
thinning medication to reduce the risk. Exercising your
legs and moving around as much as you are able to
can help reduce the risk of blood cots.
Difficulty passing urine – You will have a catheter
inserted at the time of the operation which will remain
in place for approximately 1-2 days. Occasionally,
when the catheter is removed, you may have difficulty
passing urine. This is more common in men and/or if
you have had difficulties passing urine prior to the
operation.
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Chest infection – the physiotherapist will give you
deep breathing exercises to help prevent a chest
infection. If you are a smoker we advise you ether try
to stop or cut down your smoking before the operation.
3. Specific complications of this operation (anterior
resection)
Anastomotic leak – this is a serious complication
which occurs if the joined ends of the bowel fail to heal
adequately, leaving a hole (leak) at the join
(anastomosis). Treatment with antibiotics and resting
the bowel may help with the healing.
If this happens, you would probably require a further
operation.
If you have a stoma made as part of the operation you
should be protected from the effects of any leaks.
Adhesions – are bands of scar like tissues that form
inside the abdomen. This can occur following any
operation on the abdomen and does not usually cause
any problems. However, it can sometimes lead to
bowel obstruction many years later.
Sexual disturbance – the nerves that supply the
sexual organs in both men and women run very close
to the rectum. When the cancer is removed these
nerves can be damaged which may lead to impotence
in men and vaginal dryness in women. Impotence
following rectal cancer surgery is one of the licensed
indications for receiving Viagra (a drug used to
overcome impotence).
Before your operation the surgeon will visit you to discuss
the operation and you will be asked to sign a consent
form. It is important that you fully understand what
operation is planned and what the likely benefits and
possible side effects are.
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After your surgery
Following surgery you will go back to the ward. The nurse
on the ward will carry out regular observations on you.
You will be allowed to drink fluids freely and to eat when
you feel able.
When you wake up you will find that you are attached to
several tubes. These may be: 




A drip in your arm or neck, which gives you the
extra fluids that you require.
A PCA System (patient controlled analgesia),
which is given via the drip in your arm.
Alternatively painkillers can be given via an
epidural drip in the back
An NG tube (a nasogastric tube), which is a
tube in your nose that goes down the back of
your throat into your stomach, this tube helps
prevent you from feeling sick and vomiting
A catheter (tube), into your bladder to help drain
and measure the amount of urine you pass.
Drainage tubes to help clear any oozing fluid
around the operation site.
These tubes are inserted while you are under anaesthetic.
The epidural drip is inserted in the anaesthetic room while
you are awake All drips and tubes will be removed over a
period of days after the operation. Depending on the
recovery you will be in hospital for approximately 1 week.
after
surgery
You can eatManaging
and drink soon
after
your surgery.
If the bowel function is slow to start food and drink may be
restricted for a few days.
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To speed up your recovery, you will be given 3
supplements drinks each day. These will be given for 3
days after your surgery.
It is important to try and move around soon after the
operation. Becoming mobile will help you to recover
quickly from the operation and also reduce the risk of
complications.
You will be helped to sit out of bed on the first day after
your surgery and by the 3rd day, you will be helped to walk
around the ward. The physiotherapist will help you to walk
up and down stairs if you have them at home.
If you have had a stoma, the Stoma Nurse Specialist will
start teaching you to look after this on the 1 st day after
surgery until you are able to manage this yourself. This
usually takes 3-4 days. She will give you support during
your recovery on the ward, and also once you are at
home.
After the operation, rest is very important as part of the
recovery process, so it is advisable to restrict the number
of visitors coming to see you so you don’t get overtired.
Visiting time on the ward is between 11.00am – 12.00pm
and 4.00 – 8.00pm. Only 2 visitors are allowed at a time
Going Home
The medical staff will be able to advise you if some
movements are restricted, like kneeling or bending down.
This may last for a short period of time, as you get better
you will be able to resume your daily activities.
For the first six weeks you are advised not to lift anything
heavy such as shopping or wet washing, and not to do
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anything strenuous like digging the garden or mowing the
lawn.
For the first week or so you will feel tired and weak when
you get home. It is therefore important that you rest
although it is not good for you to stay in bed all the time.
You should try gentle exercise first like walking around the
house or to the end of the street. Your appetite may be
reduced so try eating little and often to begin with.
If you have a stoma, the stoma care CNS will arrange for
your stoma supplies for home. They will visit you within the
first week of discharge home. If you need any additional
help the district nurse will be asked to visit you.
For most people it will take 6-8 weeks to recover from this
type of operation. You may feel some pain and ‘twinges’
around your wound for several months. This is normal as it
takes a while for full healing to take place. Taking a mild
painkiller will help you feel better and help with recovery.
For the first six weeks you are advised not to lift anything
heavy such as shopping or wet washing, and not to do
anything strenuous like digging the garden or mowing the
lawn.
You should not drive until you can do an emergency stop
without hesitation that your wound will hurt. To test if you
could do an emergency stop, lift both feet off the ground at
the same time. If it does not cause you abdominal pain
you would be able to do an emergency stop. It is
advisable to check your car insurance for any clauses
regarding driving after an operation.
The length of time before you are fit to return to work will
be individual and dependent on the type of work you do.
When you get home you may find that your bowel habit is
still unpredictable. When you have had some of your
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large bowel removed you may find your stools are slightly
loose, over time this will resolve itself. You may also find
that you open your bowels more frequently than you did
before your surgery. This could be anywhere between 1-4
times per day. If your bowel habit does not settle, there
are medications that can help. If you have any queries ask
the specialist nurse or your doctor.
The length of time before you are fit to return to work will
be individual and dependent on the type of work you do.
Once you have recovered from your operation there is no
reason why you can’t go back to your normal sex life.
However, operations on the rectum can cause damage to
the nerves that connect to the sexual organs. If there is
damage men may find in difficult to get or maintain an
erection, and may have problems with ejaculation.
Women may experience pain when having sex or a lack of
lubrication fluids (natural fluids in the vagina). If you do
have problems talk to you doctor or specialist nurse.
Dukes’ Staging
Doctors use a system to describe the different stages of
cancer of the large bowel – Dukes’ staging. The staging
system is based on the depth the tumour has invaded
through the bowel wall and whether any cancer has
spread to the lymph nodes (lymph node metastasis).
After your operation the histopathologist will examine the
cancer under the microscope, we usually have the results
within 17 days and will then be able to tell you about the
stage of your bowel cancer.
Dukes’ Stage
Dukes’ A
Extent of cancer
The cancer is confined to the bowel
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wall
The cancer has spread through the
full thickness of the bowel wall, but
the lymph nodes are not affected.
The cancer has spread to the lymph
nodes. The lymph nodes are part
of the lymphatic system, which is
part of the body’s natural defence
against infection. This is one of the
first places the cancer can spread
to.
Dukes’ B
Dukes’ C
Medical Terms and Words
These are some of the medical words and terms you may
come across during your investigation and treatment.
Abdomen
Acute
Adjuvant therapy
Anaemia
Analgesia
Anastomosis
Anus
Benign
Biopsy
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Tummy or belly
Sudden onset of symptoms
Chemotherapy and radiotherapy
in addition to surgery
A reduction in the number of red
cells, haemoglobin (iron) or
volume of packed red cells in the
body
Pain killers such as paracetamol
and morphine
The joining together of two ends
of healthy bowel after diseased
bowel has been cut out
(resected) by the surgeon
The opening to the back passage
Non-cancerous
Removal of small pieces of tissue
from parts of the body (e.g. colon
– colonic biopsy) for examination
under
the
microscope
for
diagnosis.
Caecum
The first part of the large intestine
forming a dilated pouch into
which the ileum, the colon and
the appendix opens.
Chronic
Symptoms occurring over a long
period of time
Chemotherapy
Drug therapy used to attack
cancer cells
CNS
(Clinical A qualified nurse that has
Nurse specialist) specialised in a particular field of
care.
Colon
The large intestine (bowel)
extending from the caecum to
rectum
Colorectal
Surgeon who specialises in the
Surgeon
treatment of conditions in the
large bowel and rectum including
bowel cancer.
Colostomy
Surgical creation of an opening
between the colon and the
surface of the body. Part of the
colon is brought out of the
abdomen creating a stoma. A
bag is placed over this to collect
waste material.
Constipation
Infrequent or difficulty in the
passage of bowel motion stool
(faeces).
CT scan (CAT (computerised axial tomography)
scan)
A type of x-ray. A number of
pictures are taken of the
abdomen and fed into a computer
to form a detailed picture of the
inside of the body.
Defaecation
The act of passing faeces (having
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Diagnosis
Diarrhoea
Distal
Electrolytes
Enema
Endoscopy
Exacerbation
Faeces
Fistula
Heredity
Ileostomy
Incontinence
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your bowels opened)
Finding out what is wrong with
you
An increase in frequency and
liquidity of bowel motions
Further down the bowel towards
the anus.
Salts in the blood e.g. Sodium,
potassium and calcium
A liquid introduced into the
rectum to encourage the passing
of motions
A collective name for all visual
inspections of body cavities with
an illuminated telescope. e.g.
colonoscopy,
sigmoidoscopy,
gastroscopy.
An aggravation of symptoms
The waste matter eliminated from
the anus (other names – stools,
motions, poo).
An abnormal connection, usually
between two organs, or leading
from an internal organ to the body
surface (e.g. between the anus
and skin surface – anal fistula)
The transmission of
characteristics from parent to
child
This is when the open end of the
healthy ileum (small bowel) is
diverted to the surface of the
abdomen and secured there to
form a new exit for waste matter
(faeces).
This is when you are unable to
hold on to or control your waste
Inflammation
Inoperable
Laxative
Lesion
Malignant
Mucus
Oncologist
Palliative care
Pathology
Perforation
Peritoneum
Peritonitis
Polyp
products, e.g. stool or urine.
A natural defence mechanism in
which blood rushes to any site of
damage or infection in the body
leading to reddening, swelling
and pain. The area is usually hot
to touch.
A growth or tumour that can not
be surgically removed
Medicine or tablet that acts to
cause emptying of the bowel.
This may be by purging (irritating
the lining) or increasing the
volume of stool (bulking)
A term used to describe any
structural abnormality in the body
Cancer
A white, slimy lubricant produced
by the large bowel
A doctor who specialises in
cancer care using drugs and
radiotherapy
Improving the quality of life by
providing support and the control
of
pain
and
unpleasant
symptoms.
The study of the cause of the
disease
An abnormal opening (hole) in
the bowel wall which causes the
contents to spill into the normally
sterile abdominal cavity.
The
membrane
lining
the
abdominal cavity
Inflammation of the peritoneum,
often due to a perforation
A protruding growth from the
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Prophylaxis
Radiotherapy
Rectum
Sigmoid
Sigmoidoscopy
Stricture
Suppository
Terminal ileum
Tumour
Ultrasound
mucous membrane (lining of the
bowel) e.g. colonic polyp – in the
colon
Treatment to prevent a disease
occurring.
The use of high energy rays
which attack cancer cells
The large intestine, above the
anus (the back passage)
The portion of the colon shaped
like a letter ‘S’ or ‘C’ extending
from the descending colon to the
rectum
Inspection of the sigmoid colon
with an illuminated telescope
called a sigmoidoscope
The narrowing of a portion of the
bowel
A bullet-shaped solid medication
put into the rectum
The last part of the ileum joining
the caecum via the ileo-caecal
value
An abnormal growth which may
be benign (non-cancerous) or
malignant (cancer)
Use of high-pitched sound waves
to produce pictures of organs on
a screen for diagnostic purposes
Useful Contacts
Beating Bowel Cancer
Harlequin House, 7 High Street, Teddington,
TW11 8EE
General Helpline: 08450 719 301
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Nurse Advisory Service: 08450 719 301 (9.00am – 5.30pm)
Email: nurse@beatingbowelcancer.org
Website: www.beatingbowelcancer.org
Provides expert knowledge support, raising awareness and
information about bowel cancer so that individuals can make
their own informed decisions of their treatment.
Bowel Cancer UK
4 Rickett Street, London SW6 1RU
Tel: 020 7381 9711
Advisory line: 0800 840 35 40 (10.00am – 4.00pm)
Email: advisory@bowelcanceruk.org.uk
Web page: www.bowelcanceruk.org.uk
Advisory line staffed by specialist nurses providing advice and
information service for all those affected or concerned about the
disease.
Bowel cancer information in other languages available.
Cancer Research UK
Cancer Research UK, P.O. Box 123, Lincoln's Inn Fields,
London WC2A 3PX
Cancer information nurses: 0808 800 4040, 9am - 5pm
Email: cancerhelpuk@cancer.org.uk
Website: http://www.cancerresearchuk.org/cancer-help/
Cancer Research UK is dedicated to cancer research, provides
information on site specific cancers and influences public
policies. The Website provides information for bowel cancer
patients.
Hackney Citizens Advice Bureau
Local Office: 300 Mare Street, London E8 1HE
Tel: 020 8525 6350
Website: http://www.eastendcab.org.uk/
Mare Street office offers drop-in clinics Monday-Thursday from
8.30am. Friday doors open at 9.30am.
Advice line operates Tuesday and Wednesday from 1pm – 3pm
and 10am-12pm (for clients with mobility problems). Tel: 0844
499 1195.
The Citizens Advice service helps people resolve their legal,
money and other problems by providing free information and
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advice from over 3,000 locations, and by influencing
policymakers.
Colostomy Association
2 London Court, East Street, Reading, RG1 4QL
Tel: 0118 939 1537
Helpline: 0800 328 4257 (24 hour)
Email: cass@colostomyassociation.org.uk
Website: www.colostomyassociation.org.uk
Provides support and advice for colostomates, their families
and their carers. Free literature and information is available
about all aspects of living with a colostomy.
Core – Fighting Gut and Liver Disease
3 St Andrews Place, London, NW1 4LB
Telephone: 020 7486 0341
Email: info@corecharity.co.uk
Web page: www.corecharity.org.uk
Fund research in order to prevent, cure or treat digestive
disorders and provide information for sufferers, their families
and friends.
Ileostomy and Internal pouch support group
Peverill House,1 – 5 Mill Road, Ballyclare, Co. Antrim, BT39
9DR.
Tel: 0800 0184 724 (Office hours)
Email: info@iasupport.org
Website: www.iasupport.org/uni_contact.aspx
Aims to help anyone who has had or is about to have their
colon removed and has an ileostomy or internal pouch.
Provides advice, information and leaflets.
Institute for Complementary Medicine (ICM)
32-36 Loman Street, London SE1 0EH
Tel: 0207 922 7980
Email: info@icnm.org.uk.
Fax: 0207 922 7981
Website: http://icnm.org.uk/
Provides the public with information on Complementary
Medicine
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Macmillan Cancer Support
89 Albert Embankment, London SE1 7UQ
Macmillan cancer line: 0808 808 0000 (9am – 8pm)
Website: www.macmillan.org.uk
Provides specialist advice and support for cancer patients and
financial advice and grants for people with cancer and their
families.
NHS Direct
Telephone: 111
Website: www.nhsdirect.nhs.uk
The Polyposis Registry
St. Mark’s Hospital, Northwick Park Hospital, Watford Road,
Harrow, HA1 3UJ
Tel: 020 8235 4270
Email: info@polyposisregistry.org.uk
Website: www.polyposisregistry.org.uk
Provides support and information to people who have, or may
have, the familial adenomatous polyposis (FAP) gene, and so
are at greater risk of developing bowel cancer.
Other sources of information
Royal College of Anaesthetists - www.rcoa.ac.uk “You and
your Anaesthetic”
- www.rcseng.ac.uk
Important information
Please remember that this leaflet is intended as general
information only. It is not definitive. We aim to make the
information as up to date and accurate as possible, but please
be warned that it is always subject to change. Please, therefore,
always check specific advice on the procedure or any concerns
you may have with your doctor.
Hand Hygiene
In the interests of our patients the trust is committed to
maintaining a clean, safe environment.
Hand hygiene is a very important factor in controlling infection.
Alcohol gel is widely available throughout our hospitals at the
patient bedside for staff to use and also at the entrance of each
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clinical area for visitors to clean their hands before and after
entering.
Other formats
If you require this leaflet in any other format such as larger print,
audio tape, Braille or another language please speak to your
clinical nurse specialist (Keyworker).
Reference
The following team members have been consulted and agreed
this patient information: Consultant, Clinical Nurse Specialist
(Keyworker), Macmillan Cancer Information and Support
Manager and Patient.
Homerton Hospital Health and Cancer Information Centre
Based at the front of the hospital
Tel: 020 8510 5191 (Mon – Friday 9am – 5pm)
Email: healthshop@homerton.nhs.uk
Homerton Health Shop is a drop-in Health and Cancer
Information Centre, based at the main entrance of the Trust.
Macmillan Cancer Information and Support Manager provides
cancer information, financial, practical and emotional support to
anyone affected by cancer, their relatives, carers and friends.
Homerton Hospital PALS (Patients Advice & Liaison Service)
PALS is based in the main entrance of the hospital.
Tel: 020 8510 7315 (9am – 5pm)
Email: pals@homerton.nhs.uk
PALS provides confidential information and support, helping
you to sort out any difficulties or concerns you have whilst in
hospital, guiding you through the different services from the
NHS
Homerton University Hospital NHS Foundation Trust
Homerton Row, London, E9 6SR
T 020 8510 5555
W www.homerton.nhs.uk
E enquiries@homerton.nhs
Reviewed date January 2014
Next review date January 2016
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