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Colon and Rectal Resection (CRR)

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Colon and Rectal Resection (CRR)

Description of imagePREPARING FOR SURGERY

Pre-Op Testing & Medical Clearance

  • Your health care team will let you know if any pre-op tests are needed.
  • Medical clearance may be required if you have diabetes, heart or lung problems, or other health issues.
  • Make sure your doctor knows which medications you are taking.

If any test is needed, your doctor’s office will order your required testing, and any additional tests you need prior to your surgery.

Bowel Prep Supplies & Directions

Supplies to Purchase

Supplies can be purchased over the counter. Prescriptions are not necessary.

  • 64 ozs of Gatorade
  • 238 grams of MiraLAX powder
  • 4 Dulcolax tablets

Some patients will require an alternate bowel prep, e.g., those with diabetes, kidney or other chronic diseases, or those who are unable to tolerate this solution. Please confirm with your physician to ensure proper preparation.

The Day Before Surgery

  1. At 3 p.m.
    • Take four (4) Dulcolax tablets by mouth with a large glass of water
  2. At 5 p.m.
    • Mix the 238-gram bottle of MiraLAX powder into the 64oz of Gatorade.
    • Shake the solution until the powder is dissolved.
    • Once mixed, drink an 8 oz. glass of MiraLAX/Gatorade solution every 10-15 minutes until the solution is gone.
  3. Additional Instructions
    • YOUR STOOL SHOULD BE CLEAR once the prep is finished. If not, call the answering service and speak to a physician for the next step.
    • Continue drinking clear liquids AS TOLERATED until you go to sleep. This will keep you from becoming dehydrated.
    • DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT (including chewing gum or lozenges).
    • No solid foods after midnight the day before surgery. When you wake up, begin a CLEAR LIQUID DIET. For example: If you are scheduled for surgery on Wednesday, your last solid food should be before midnight on Monday. Begin a clear liquid diet on Tuesday.
    • Drink plenty of clear, non-carbonated liquids to prevent dehydration and to ensure bowel is thoroughly cleaned out.

Examples of clear liquids:

  • Water
  • Fruit juices without pulp (e.g. apple juice, white grape juice)
  • Clear broth or any flavor bouillon
  • Gatorade, Powerade, Kool-Aid, or Crystal Light
  • Jello
  • Popsicles, ices, or sorbet
  • Tea or black coffee (no milk, cream, or non-dairy creamers. Sugar is OK)

Bowel Prep Tips

  • The laxatives will cause diarrhea to clean out your colon.
  • Plan to be near a bathroom right after you take the laxatives and for the remainder of the evening.

Individual response to laxatives may vary:

  • They may start to work as early as 30 minutes or take as long as 3 hours.
  • It is not unusual for the solution to cause nausea.
  • If you vomit, please call physician’s office to speak with the physician on call.

Chlorhexidine Scrub (CHG) Directions

  • Use before surgery as an extra measure to remove bacteria.
  • CHG scrub is also known as Hibiclens or Bactoshield
  • Can be purchased at most large pharmacies
  • Available in liquid form or scrub brush applicator; either form is OK to use

Starting 3 days before surgery:

  • Shower daily with CHG for three (3) consecutive showers before surgery and the morning of surgery (4 times in total). For example: If your surgery is scheduled for Wednesday, please start using your CHG scrub on Sunday, then continue to use Monday, Tuesday, and Wednesday morning prior to surgery.

How to Use CHG

Showering Process:

  • Shower as usual and be sure to rinse your body thoroughly to remove any residue.

Towards the end of your shower:

  • Turn off the water
  • Apply the CHG soap to your torso (area where surgery will be performed). Avoid your genital area, your eyes, ears, and face. Pay particular attention to abdominal area.
  • Leave CHG on your skin for 5 minutes.
  • Turn the water back on and rinse your body thoroughly. (Do not use your regular soap after using CHG soap.)
  • Do not shave area where the surgery will be performed.
  • Pat yourself dry with a clean, soft towel.

If you moisturize your body, wait a few hours before applying lotion after using CHG scrub.

Where should you apply the CHG soap?

  • Please scrub the abdominal area only.

Description of imagePREPARING TO GO TO THE HOSPITAL

What to Bring to the Hospital

  • A list of all your current medications, i.e.,
  • Prescriptions and over-the-counter medications
  • Vitamins
  • Herbal supplements
  • Dosage and frequency of all medications
  • List of allergies (medications, latex, food, etc.)

What to Pack

Description of imageDO BRING:

  • Personal toiletries (toothbrush, comb, soap, etc.)
  • Slippers and bathrobe
  • Reading glasses
  • Magazines/books
  • Loose fitting clothing for going home
  • Notebook and pen to write questions or make notes

Description of imageDO NOT BRING:

  • Jewelry or other valuables
  • Your medications from home
  • Electrical appliances (i.e., hairdryers, other plug-in items)

You may wish to bring a phone charger and/or a music device with earphones.

Description of imageDAY OF SURGERY INSTRUCTIONS

You will be contacted by the team with location details and arrival time the day prior to your procedure.

Description of imagePOST-SURGERY: EXPECTATIONS

About Enhanced Recovery After Surgery (ERAS)

ERAS is a program to help you get better faster after your surgery. It’s important to do certain things before and after your surgery as part of the ERAS program.

Before your surgery, make sure you’re ready by:

  • Exercising and following a healthy diet. This will help get your body ready for your surgery.

After your surgery, help yourself recover more quickly by:

  • Starting to move around as soon as you can. The sooner you get out of bed and walk, the quicker you can get back to your usual activities.

Pain Management

We provide multi-modal pain control with minimal narcotics to help you recover faster.

What to Expect After Surgery

  • Immediately after surgery, you will be allowed to drink any clear liquids.
  • Liquids and solids will be introduced to your diet as you recover.
  • After anesthesia, deep breathing is an important part of your recovery. You will be given an incentive spirometer to encourage deep breathing. It is recommended to use this 10 times per hour when you are awake.
  • Sitting up and walking (as tolerated) is recommended.
  • You are expected to get out of bed with assistance within 12 hours after surgery.
  • Slowly increasing your activity (as your pain tolerance allows) is important for your recovery. If you are experiencing difficulty sitting up in a chair, getting out of bed independently, or walking, please notify your medical team.
  • The team recommends that you plan activities in coordination with pain medication administration. For example, wait to take a walk around the floor until after receiving pain medication if pain is a limitation.
  • You will be seen twice daily by members of the colorectal team.

Description of imagePOST-SURGERY/DISCHARGE

Going Home

Your unit’s social worker will review the following with you, and address any concerns:

  • Do I need home or rehabilitation services?
  • Will my insurance pay for these services?
  • How will I get my prescriptions filled?
  • If you are known to a home care agency prior to admission, please provide the name and contact information.

Other things to consider:

  • Ask your physician if you will be on a special diet.
  • Call your doctor’s office the day after you get home if there isn’t a follow-up appointment scheduled.

Home Instructions

  • No heavy lifting (10-pound limit)
  • Climbing stairs is allowed
  • No gym workouts – only walking until cleared by your surgeon
  • No driving until cleared by your surgeon
  • Maintain a low-fiber diet until advised by your surgeon
  • If you are allowed to shower, pat dry your surgical area
  • No baths, no swimming

Please review documents given to you at discharge to review a detailed explanation of what you may experience, and the next steps that should be taken.

Once You Are Home

  • If you have any questions or concerns once you return home please call your doctor’s office at 305-243-9110, option 4.
  • If you are having any issues with your home health agency, please call 305-689-5512.
  • Remember: Your surgeon’s instructions are tailored specifically to you, so they supersede any material discussed in the document.