Ostomy reversal: What to expect

If you have a temporary ostomy, it’s likely that you will have it reversed at some point. In this procedure, the surgeon will move the stoma back into your abdomen and sew your intestines back together. 

You will need several weeks to recover from your initial surgery, and you may need other treatments such as chemotherapy. In that case, your ostomy reversal surgery will be after you have finished chemo or if you’re in a good position to have take a chemo break. You also need to be well enough to tolerate the surgery. Many patients have their temporary ostomies reversed within 3 to 12 months of their initial surgery, but this can vary depending on your individual circumstances.

Before the procedure

Bowel prep, like before a colonoscopy or resection, is not usually required for ostomy reversal surgery. You will probably be told not to eat or drink anything for several hours before the procedure. Small sips of water to take your medication should be ok, but it is important to follow your surgeon’s instructions. You may be given antibiotics to take before the procedure to prevent infection. Chat with your surgeon about any vitamins, supplements or prescription medications that you are taking, as some of these may need to be discontinued for a period of time before or after surgery.

Before starting the surgery, you will receive anesthesia and have a fluid IV drip to keep you hydrated. 

After the procedure

After the procedure, you will need to stay in the hospital until your bowels start working again. This may be anywhere from a day or two to a week or more if there are complications. After your bowels start working again and your team has determined that you are healing well, you will be sent home.

During your recovery, it is very important to follow the instructions of your surgeon regarding wound care, diet and exercise. It is a good idea to check your wound regularly for signs of infection and follow the wound care instructions given to you be your surgeon. If you notice increased pain, redness or swelling around the wound or any discharge of pus or fluid, call your team as these could be signs of infection. You will also be given pain meds to take at home. If you need a prescription refill, it is a good idea to call your team several days before running out so that you are not stuck without them. You will be scheduled for a follow-up visit with your surgeon where you can discuss any questions or concerns you have following your surgery.

What side effects might I experience?

Lower anterior resection syndrome (LARS)

This is probably the most common side effect that patients experience following ostomy reversal. LARS refers to a group of symptoms related to bowel function that patients may experience. These symptoms include:

  • Increased frequency/urgency of stools
  • Incontinence
  • Clustering (needing to poop several times in a short span of time)
  • Constipation
  • Uncomfortable gas
  • Abdominal pain

Your bowels have not been working for a period of time, so the nerves and muscles in the area may not be working properly. This can make it difficult to regulate bowel function.

Unfortunately, these symptoms are quite common, particularly in the first year or so following ostomy reversal surgery. Many patients report that they have a negative effect on their quality of life. Luckily, there are some things that you can do to help improve symptoms:

  • Try pelvic floor physical therapy. Pelvic floor exercises can help strengthen the muscles in your pelvic floor. Many patients find that working with a pelvic floor therapist is extremely beneficial. The sooner after surgery you start therapy, the better. You should be able to request a referral from your surgeon or PCP.
  • Make some diet changes. Modifying the amount and types of fiber in your diet can help improve symptoms. This can be different for each individual and may require a bit of trial and error to figure out what’s right for you. A dietician can also help with this. If you feel that would be helpful for you, ask for a referral from your oncologist or surgeon.
  • Try medications. Immodium can help with diarrhea and Metamucil or Miralax can help with constipation.
  • Drink water. Staying well-hydrated is crucial for regular bowel function. Aim to drink 8 to 10 glasses of water a day to keep things moving.
  • Get moving. Gentle exercise can help stimulate the bowels and get things moving if you are experiencing constipation.

For more tips and tricks on regulating bowel function, read our Diet & Lifestyle section here.

Scar tissue

Scar tissue from surgical healing can cause difficulties with healing and bowel function. If you think this may be the case, speak with your surgeon, as they may be able to recommend physical therapy or scar tissue massage to help.

Hernias

A hernia happens when part of your bowel pokes through the cut made for your stoma. It is particularly important to avoid any heavy lifting post-surgery, as physical stress can cause hernias to form. Don’t lift anything more than 5 to 10 pounds until you are well healed. Just for reference, a jug of milk weighs around eight pounds! 

Nerve damage

When you have surgery, nerve damage can happen. It can affect your bowel function, your ability to pee, or your ability to have sex. Connecting with a pelvic floor physical therapist soon after surgery can help you heal correctly. If you think you have nerve damage, chat with your team about physical therapy or medication options.

What should I eat and drink?

You’ll probably be advised to follow a low-residue, low-fiber diet in the initial weeks following your surgery. This means avoiding whole grains, beans, raw fruit and vegetables. White pasta, white bread, white rice, cheese, meat and well-cooked vegetables should be fine. Low-fiber foods are a bit easier to digest and will pass through your system more easily. Eating a low-residue diet will help your bowels to recover in the initial weeks following surgery. Try to include protein-rich foods at every meal to aid in wound healing. Avoid foods that can be hard on your stomach, like coffee, fried foods or spicy foods. Make sure to drink plenty of water, as this is also important for bowel function.

As mentioned above, you may find that your appetite is affected by the surgery. If you experience loss of appetite or taste changes, try eating small amounts of food throughout the day rather than large meals. Your appetite will likely return to normal after a couple weeks.

In the weeks and months following surgery, you will probably notice changes in bowel function and things may not work exactly as they did before. Adjusting the amount of fiber that you eat can help. It is a good idea to slowly introduce new foods to your diet every day or two, so that if you have any problems, you will know what caused them and you can cut back on that particular food. Starting a food diary can help you keep track of what you eat. Remember to take things slowly and listen to your body. A dietician can also be helpful in terms of advising you on what to eat following reversal surgery.

When should I call my doctor?

Although the risk of severe complications following ostomy surgery is low, it is important to know when to contact your care team. If you have any worrying symptoms, early reporting leads to earlier intervention and better outcomes in general. So if you feel that something is not right, it is always a good idea to call your doctor. If you experience any of the following, contact your team immediately:

  • Increased abdominal pain, discomfort or bloating
  • Difficulty breathing
  • Persistent diarrhea
  • Increasing pain when urinating
  • High temperature
  • Persistent nausea and vomiting
  • Inability to eat or drink
  • Unusual bleeding, redness or swelling

Want to learn more about ostomy reversal?

Join one of our COLONTOWN Facebook groups:

  • In Stoma City you’ll find answers to your ostomy questions and lots of stories of ostomates living life to the fullest!

Want to join? Fill out the registration form here.

COLONTOWN University has so much more to offer, from DocTalk videos with CRC experts to easy-to-understand biomarker test breakdowns. We’re here for you! See our list of Learning Centers here.

Questions to ask your surgeon

Before surgery, you’ll have an opportunity to speak with your surgeon and ask all the questions you want. Your surgeon wants to know that you both are on the same page about the procedure. Below are some questions you may want to ask:

  • Where exactly is my cancer located?
  • Can you describe to me what will be happening during the procedure?
  • What are you planning to remove? 
  • Do I need any treatment before surgery, such as chemotherapy or radiation?
  • Is this the standard type of surgery for my condition?
  • What type of surgery will I have (open or laparoscopic)?
  • Do you offer additional procedures for pain control, such as a nerve block? 
  • What will my scar look like?
  • How many times have you performed this type of operation successfully?
  • What do I need to do to prepare for surgery?
  • How long will I stay in the hospital?
  • Will I have an ostomy? If so, which kind? Will it be permanent or temporary?
  • What side effects might I experience after this surgery?
  • What will I need to do to care for my incision?
  • What will recovery look like?
  • Will I experience any permanent physical changes?
  • What can I expect in terms of bowel function after surgery?
  • When can I resume my daily activities?
  • When can I go back to work?
  • Will I need chemo after surgery? If so, how long after surgery will I start?
  • Will I need to follow a special diet after surgery?
  • When can I start exercising again?
  • How often will I follow up with you after the surgery has finished?

Here is a downloadable list of these questions that you can print out and take with you to your appointment: Questions to ask your surgeon

Want to learn more about surgery?

Join one of our COLONTOWN Facebook groups:

  • COLONTOWN Downtown Come visit COLONTOWN’s main street for general discussions about surgery
  • Corner Cupboard for discussions on side effect management
  • Palliative Pathways for advice on how your palliative care team can help you cope with side effects
  • Rectalburgh for patients with rectal cancer

Want to join? Fill out the registration form here.

COLONTOWN University has so much more to offer, from DocTalk videos with CRC experts to easy-to-understand biomarker test breakdowns. We’re here for you! See our list of Learning Centers here.

Ostomy surgery: What to expect

If you have surgery to remove certain parts of your colon, rectum, anus or bladder, you may no longer be able to poop or pee the same way you did before your surgery. In that case, your surgeon will connect a piece of your intestine to the outside of your skin — called a stoma — so that waste can exit from the body into a bag that hangs from your stomach. This procedure is called an ostomy. 

Ostomies can be permanent or temporary. If you have a permanent ostomy, you will have it for the rest of your life. Some ostomies — particularly those used for rectal cancer surgeries —  are temporary. 

Depending on which part of the body has had surgery, there are different types of ostomies. This section will mostly focus on colostomies and ileostomies. If you have questions about other types of ostomies, join COLONTOWN and ask our community!

What kinds of ostomies are there?

Colostomy

For a colostomy, the surgeon removes the lower part of the colon and/or rectum and brings the lower part of the large intestine out to the skin to form a stoma. A colostomy bag is placed over the stoma for waste to exit the body. If you have a colostomy, your poop will probably come out on a fairly regular schedule and look very similar to what it looked like before your surgery.

Ileostomy

With an ileostomy, the surgeon removes part of the large intestine and/or rectum and brings the end of the small intestine — also called the ileum — out to the skin of the stomach to form a stoma. An ileostomy bag fits over the stoma so that waste can exit the body into a bag. If you have an ileostomy, your poop will exit your body without passing through your large intestine. While your small intestine is responsible for absorbing most of the nutrients from your food, your large intestine is responsible for absorbing water so that your stool exits your body in a solid, formed state. Because an ileostomy bypasses your large intestine, waste comes out very regularly throughout the day and tends to be more liquid than a colostomy. Depending on what you have had to eat or drink, it may be completely liquid or more like the texture of nut butter.

Urostomy

There are two main types of urostomies. In one type, the surgeon will take a small piece of your bowels (about 5-6 inches) and connect it to the ureters, which carry urine from your kidneys. The surgeon will then bring the piece of bowels outside of the body to form a stoma. A bag is placed over the stoma for the urine to flow into.

In the second type of urostomy, the surgeon will remove the bladder and attach both ureters to a stoma, which will bring the urine into a bag that connects to the stoma on your abdomen.

image (81)

Nephrostomy

If you have a nephrostomy, the surgeon connects a tube to your kidney or kidneys, which will then come out of a small incision in your side or back. This tube hooks up to a bag that collects urine outside of your body.

Before the procedure

Your ostomy will be placed during the same procedure as your bowel surgery. So the prep work you do for your bowel surgery will be good preparation for your ostomy surgery. Your surgeon will give you specific advice and instructions for preparing for surgery. It’s important to follow these guidelines exactly. Some requests may include laxatives, enemas, and fasting after midnight the day before your surgery.

After the procedure

Right after surgery, you will likely have a clear bag over your stoma. This is so your healthcare team can monitor how you are healing.

You might be alarmed by the size or shape of your stoma. For the first few weeks after surgery, your stoma will be swollen. It may also bleed for the first few days. Your surgeon will have placed stitches around the outside of the stoma to connect your bowels to the skin on your stomach. These stitches will either be dissolvable, or you may need to get them removed.

Two or three days after your surgery, an ostomy nurse will teach you how to clean your stoma and change your pouch. It will take a few days for your bowels to wake up and for your stoma to start having any output. You will be on a liquid diet directly after surgery, so once your stoma does start working, you may have loose stools. This should firm up with time.

Managing your ostomy

Managing an ostomy can take some getting used to. Your body is learning a whole new way of going to the bathroom and emptying and changing your ostomy bag may take some troubleshooting in the beginning. But don’t worry! Learning how to handle an ostomy takes time.

After your surgery, your ostomy nurse at the hospital will help teach you how to empty and change your ostomy bag. They will also give you advice related to daily activities and diet and will probably send you home with lots of reading material and an initial stock of ostomy supplies. You should be offered a home health nurse who can visit your house for several weeks after the surgery to help support you with bag changes or anything else you need. If this is not offered and you don’t feel comfortable managing your ostomy by yourself when you are discharged, you should be able to request a referral from your surgeon or ostomy nurse.

For more information on managing your ostomy, check out our ostomy management section.

When should I call my doctor?

Most ostomates do not have any major complications. However, here are some things to look out for:

  • Cramps lasting more than 2 hours
  • Continuous nausea and vomiting
  • Watery output or diarrhea, lasting more than 5 hours
  • A cut or injury to the stoma
  • Severely irritated skin or lots of bleeding around the stoma. The surface of the stoma is very delicate so a small amount of blood when changing your pouch is nothing to worry about.
  • Bad odor lasting more than a week could be a sign of infection
  • Anything unusual about your stoma, such as a change in size, shape or texture

Want to learn more about ostomies?

Join one of our COLONTOWN Facebook groups:

  • In Stoma City you’ll find answers to your ostomy questions and lots of stories of ostomates living life to the fullest!

Want to join? Fill out the registration form here.

COLONTOWN University has so much more to offer, from DocTalk videos with CRC experts to easy-to-understand biomarker test breakdowns. We’re here for you! See our list of Learning Centers here.

What side effects might I experience?

After your surgery, you will likely experience side effects. Speak with your healthcare team beforehand so you know which side effects are expected, and which may be concerning. Remember that you can always ask a palliative care team for support with managing your side effects.

You may expect your side effects to steadily improve, but don’t get discouraged with ups and downs. Check in with yourself on a weekly basis to see if the overall trajectory is improving.

This section will be most useful for those who have had lower GI surgery.

Changes in bowel movements

After your surgery, you will likely experience changes when you go to the bathroom. Because surgery has changed the structure of your colon or rectum, your body will need some time to adjust to its new normal. Other factors — like air put into the body during laparoscopic surgery, anesthesia and pain meds can have an effect on bowel movements immediately after surgery.

You might need to go to the bathroom more frequently, or feel as though you have little to no warning before having to poop. It may also feel as though you can’t completely empty your bowels. You may feel bloated and fart more than usual. Get ready to be asked about your ability to fart and poop a lot as you recover from your surgery! 

Getting upright and moving as soon as you can may help the bowel process start up again.

If you have an ostomy, many things will change when going to the washroom. Learn more about your ostomy here.

Constipation

Feeling like you need to go, but can’t go to the bathroom is a common side effect of surgery. This is called tenesmus! Speak to your doctor about taking laxatives, either over the counter or prescription. With time, this symptom may improve.

Diarrhea

You may also have very loose bowels. Your colon’s job is to reabsorb water from your poop — so if you have lost a part of this system your bowels can change. Give your body some time to adjust. If this symptom does not improve, speak to your doctor about medication options.

Nausea and appetite loss

After surgery, you may find that certain foods upset your stomach. When returning to your usual diet, introduce one food at a time. If something causes a problem, try the food again in a few weeks. Keep a diary of what you eat, noting in particular if something causes you to feel nauseous or throw up.

While surgery is an effective treatment for removing cancer cells, it can also be a very traumatic experience for your body. Some patients experience appetite loss. Others report that food doesn’t taste quite right. If this is the case, take it easy. Try to eat things that sound appetizing, and eat several small meals throughout the day. Know that this is temporary, and that you will eventually recover your appetite. Some patients bounce back in a few days, others a few months. If this is a problem that is affecting your quality of life or causing you to lose weight, talk to your healthcare team. Your doctor can prescribe medication or refer you to a dietician who can help. 

Pain

Pain management is a big part of surgery recovery. Pain can be managed immediately with epidural or nerve blocks, often placed before or during surgery. This can help speed up the process of being able to walk post-surgery.

You may also be on IV or oral pain meds. As you recover from surgery, the goal will be to move you to oral pain medication, as being able to manage your pain at home is key to being discharged. There are a variety of pain medications and dosages that can be adjusted for you.

You’ll receive a prescription for pain medication after your surgery. It’s important that you take your medication on a schedule as prescribed, so you can get ahead of the pain. If you find that your medication is not adequately controlling your pain, speak to your doctor. They may be able to prescribe a higher dosage or add another medication. If you need to refill your pain medication, make sure to call a few days in advance to ensure that you are not left without it.

If pain is preventing you from returning to daily activities several weeks after surgery, speak to your team. They may be able to prescribe a different medication or refer you to a physical therapist.

Changes in sexual function

You will likely need at least 6 weeks of recovery after a major surgery before your body is ready to have sex again. Operations involving the rectum can affect the nerves to sex organs. Men may experience erection problems. Women may also notice sexual changes. Make sure that you and your partner are communicating well throughout this time — and make sure you are patient with yourself. Speak to your doctor about sexual function and what you can do to improve your sex life after surgery.

Fatigue

It’s normal to feel tired after surgery. Listen to your body. Rest and take breaks when you need to. As you recover, remember to stay active. Funny enough, light exercise can help with fatigue. Remember to listen to your doctor’s advice about avoiding heavy lifting. 

Want to learn more about surgery?

Join one of our COLONTOWN Facebook groups:

  • COLONTOWN Downtown Come visit COLONTOWN’s main street for general discussions about surgery
  • Corner Cupboard for discussions on side effect management
  • Palliative Pathways for advice on how your palliative care team can help you cope with side effects
  • Rectalburgh for patients with rectal cancer

Want to join? Fill out the registration form here.

COLONTOWN University has so much more to offer, from DocTalk videos with CRC experts to easy-to-understand biomarker test breakdowns. We’re here for you! See our list of Learning Centers here.

What happens after surgery?

After you come out of surgery, you will stay at the hospital for several days. The length of time you’ll stay depends on a couple factors, including your health history and the type of surgery you had. At the hospital, your healthcare team will monitor you and make sure that you are recovering well.

Initially, you may be hooked up to lots of tubes and wires. You will have nurses and doctors coming in at regular intervals to check on your vital signs and administer medications. 

It’s important to note that this section is most relevant for those having lower GI surgery. 

At the hospital

Can I eat?

When you wake up from surgery, you may have a nasogastric (NG) tube. This tube goes through the nose and into the stomach, and provides you with nutrition without putting stress on your digestive system. After surgery, your intestines will likely be paralyzed, which means that you can’t properly digest anything you eat or drink. So it’s especially important to start eating and drinking slowly to make sure everything is working properly.

First, you will receive all the fluids you need intravenously. When you start to pass gas — also known as farting! — it’s a good sign that your colon is starting to work again. Then, your healthcare team will remove your NG tube and start you on a liquid diet. They may start you off with ice cubes. They will monitor your nausea and abdominal pain levels. If this goes smoothly, then you will progress to a low-residue/low-fiber diet. You should continue a low-residue diet for 2-8 weeks after your procedure, depending on your surgeon’s instructions. This is particularly important if you have an ostomy, in order to prevent dehydration and blockages in the initial weeks after surgery. You can learn more about low-residue diets in our ostomy section.

Can I walk around?

Within a day or two, you should be able to sit upright and walk short distances. Walking as soon as you can helps with your circulation and encourages your bowels to return to normal. Regular movement will also help your recovery in general. This will be difficult and painful at first, but your nurse is there to support you and make sure that you are moving safely. It is also easier to start walking while your pain is well-managed with medication. After you become more comfortable getting out of bed and moving around, you can start walking independently or with the help of a visitor.

Your team should be able to arrange for a mobility device for you to take home, such as a walker or a wheelchair. They can also refer you to a physical therapist who can visit you in the hospital and at home to help with your recovery

What kind of exercises should I do?

Your healthcare team will give you personalized instructions to follow after surgery. Likely, these instructions will include breathing exercises to prevent respiratory complications like pneumonia. Make sure that you are inflating your lungs completely. It may be painful at first, but these exercises help clear any fluid leftover in the lungs from surgery. Chat with your physical therapist about other types of exercise they recommend.

What do I do if I’m in pain?

You will be prescribed pain medication, likely intravenously at first. You will then transition to oral pain meds before you are discharged. If you are feeling uncomfortable, let your healthcare team know. 

At home

How do I take care of my incision?

Your surgeon or nurse will give you instructions on how to care for your incision. Follow these instructions carefully!

Your incision will be dressed with a sterile bandage. Keep this bandage on until it falls off, or until your doctor removes it. You may also have stitches or staples that will fall out on their own, or need to be removed later by your surgeon. Ask your healthcare team which type of sutures you received. 

There may be some redness around the edges of your incision. Keep an eye on it and check for infection. If the drainage is green or yellow, or if the skin around the incision is getting increasingly red or warm to the touch, call your doctor.

What do I do if I’m in pain?

Make sure to take your pain medication as prescribed. You want to make sure that you are staying ahead of the pain — don’t wait until you are feeling poorly to take your next dose. If you need a refill of your prescription pain medications, be sure to call several days in advance to make sure you receive more before you run out. After checking with your doctor, you may also add ibuprofen (Advil) or acetaminophen (Tylenol) to your pain medication regimen. 

What if I have a fever?

A low-grade fever is common after surgery. Your temperature may vary, but if it exceeds 101.5°F or if you are vomiting, have chills or flu-like symptoms, contact your doctor immediately.

What if I’m constipated?

Constipation is common after surgery. Taking common prescription pain medications can cause your intestines to move slower.  Constipation is less common if you have an ileostomy. You can speak with your doctor about taking a stool softener with your pain medications. You may also try prune juice or milk of magnesium, if your doctor okays it.

What if my ostomy output is too liquidy?

Liquid output is common in people with new ileostomies. People with ileostomies can become easily dehydrated, so avoiding liquid output is really important. Ileostomy output should be the consistency of nut butter. If it isn’t thick enough, foods like white rice, bananas, white bread and pasta can help slow down your digestion. If that doesn’t help, contact your team. It may be necessary for you to take anti-diarrhea medications such as Immodium.

What kind of activities can I do?

Take it easy. Do not do any strenuous activities or lift more than 5 to 10 pounds for at least 4 to 6 weeks after surgery. Just for reference, a gallon of milk weighs over 8 pounds! If you are struggling with returning to physical activity, you can request a referral to a physical therapist to help. You can begin having sex again when you feel ready, usually 4-6 weeks after your surgery. Chat with your doctor about any specific questions you have.

Can I shower or bathe?

Do not fully immerse yourself in water, like in a bath tub or hot tub. You can shower 24 to 48 hours after surgery, unless your doctor says otherwise. Leave all of your bandages on while showering. Be sure to dry the area very well afterwards.

Can I drive?

Don’t drive while taking prescription pain medications. Reach out to family and friends if you need them to run errands for you, or drive you places. After you stop needing pain medications, and you feel ready to get behind the wheel again, you can drive.

When can I go back to work?


You can likely return to work 3 to 4 weeks after a traditional open surgery, and 1 to 2 weeks after a laproscopic surgery. However, this all depends on what kind of work you do. Warehouse work and office work will require different reintroduction plans. Chat with your family, doctor and employer to make a plan.

How should I monitor my cancer?

There are a number of things your team will do after surgery to monitor your cancer. If you live in the US, your oncologist will be guided by the NCCN recommendations for colon and rectal cancer.

If you were diagnosed at stage I, II or III, you will have a colonoscopy one year after your surgery. If the results are normal, you will come back after three years, then every five years after that. If any cancer is found, you will come back more frequently.

If you are stage II or III and having chemo, immunotherapy, or other targeted therapies, you will have scans every 3 months while on treatment, then every 6 to 12 months after finishing treatment for the first 5 years. You will also have a general medical exam, including routine blood work and CEA testing every 3 to 6 months for the first two years, and every 6 months for the next three years after that.

If you were diagnosed at stage IV, you will have scans approximately every three months while on treatment. If you reach NED following surgery, the monitoring recommendations are similar to those for stage II and III patients.

Your healthcare team may also recommend some newer tests, such as Signatera and Guardant Reveal, which test for ctDNA (circulating tumor DNA). They may be able to detect reoccurrence several months before they become visible on scans. For more information, check out our testing Learning Center.

When can I start chemotherapy?

Most people need 6-8 weeks to recover after surgery, and if you need post-surgery chemotherapy, it will usually start around that time. However, the timing depends on your own personal situation and recovery plan. Chat with your oncologist about your treatment timeline for more information.

Want to learn more about recovering from surgery? 

Check out this video by FightCRC.

Diagnosed: November 2018

Stage: IVA

Type: Rectal cancer with 5/24 positive lymph nodes and two liver mets

Biomarkers: MSS, KRAS, G12D

Treatments: Surgery to remove primary tumor and complete hysterectomy, six treatments of FOLFOX with Avastin, liver resection with gall bladder removal, six treatments FOLFOX with Avastin. Curative intent from the beginning of treatment. After six treatments of FOLFOX with Avastin, referred to a surgical oncologist for open liver resection.

At the first appointment, the surgery date was set up, all pre-surgery bloodwork was ordered and I met with a dietitian that helped me plan for what I should eat following surgery. They gave me a lot of information and I felt well-prepared for the post-surgery challenges, particularly the depressed appetite and extreme fatigue. In anticipation of low energy, I prepared several high-protein, single-serving freezer meals to make it easy to follow the dietitian’s suggestions following surgery. Eating enough was a challenge and I had a pretty limited diet of protein drinks, boiled eggs, and peanut butter on half a bagel, along with the meals I had frozen, to ensure I was getting the protein needed for recovery.

Because I was getting Avastin with chemo, surgery was scheduled for six weeks into my chemo break and chemo was not resumed until seven weeks post-surgery. Two portions of my liver, one in each lobe, were removed, along with my gall bladder. The incision was closed with glue. Pathology confirmed clear margins. The hospital placed a binder around my abdomen that remained on at all times, except when showering. I continued to wear the binder for about 8 weeks following surgery to support my weakened abdominal muscles. Unfortunately, I later developed a hernia at the incision, about six months after the resection, when I started doing exercises, like crunches, to strengthen my abs.

I was given a choice between a nerve block and an epidural for the surgery. I chose the epidural, which meant the catheter remained until 24 hours after the epidural was removed. Overall, the epidural did a good job with pain management in the first couple of days following surgery.

Walking, beginning the day after the liver resection, is so important. Because the fatigue is tough in the first few weeks, I focused on many short walks throughout the day. I had been very active leading up to surgery, walking or running most days, which helped with my recovery. Regular napping was also important in the recovery process. Slowly, I was able to walk longer distances and nap less.

I was in the hospital for five days. My surgeon and two of his nurses checked on me every day. They were so good about answering my questions and making sure I was as comfortable as possible after such a tough surgery. Having confidence in your surgeon is so important and I could not be happier with the care I received from his entire team.

Once home from the hospital, I quickly learned I could not comfortably lay flat. I chose to sleep in a recliner for many weeks, as I just found it easier to get up and down. My husband stayed with me for the first couple of days after I returned home, but I was quickly able to take care of my basic needs.

One thing that surprised me was how much hair I continued to lose after the surgery, especially after being off chemo for so many weeks.

From the beginning of treatments, I asked my mother to be the one to update my family after surgeries and/or treatments. This was so helpful since I did not have the energy to talk to many people.

 

Want to learn more about surgery?

Join one of our COLONTOWN Facebook groups:

  • COLONTOWN Downtown Come visit COLONTOWN’s main street for general discussions about surgery
  • Corner Cupboard for discussions on side effect management
  • Palliative Pathways for advice on how your palliative care team can help you cope with side effects
  • Rectalburgh for patients with rectal cancer
  • In Stoma City you’ll find answers to your ostomy questions and lots of stories of ostomates living life to the fullest!

Want to join? Fill out the registration form here.

COLONTOWN University has so much more to offer, from DocTalk videos with CRC experts to easy-to-understand biomarker test breakdowns. We’re here for you! See our list of Learning Centers here.

Surgery day: What to expect

Before surgery

Surgery day has arrived! What happens on the day of surgery can vary greatly depending on your specific procedure and the hospital you’re having your operation at.

When you arrive at the hospital, you will be asked to register. You may be asked for a photo ID and your insurance details. You will also be asked to sign consent forms for the procedure.

Once the surgical team is ready for you, you’ll change into a hospital gown. Your care team may ask you why you are there. This is to find out what information you already know about your procedure! A nurse will ask you some basic questions about your recent medical history and check your vital signs. Then, they will insert an IV, so you can receive drugs and fluids throughout your procedure and hospital stay. Sometimes you can get your IV in your port or PICC line, other times they will insert a cannula in your arm. You may get some basic lab work done, or other types of monitoring such as an EKG, to make sure that you are healthy enough to go into surgery. You may also be asked to confirm the contact details of the person you would like them to call with surgery updates. 

During this time, you will probably have a lot of different people asking you to repeat your name and date of birth multiple times. It can get pretty annoying! But this is to make sure that there is no mix-up between patients, and that you are getting the right procedures, tests, and medications. 

After all this prep is done, you’ll be taken to the operating room where you will be given general anesthesia. This is administered through your IV. You may be asked to start counting to 10 — and you will likely doze off before you hit 5. That’s the last thing you’ll remember before waking up in the recovery room!

After surgery

You may wake up with a lot of tubes and wires all over your body. Don’t be alarmed! You may have an IV drip for fluids and medications, as well as a heart monitoring device, a device to monitor your oxygen levels, a catheter so you don’t need to move to pee, and a nasogastric tube to give your digestive system a rest. You may also have a device that delivers morphine when you press a button. It seems like a lot, but don’t worry, this will all come out before you go home. If you are in pain, or have any concerns, let your team know right away so they can adjust things for you.

Some patients may be offered a pain-reducing procedure called a nerve block, which can be administered after surgery and requires an additional consent form. Nerve blocks can reduce the amount of pain medication needed after surgery.

After a period of time in the recovery room, you’ll be taken to your hospital room. Here, you’ll be monitored for a couple days, depending on your type of surgery and your health history.

In the US, you will likely not get anything to eat the day after surgery. Patients are given ice cubes or a wet towel to suck on for hydration. The day after, you may start eating a little bit of food.

Patients receive medication to stop gut motility for surgery, so you may need some extra time for your digestive tract to wake up. Some patients have issues peeing after surgery, but this improves over time. Make sure to communicate with your care team about your side effects throughout the recovery process. 

How long you stay in the hospital is usually based on specific milestones as well as a potential observation period to make sure you don’t have an infection. These milestones can include how well you fart and poop, as well as how well your pain is managed by oral medication. If a specific discharge timeline is helpful for you, chat with your surgeon about what specific milestones they want you to reach before discharge.

Want to learn more about surgery?

Join one of our COLONTOWN Facebook groups:

  • COLONTOWN Downtown Come visit COLONTOWN’s main street for general discussions about surgery
  • Corner Cupboard for discussions on side effect management
  • Palliative Pathways for advice on how your palliative care team can help you cope with side effects
  • Rectalburgh for patients with rectal cancer

Want to join? Fill out the registration form here.

COLONTOWN University has so much more to offer, from DocTalk videos with CRC experts to easy-to-understand biomarker test breakdowns. We’re here for you! See our list of Learning Centers here.

How should I prepare for surgery?

It’s important to follow your surgeon’s specific advice when getting ready for surgery. Here are some general guidelines, and things to keep in mind.

What should I do before surgery?

Before your surgery date, you’ll have a preoperative appointment with your surgeon. In this appointment, you’ll receive instructions on how to prepare for surgery. Make sure you understand all of the instructions and address any questions or concerns that you have. It’s very important to follow the surgery prep as closely as possible to help make sure your procedure goes well.

Be sure to tell your surgeon about any medications, vitamins or supplements that you take. You may be asked to discontinue some of these one or two weeks before surgery, because some medications and supplements can thin the blood or interact with anesthesia drugs.

Your cancer center will likely give you a pre-surgery protocol to help your body prepare for surgery. If you are not given one, you can ask your surgeon. 

An evidence-based pre-surgery protocol that you may be directed to by your care team is the ERAS protocol (Early Recovery After Surgery). Read more about the ERAS protocol here.

Here is a general example of a pre-surgery protocol:

Check out this example from the University of Kansas Health System. Of course, your surgeon will give you a protocol specialized for you.

If you are having your primary rectal or colon tumor removed, you will need to clear out your colon so the surgeon can see the area clearly — just like having a colonoscopy. This is called “bowel prep.” Starting at midnight the night before your surgery, don’t eat or drink anything. This includes water! Your healthcare team may refer to this as “nothing by mouth” or “NPO.”

If your doctor okays it, you may continue to take your medications as prescribed with a small sip of water. You may be given antibiotics to take the evening before surgery to help prevent infection. Do not smoke, starting at midnight before your surgery.

If you are having a different type of surgery, for example, a liver or lung resection, you will probably not be required to do a bowel prep — but you will have other instructions to follow. Make sure you understand the instructions and follow them as closely as possible. 

How do I prepare my colon or rectum for surgery?

Your colon or rectum needs to be cleaned out before your surgery. This is often called “bowel prep,” and if you’ve had a colonoscopy before you have already done this process! You will probably be asked to go on a clear liquid diet for 12 to 24 hours before surgery. This means you can only drink liquids, including clear broth, black coffee, jello and clear fruit juice.

Enemas and laxatives are also used to physically clean out your colon and rectum. Your healthcare team will either provide these for you, or give you directions on where to purchase them. None of this is very comfortable, but it’s crucial to follow your surgeon’s instructions.

What should I bring to the hospital?

In general, it’s a good idea to avoid taking too many things with you. You don’t want to lose track of your items, or stress about where things are. The hospital will provide most things that you need. You will likely be in the hospital for several days following your surgery, so you can always have visitors bring anything you forgot. You will probably need help and support while in the hospital, so enlist family and friends ahead of time.

Here’s a basic list of what you might need to bring:

  • A list of all your medications and their dosages
  • If you wear contact lenses or glasses, bring a case and remove them before going into surgery
  • Insurance identification cards and photo ID
  • A copy of any Advanced Directives you may have
  • Contact details of the person you would like your surgeon to call about updates on your surgery
  • A friend or family member to drive you home from the hospital after you are discharged
  • A change of clothes to wear after you are discharged
  • Basic toiletries: toothbrush, toothpaste, shampoo, etc
  • Simple home comforts: slippers, cozy socks, a fuzzy blanket, etc
  • Many COLONTOWN members suggest bringing an extra-long power cord and ear plugs

What should I leave at home?

The hospital will provide the great majority of what you need. 

Here is what you should leave at home:

  • Anything that is irreplaceable, such as family heirlooms or jewelry
  • Large sums of money or credit cards
  • Artificial nails or nail polish. Your nails will be monitored during surgery to check oxygen levels and blood circulation
  • Makeup, lotions, powders, etc. Make sure your face is clean before surgery

Want to learn more about surgery?

Join one of our COLONTOWN Facebook groups:

  • COLONTOWN Downtown Come visit COLONTOWN’s main street for general discussions about surgery
  • Corner Cupboard for discussions on side effect management
  • Palliative Pathways for advice on how your palliative care team can help you cope with side effects
  • Rectalburgh for patients with rectal cancer

Want to join? Fill out the registration form here.

COLONTOWN University has so much more to offer, from DocTalk videos with CRC experts to easy-to-understand biomarker test breakdowns. We’re here for you! See our list of Learning Centers here.

What kinds of surgery are there?

Some early-stage colorectal cancers can be removed during a colonoscopy. Other tumors require more extensive procedures — which come with additional prep work and recovery time.

How surgery is used in a treatment plan and the timing of surgery depends on the stage and location of the tumor(s). Other factors include your health, risk of disease growth, goal and type of surgery, chance of recurrence and risks to the organs involved. Similarly, your eligibility for surgery depends on the moment in time and can change as your disease, health and circumstances change. 

It’s important to talk with a surgeon to get an opinion about your eligibility for surgery. You may want to talk with multiple surgeons, as opinions can vary. 

Here are some of the procedures that colorectal cancer patients commonly have:

Primary tumor procedures

Metastases procedures

Sound like a lot of different options? We’ll walk you through what all these words mean. And warning — there are some images and depictions of surgery ahead.

Primary tumor procedures

Polypectomy

Polyps are growths that stick out from the lining of the colon or rectum. These growths may contain cancer, or may develop into a cancerous tumor if left unchecked. Polyps are usually found during a colonoscopy, and this minimally-invasive procedure is done to remove them. 

Local excision

This procedure is done on very early stage tumors. The doctor uses a colonoscope inserted into the anus to remove the tumor, along with some surrounding healthy tissue. This procedure is minimally invasive and usually done as an outpatient procedure.

Colectomy/Resection

Through a colectomy, part or all of the colon is removed. This is also commonly referred to as a resection. This is a major surgery that may require significant preparation and recovery, depending on the surgical methods used and type of colectomy. This surgery may result in a temporary ostomy. Here are some of the types of colectomies available.

In this surgery, the upper part of the rectum is removed, along with local lymph nodes. Depending on various factors, a temporary ileostomy may be required.

This procedure is referred to humorously by COLONTOWNies as the “Barbie/Ken butt surgery” because the sigmoid colon, rectum, and anus are completely removed. The area where the anus used to be is stitched up. This surgery is done when patients have tumors that invaded all those areas. In some cases where patients have had prior radiation for a rectal tumor, the surgeon may need to transplant a section of the abdominal or thigh muscle to strengthen the area and help the incision heal properly. After this procedure, patients will have a permanent colostomy.

This is also referred to as a hemicolectomy or segmental resection. In this procedure, a surgeon removes part of the colon, its blood supply, the peritoneal covering and nearby lymph nodes in one block. The remaining parts are joined together after in a procedure called anastomosis. If your tumor is not too large, and in an area that can be easily reconstructed, you may have this procedure. The image below shows an example of one type of partial colectomy.

This procedure is done when a patient has a right-sided tumor that requires removal of the entire right side of the colon. All lymph nodes in the area are removed.

Patients who have this surgery usually have tumors in the sigmoid colon and rectum. During this operation, the diseased part of the sigmoid colon and rectum are removed, along with local lymph nodes. The surgeon can usually connect the sigmoid colon to the anus, so an ostomy is sometimes not required.

This surgery is usually done for stage II and III rectal cancer patients who have tumors in the middle or lower third of the rectum. The procedure involves the removal of the entire rectum, including all lymph nodes near the rectum. The surgeon can usually connect the colon and anus, so patients may not need an ostomy. Sometimes a surgeon may put a colonic j-pouch in to prevent a permanent ostomy. In this case, the surgeon doubles back a small section of the colon to serve as a pouch to hold stool in place of the rectum. If this happens, patients may require a temporary ileostomy while the surgical site heals.

This operation is done when a patient has a rectal tumor that has grown into nearby organs. In that case, the entire rectum, along with any diseased organs, such as the bladder, prostate, or vagina are removed. This surgery requires a permanent colostomy, as well as a urostomy or nephrostomy if the bladder is removed.

In this procedure, the entire colon is removed. After a total colectomy, patients will have a permanent colostomy. This is usually a prophylactic surgery done for people who have an inherited predisposition to colorectal cancer.

This is an extensive bowel operation. It involves the removal of the entire rectum and colon. After this procedure, patients have a permanent colostomy. This is usually a prophylactic surgery done for people who have an inherited predisposition to colorectal cancer and are not applicable to everyone.

Confused about all the different types of resections?

Here’s an image that should make things clearer:

Exploratory laparoscopy

An exploratory laparoscopy or diagnostic laparoscopy is a minimally invasive procedure done to diagnose disease that can’t be seen well on scans. This procedure can be done for other reasons too, such as to take a better look at possible peritoneal metastases. In CRC, this is sometimes used for patients with peritoneal mets to determine whether a patient is a candidate for cytoreductive surgery or HIPEC. In this procedure, the surgeon makes several small incisions in the abdomen, and inserts a laparoscope (a small camera) to take images. After the procedure, the laparoscope is removed and the incisions are stitched up.

Fecal diversion (colostomy or ileostomy placement)

Usually, poop travels through the colon, rectum and finally, anus. When the path between stomach and anus is disrupted by surgery, poop needs to be diverted elsewhere. In a fecal diversion surgery, surgeons create a stoma — an opening of the bowel through the skin. In a colostomy, the end of the colon is attached to the skin. In an ileostomy, the small intestine is attached to the skin. Ostomies may be temporary or permanent, depending on the type of surgery. This surgery can be done at the same time as another resection surgery, or is done when there is an issue like a blockage. For more information about ostomies, check out our ostomy section.

Ostomy reversal

As mentioned above, some ostomies are temporary and are meant to give the surgical site time to heal. If you have a temporary ostomy, you will likely have it reversed at some point. In this procedure, the surgeon takes the piece of colon that formed your stoma and reconnects it to the rest of your intestines. For more information on what happens after ostomy reversal, and how to help get your bowels working again, see our section on ostomy reversal.

Want to learn more about surgical options?

Watch this webinar by FightCRC. 

Metastases procedures

Lung resection

If your cancer has spread to the lungs, you might have a lung resection. In this procedure, part or all of the lung is removed. This procedure can be done either through traditional open surgery, or through more minimally invasive procedures, such as video-assisted thoracoscopic surgery (VATS). In this procedure, the surgeon makes several small cuts, then uses a special camera called a thoracoscope to help locate and remove tumors. This procedure is usually done one lung at a time

For more information on lung resection, see this article from the Cleveland Clinic.

HIPEC

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a two-part treatment used to treat cancer that has spread to the peritoneum (the lining that surrounds the abdomen). The first step is called tumor debulking, or cytoreductive surgery (CRS). In this procedure, the surgeon cuts into the peritoneum and removes any tumors that they can find. Next, heated chemotherapy drugs are delivered directly into the abdomen to treat any microscopic cancer cells that remain. The combination of heat and chemotherapy can eliminate more cancer cells than can be found by the naked eye. This is a very specialized and extensive surgery and often takes more than 10 hours to complete.

HAI pump placement

A hepatic artery infusion (HAI) pump is used to treat cancer that has spread to the liver. This is usually done in patients with limited liver disease. In this procedure, a device the size of a hockey puck is implanted in the skin between the ribs and pelvis, and is connected to the liver by a small catheter. It delivers targeted, concentrated chemotherapy to the liver. HAI pumps are often placed during surgery to remove liver tumors. Research has shown that patients who have a HAI pump placed during liver resection may have a lower chance of liver reoccurrence than those who did not have a HAI pump placed. However, the HAI pump is not available at every cancer center, so you may have to travel to receive this treatment.

Watch this DocTalk with Dr. Gholami from UC Davis for more information on the HAI pump:

Liver resection

Some patients with liver metastases will qualify for surgery to remove their liver tumors. Sometimes the surgeon will remove only the sections of liver that contain tumors, while other times, the entire right or left lobe of the liver is removed. The liver has the capability of regenerating after surgery, so some patients may have up to 70% of the liver safely removed. If tumors are located on both lobes of the liver, it’s sometimes possible to remove them in two separate surgeries.

Liver surgery may be part of a larger treatment plan. In addition to surgery, patients may need chemotherapy, radiation therapy, or other treatments in combination with liver resection. When deciding whether or not liver resection is a good option, surgeons will consider the location and size of the tumors, as well as any other tumors the patient has. 

DocTalk: Dr. Hernandez-Alejandro gives an overview of surgical options for liver mets:

Want to learn more about liver resection? 

Check out this guide by the UCSF Helen Diller Family Comprehensive Cancer Center: Understanding Liver Resection

Liver transplant

Liver transplant surgery is currently being used to treat CRC patients with liver-limited disease. A liver transplant usually requires a living liver donor and the patient has to meet very specific criteria in terms of their diagnosis, overall health and performance status. 

Meet four liver transplant patients and hear about their experiences:

Why liver transplant for mCRC is taking off: Dr. Hernandez-Alejandro

Local treatments

Ablation

Ablation is a minimally-invasive technique that is commonly used to treat small liver and lung mets. This procedure is done by inserting a needle or probe into the tumor. The surgeon uses scanning technology to guide the needle into the correct position. Depending on the type of ablation, the needle delivers a dose of either high heat or extreme cold to kill the cancer cells.

Ablation is most successful with mets that are smaller than 3cm or 1 inch, and can only be used to treat a limited number of tumors — although doctors don’t always agree on what number that is. Ablation damages a small number of healthy cells surrounding the tumors, so it may not be possible if the tumor is near a major blood vessel, bile duct, or other sensitive area in the body.

Ablation is a procedure with few side effects, although some patients may experience mild pain or discomfort, temporarily reduced lung or liver function, elevated temperature, and in rare cases infection. If you experience any of these side effects, communicate with your team so they can help you manage them.

There are several types of ablation that may be used:

Radiofrequency ablation (RFA)

This is the most commonly used type of ablation. In radiofrequency ablation, a needle or probe is inserted through the skin into the tumor and high-energy radio waves heat up the tumor and kill cancer cells.

Microwave ablation (MWA)

In microwave ablation, a needle or probe is inserted into the tumor and electromagnetic waves are used to heat up the tumor and kill the cancer cells.

Cryoablation (Cryotherapy)

In cryoablation, a metal probe is inserted into the tumor and cold gasses are injected into the tumor. This causes the tumor to freeze, killing the cancer cells.

Want to learn more about surgical options?

Watch this webinar by FightCRC. 

Want to learn more about surgery?

Join one of our COLONTOWN Facebook groups:

  • COLONTOWN Downtown Come visit COLONTOWN’s main street for general discussions about surgery
  • Corner Cupboard for discussions on side effect management
  • Palliative Pathways for advice on how your palliative care team can help you cope with side effects
  • Rectalburgh for patients with rectal cancer
  • Liver Lover’s Lane for info on treatment for liver mets
  • Lungston for info on treatment for lung mets
  • Peri Place & HIPEC Heights for info on treatment for peritoneal mets
  • Transplantation Station for info on liver transplant surgery
  • HAI Pump People for info on the HAI Pump for liver mets

Want to join? Fill out the registration form here.

COLONTOWN University has so much more to offer, from DocTalk videos with CRC experts to easy-to-understand biomarker test breakdowns. We’re here for you! See our list of Learning Centers here.

What is surgery?

Many patients with colorectal cancer will have surgery at some point during their treatment. In surgery, tumors are physically removed from the body by a surgeon or surgical oncologist, a doctor who specializes in removing cancer. For non-metastatic cancer, treatment usually involves removing the primary tumor. For metastatic cancer, several factors determine whether the primary tumor will be removed.

The majority of this section will focus on surgeries in the colon and rectum.

How is surgery used to treat colorectal cancer?

Surgery can play different roles in treatment depending on the stage of your cancer.

Non-metastatic cancer

For patients with early-stage cancers, surgery can be curative on its own. Some patients also receive chemotherapy after surgery. 

Metastatic cancer

For patients with oligometastatic cancer — meaning cancer with some, but limited, cancer spread — surgery is used to remove a small number of metastases in patients with a good response to chemotherapy. Some stage IV patients have surgery first to address a blockage or something that needs to be addressed immediately. 

How will surgery fit into my treatment plan?

Your healthcare team has many different experts, including an oncologist and surgeon. Together, they will come up with a plan for treating your cancer, which can include surgery, radiation, chemotherapy or other medications.

Stage I and II colon cancer patients usually have surgery shortly after diagnosis. After surgery, patients may have chemotherapy. However, chemo is not usually recommended for stage I or II patients who are MSI-H or have a low risk of recurrence. Most stage III colon cancer patients will also have surgery first, while most stage II and II rectal cancer patients will have either chemo or chemoradiation first. Some stage II and III rectal cancer patients who have a complete response to chemo and radiation (tumor not seen based on many criteria) may not get surgery and instead follow a “watch and wait” approach.

For stage IV patients, chemo is usually the first and primary treatment. It is understandable that some patients want their tumors removed immediately, but research suggests that removing the primary tumor does not affect overall outcomes (meaning with and without removal of the primary tumor, the outcomes for stage IV patients with more extensive disease are similar).

Some stage IV patients who respond well to chemo may eventually qualify for surgery at some point during their treatment. These patients may have multiple surgeries to remove both their primary tumor and metastases.

For more information on sequencing chemotherapy and surgeries, read our chemo sequencing section. The NCCN Guidelines for Colon and Rectal Cancer are a great place to start as well.

Want to learn more about surgery?

Join one of our COLONTOWN Facebook groups:

  • COLONTOWN Downtown Come visit COLONTOWN’s main street for general discussions about surgery
  • Corner Cupboard for discussions on side effect management
  • Palliative Pathways for advice on how your palliative care team can help you cope with side effects
  • Rectalburgh for patients with rectal cancer

Want to join? Fill out the registration form here.

COLONTOWN University has so much more to offer, from DocTalk videos with CRC experts to easy-to-understand biomarker test breakdowns. We’re here for you! See our list of Learning Centers here.