Questions about surgery..

[Kirsty5]

Hello everyone,

My Dad (76) is having an anterior colon resection at the end of this month. He has multiple myeloma, and was having bleeding and it was determined that he had a tumor (with no lymph node involvement) that will have to be removed. The first surgeon that he went to see was a general surgical oncologist in Surrey BC. During the meeting with this surgeon (of whom I could find absolutely no online trace) he said he was confident that my Dad would " Definitely not need a (colostomy) bag..." Looking around on these forums, I learned that a colorectal surgeon is preferable over a general oncologist. I suggested a gastro Doctor that his GP referred him to, and have every confidence in the second surgeon (Vancouver B.C.) This doctor will be performing the surgery laparoscopically which is by no means standard practice yet here in BC. However, this surgeon said that my dad will have a bag for six weeks in order for proper healing. (He said there is a small chance that it will be permanent, but my Dad's resection is high enough in the intestine that is seems unlikely) My Dad has some problems with his fingers, they are not very dexterous due to myeloma joint pain and he is understandably anxious about using the ostomy bag. (The stoma will hopefully be reversed in 6-8 weeks, as I remember. I am part of making these choices for my Dad, and I want to make sure we are making the right one.

Can anyone tell me why two surgeons (one considerably more experienced) would have such different opinions on a surgery? From what I see online, some laparoscopic surgeries do not always require an ostomy appliance. This confuses me... if my Dad's cancer is early stage and in a favorable place in the colon (maybe favorable is a stretch..) why will he need a stoma? We have been assured by many that this doctor/hospital performs more of these surgeries than any other area, and I cannot understand why two surgeon's approaches would vary so much.

Sorry for the long post, any and all insight will be truly valuable.

[weisssoccermom]

Welcome to the board. A colostomy is different than an ileostomy which is what the second surgeon is likely referring to. Make sure that although the first surgeon doesn't think he will need a colostomy (generally a permanent ostomy), that your dad might not need an ileostomy.

After some colon and most rectal surgeries, it is not uncommon for a surgeon to perform an ileostomy ...a surgical procedure where a part of the small intestine is pulled through the abdominal wall to form a stoma.....in order to allow the anastomosis (the parts that are rejoined) to heal without anything going through it. That is very common.

My point is ask the first surgeon if he is planning of performing an temporary ileostomy. This may be a case of semantics and not being 100% truthful. No surgeon can give the patient a 100% guarantee about whether he/she needs any form of an ostomy until that surgeon is inside and sees exactly what he/she is dealing with. I'm guessing that the second surgeon is erring on the side of caution to allow your dad the ability to heal correctly. As we age, we heal slower and the second surgeon may be feeling that he would be rather be safe than sorry. If, for example, the connection has a leak or something happens, that could be devastating to any patient but a patient of your dad's age could suffer serious consequences.

My advice...ask the first surgeon WHY he isn't planning (perhaps he is but is just telling you that your dad won't need a PERMANENT colostomy) on doing a temp ostomy to allow your dad to heal.

[crikklekay]

Before his surgery to remove the part of his colon with the tumor we were told by his surgeon that she would try to reconnect him without an ostomy but she couldn't guarantee it, it would all depend on what she found once she got in. Unfortunately, he was so bad off an ostomy was needed which he had for his 10 months of treatment. Then when it was time to reverse the colostomy she said that she may still need to do a small ostomy (I think the term is loop ileostomy) to give his rejoined parts time to heal and she assured us it would be easy to reverse once he was good to go. Thankfully that wasn't needed, but we had a good doctor who explained all the possibilities to us beforehand.

If your Dad's surgeon goes in and worries that it may not heal properly without the rest he may need an ostomy temporarily. If that is the case you should talk to the wound care department and see if you can have home health come by to help your Dad. It takes some getting used to, and the wound care nurses were a lifesaver for us.

Good luck!!

[Kirsty5]

Thank you for these lovely thoughtful replies, and for the patience when I don't have all the terms right. I certainly have faith in this surgeon, though I am confused as to why they keep calling it a complex surgery when there is (thankfully) no lymph node involvement. I have since learned that it is a loop ileostomy after TME surgery. Sorry for the late reply, I had submitted a reply much earlier but my connection had dropped. Surgery is tomorrow.