Upcoming surgery nervous and looking for pointers

[Sgost]

I am new to the club and have been lurking in the shadows for the past month or so. I was diagnosed 3-16-2017 with cancer of the sygmoid close to the rectum. I have my surgery scheduled for 5-13 a lap performed robotically. I am quite nervous as I am an obese person and they have said that they cannot do an ileostomy or colostomy on me because of my weight. The surgeon state he does not foresee any issues as I am otherwise perfectly healthy. He did state there is a small chance that a leak could happen in the resection of the colon and that in my case it could most likely be fatal. My question is has anyone had an issue with a leak after the surgery or are there any other obese patients that have undergone this surgery that can give me some insight on how it went. They are staging the tumor as III b so I will be getting chemo following the surgery. My Ct scans were clear. I appreciate anyone giving me what I should expect after the surgery and any insight you can share. I am 50, scared, and doing way too much googling.

[mpbser]

Hi sgost,

I can relate, big time. I am supposed to be having surgery soon myself and am obese. My surgeon did not caution me at all about obesity interfering with ileostomy. Now I am super worried.

How did you manage to get a staging before any surgery? My oncologist won't even see me until after I have surgery. My surgeon gives his rough, non-oncologist estimate that I have stage III based on the CT showing suspicious nodal involvement but nothing more specific than that. I am especially interested in how they determined it to be "b" in your case.

I wish I had more information to help you. You do sound like you are in good hands, though.

Best,
mpbser

[Lee]

Hi and welcome.

I am not over weight. Butt I know that being over weight can come with it's own set of issues, butt I do believe it is possible. Many people are overweight and have this surgery. By any chance is a "board certified" colon rectal surgeon doing your surgery? If not, might want to consider looking for one. They have the extra training dealing with these types of surgery.

Best advice I can give you, walk, walk, walk those hospital halls following your surgery. It helps in the healing process and will get you out of the hospital faster.

Bring some comfortable walking slipper and a long wrap around robe. You will be hooked up to an IVs those first few days with a gown open to in the back . That robe will be easy to get in and out of and provide the proper protection you need.

Many people bring computers, IPod, etc for entertainment. I remember mostly being out of it those first few days with the attention span of a "nat"

All the best, let us know how you are doing,

Lee

[Sgost]

My surgeon basically has just given me his take for staging on what they know now. They know what layers it is through and they see a couple of lymph nodes that may be involved. They have done scans and it has not spread so that is the way they staged it.

I am at University of Michigan Cancer center he is definitely certified and does this on a daily basis. He was just straight forward in letting me know the possible challenges we face due to weight. He says he doesn't foresee any problems but does not want to have an emergency situation arise and have us not aware of the possible complications.

Thanks for responding it helps to know you are not alone and it is good to hear from those who know.

[Lee]

Thanks for responding it helps to know you are not alone and it is good to hear from those who know.

Know that you are not alone here. We have your back and there is a lot knowledgeable people here. This site was not here when I was going through treatment. Sure wish it was, would have made life a lot easier for me. Certain things that happened, I thought it was me. Found out through this site, normal.

All the best with your upcoming surgery, and remember, walk, walk, walk.

Lee

[MissMolly]

He was just straight forward in letting me know the possible challenges we face due to weight

That your surgeon is going to aim for a direct reconnection at the time of your resection, avoiding a temporary ostomy, is likely the best strategy if you are morbidly obese with the majority of your excess weight carried around your mid-section.

Here's the problem with morbid obesity and an ostomy . . . The stoma potentially can become "lost" in deep tissue folds of adipose tissue.

An ileostomy stoma is best when it is 3/4" to 1" in length, providing a spout through which fecal output falls into the ostomy pouch.

When a person has significant excess weight carried around the torso and mid-section, the stoma actually sinks into the deep tissue folds and can barely be found. The stoma comes to lie below the surface of the skin (referred to as a retracted stoma). Trying to pouch a retracted stoma is fraught with difficulties. The wafer of an ostomy pouching system does best with a flat abdominal surface. Deep tissue folds can be a nightmare when trying to pouch a stoma. Distressing leaks and severe skin irritation are frequent obstacles for the morbidly obese.

There are plenty of people who are overweight with an ostomy and do fine with finding an effective pouching system. The difficulties arise with obesity of significant magnitude where the excessive weight is carried around the torso and mid-section (as opposed to excess weight carried on the thighs or buttocks, which does not impact ostomy pouching success).

Best wishes with your surgery and recovery,
- Karen -

[mpbser]

Sgost definitely is in good hands. My surgeon told me nothing about the things you describe Karen. I'm starting to wonder if he KNOWS these risks or not! This is really quite terrifying.

[MissMolly]

In full disclosure, the other difficulty with an ostomy and morbid obesity is in the surgical creation of the stoma itself. Morbid obesity creates its own surgical challenges.

Creating a stoma demands that the surgeon be able to free adequate length of bowel to bring up to the surface of the abdomen. It is not an indiscriminate process. The bowel is innervate by vascular and nerve bundles that branch out to segments of the large intestine much like an open paper fan. The location of an intestinal resection takes into account the vascular and nerve networks and its layout. With a protuberant abdomen with grossly excessive weight, the length of bowel that must be freed is much greater . . It is like trying to free up additional line in laying of an internet cable line. Together with the limitations of the vascular and neurological tree, the freeing of sufficient length of free bowel to create a spout of a stoma (end ileostomy) or a bridge of a stoma with two openings (loop ileostomy) is more of a challenge in the bariatric patient.

In the afterncare setting, I have seen it common for the surgeon to "blame" the obese patient for the pouching difficulties that ensue. Surgeons are not good aftercare partners for those with ostomy pouching challenges. If you are morbidity obese, do resource a caring and emphatic wound and ostomy care nurse (referred to by the initials WOCN) prior to surgery.

All to say, being morbidly obese presents its own unique surgical challenges. Hospitals are more and more addressing the unique needs of the bariatric patient. Best to make sure that your surgeon is comfortable with addressing your unique surgical needs. It is always best to discuss scenarios and plan for the expected as well as possible speed bumps.

Sending you faith and hope in the days ahead,
- Karen -

[Sgost]

Got home 5-15-2017. Surgery went great. 6.5 hours but they got it all out and put back together. They took 2 lymph nodes and we will hear about their pathology in a few days. Thanks for the direction and guidance. Luckily my surgeon and team were fantastic.

[mpbser]

Great to hear it went well. Keep us posted!