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Sub-Total Colectomy Advice Needed (Due to Slow Transit Constipation)

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Posted 10/29/2010 7:44 PM (GMT 0)
Hi,

I just had the sitz marker test performed by my Gastro.  At day 3 they were in my descending colon and at day 5 90% were in my sigmoid colon (the xray people showed me).  I have a follow up appt with the Gastro in 2 weeks.  In the mean time I was visiting a friend and one of his good friends is a colorectal surgeon (ironic right!).  I told him about the way I've lived for the past 10 years and how unless I'm taking something I can't really have a normal BM by myself.  If I get off all laxatives I just push out little pebbles and use enamas.  He basically said "you should get your colon removed".  He said he does about 2 of these surgeries a month on people with slow transit and they all feel like new people afterwards.  He also said it is one of the easiest surgeries he performs and that I shouldn't be worried about having such a procedure.  He also said there are no long-term issues associated with it.  I also talked with my aunt who had her entire colon removed (small bowel attached to rectum) due to colitis and she said after she healed up she was back to new after 2 months and besides watching what she eats she really doesn't even notice she had it done (which makes me feel a lot better about a sub-total).

My questions:

--  Since the markers were in my sigmoid/rectal area at day 5 do you think I'm "bad" enough where I should get something this done?  The surgeon says the way he looks at the test is if a majority of the markers are in there at day 5 he would make a case for the procedure.  And,

--  Is the surgery and simple and non-worrisome as the Dr. makes it sound?  

Thanks!!

Posted 10/30/2010 12:01 AM (GMT 0)
sonnygarcia,
a sitz marker test is the beginning of testing, not the end. there could be other contributing factors to your constipation. these need to be ruled out or you will have your colon removed and still end up in your current predicament.

this is not a small/simple surgery like having your tonsils out. if it's done open (or even if not) there are significant risks, blood clots, adhesions, ileus, small bowel obstructions (not fun), wound infections (you might end up having to have your wound packed open until it heals), possibility of needing an ileostomy (most likely temporary but not necessarily), strictures and more. you might wake up with an NG tube until you pass stool and gas depending upon what your surgeon normally does. after surgery your small intestine needs time to adjust to it's new function. your colon mainly absorbs water. when it's gone, your small intestine needs to take over that function but it takes time. initially you most likely will have 10-20 BMs daily, mostly liquid. you have to start out slow with solid food and watch what you eat for awhile.

some people end up going back after awhile for an ileostomy because the colectomy doesn't work out for various reasons. read total colectomy parts 1-37 here and see what people have gone through, most of which do not relate to the quality of the surgery but just that things that can happen. these are not meant to scare you but inform you. that colorectal surgeon sounds a bit cavalier.
Posted 10/30/2010 3:01 AM (GMT 0)
I tried reading through the "total colectomy parts 1-37" threads but I didn't read much stuff on the Sub-total Colectomy procedure. From what I've read they would just be reconnecting the colon but removing something like 90% of it? Is that right? I was going through the threads and haven't found much stuff on it. It seems most people are talking about removing the entire colon (connecting small bowel to rectum) or having the total colectomy with a bag. I could possibly be reading this stuff wrong, to be honest I haven't done a ton of research on all the different surgeries associated with this stuff. Thanks!
Posted 10/30/2010 11:07 AM (GMT 0)
generally if you have colonic intertia they remove the entire colon. they don't know what section is not working so it all needs to come out or you could end up with the same issues. sub-total and total are often terms used interchangeably on this board. and even if not, most of the posts on total colectomy 1-37 will give you an idea of issues associated with the procedure. i had a sub-total done but my entire colon was removed and i had an IRA, ileo-rectal anastomosis.

it's important to remember that you get a distorted picture from reading these boards. people who are doing well generally don't come here for support of information as they don't need help so this board is skewed towards those having issues. but it does give you an idea of what you might have to deal with in terms of complications.
Posted 10/30/2010 12:51 PM (GMT 0)
Also remember to talk with your doctor/surgeon about ruling out slow transit disorder of the small intestine. If your problem is limited to the colon the surgery can be very effective but if you have motility disorders of the small intestine a colectomy will not improve your situation.

Sue
Posted 10/30/2010 1:20 PM (GMT 0)
Welcome Soniagarcia.  I'm sorry that you are dealing with this terrible condition.  After a lifetime of colonic inertia, this July I had a subtotal colectomy (leaving two inches of colon) and am a success story.  While many people have to deal with issues as a result of the surgery, many others don't.  In my case, the worst problem I've had is that I haven't been able to eat certain foods without it causing gas and diarrhea:  fruits, veggies, fiber.  So I take a multivitamin and so far there have been no diet related issues.  Of course, it’s only been three months so I’m hoping that this is temporary.  If not, that’s fine too because I feel better than I have in many years.

 

Val

Posted 11/2/2010 8:16 PM (GMT 0)
Hischildvalda (and all others whom could add insight),

How were your sitz marker transit times? If you read my initial post I discussed mine. I don't have my follow up appt for a few weeks so I am just curious as to how people on here would interpret those.

Thanks!
Posted 11/3/2010 1:25 AM (GMT 0)

Hi Sonny and welcome to the site!

I haven't been on here much since school started in Sept. bc I'm usually there until 6 or 7 at night and that's after I have been there since 7 am.  This is an awesome place to get great info and is a wonderful place for support!!!!  I had a sub-total July 08 and normally try to stay active on this site to encourage others who continue to struggle and to offer kind words to those who are just beginning their colectomy journey. 

Now to hopefully help you a little with your questions: I too struggled for years and would go for weeks with only pellet-like bms after taking large doses of miralax, lactulose & amitiza.  After 6 different GI drs (most just wanted to give me more meds and not find what was truly wrong) for mutliple disorders, one finally said this whole constipation thing isn't right and sent me for the sitz marker test and some others.  My current GI does a very detailed sitz marker where I took 50 markers and came to the office every day except Sunday to get x-rays with a special machine.  (He does a lot of research)  After 3 full weeks I still had most of the markers in my ascending colon, and a few in my small bowel.  This was while I continued to take my medications bc he allowed me to due to my history of colon preps not passing through for 10 days.

I ended up with an open sub-total with 2 inches of my colon  attached to my rectum.  I was in the hosp. for 5 days, had 20+ bms a day to start and by 6 wks went back to work full-time with  8-10 bms a day.  Yes, I am a HUGE success story BUT this is NOT an easy surgery and does NOT just take a couple of months to heal.  I've had numerous abdominal surgeries and though the surgery itself wasn't bad for me, it IS MAJOR surgery and it did take my body almost a whole year to get well.  I do have to remain on the low residue diet and will probably be on it forever; I still have a very slow stomach but am hoping this will not cause problems in the future. Yes, this is the best decision I ever made but I mentally I was very prepared to concure the challenges after the surgery so that I could get back to work in 6 wks.  So my best advice is to not go into this blindly but don't get too freaked out by the info on this forum bc as you stated many here have ongoing problems. 

There are many success cases and we are very happy with our decision as are the others who continue to have issues.  I wish you the very best and will try to get back on here to answer any questions you may have.  I may get back to you quicker if you email me, you can click on the icon under my screen name.

Peace and prayers to you,

Judy

Posted 11/3/2010 11:35 AM (GMT 0)
Sonny - Re: my sitzmarker study At day five I had retained 100% of the markers. They were spread throughout the ascending, descending and sigmoid, with the majority being in the descending colon. I think you really need more testing before making the decision regarding surgery. The next step would be getting a referral to a gastric motility center. Do you know if there is one in your area?

Val
Posted 11/3/2010 1:38 PM (GMT 0)
I don't know if there is a motility center in my area. What other kinds of testing would they do there? I had the pelvic floor testing and all that came back fine.
Posted 11/4/2010 12:31 AM (GMT 0)
sonnygarcia
I had a colon resection in 93 and did ok for a bit but then things just gradually got worse.  So I ended up with a Total Colectomy, none of my markers moved through the lg colon at all, so mine had completely stopped working.  I had a defogram, rectal memometery pressure, and sitz marker.  They thought it was a out-let issue but I said your wrong so found my own surgeon and he did a repeat sitz marker and said yep your right its not working at all and it had to come out.  So I have been reconnected, had the big surgery not Lap...it takes time to recover.

I still eat cautiously but try new things from time to time, if they give me heck I back off and try them again in a month or so...and it does not work then well for me I just don't go there again.

If you stay with chicken and turkey it has less fat, fat is a killer for me.  So take your time and know your options...for me it was chose life or living in constant hell...no choice I asked for the surgery even if they had to do a colostomy, but that was not the case for me as the just hooked me back up...

So do your do dilligance and may God be with you

Leslie

Posted 11/4/2010 11:59 AM (GMT 0)
Sonny - These are the tests I had: Gastric Emptying Scintigraphy is a test whereby the patient eats a meal of scrambled eggs, which contain a small amount of radioactivity, bread, and four ounces of water. A gamma camera, which makes images from emitted gamma radiation, will take images of the patient's stomach from the front and back for one minute every four hours.
Anorectal Manometry is accomplished by having the patient lie on his/her side and a small tube with a balloon at the end is inserted into the rectum. The catheter is connected to a machine that measures the pressure.
Balloon Expulsion Test uses a small balloon which is inserted into the rectum and then inflated with water. The patient is instructed to defecate the small balloon from the rectum.
Methane Breath Test where you fast, blow into a bag, then are given a syrup. After than you blow into a bag once an hour for three hours.
Feel free to click the envelope under my name if you want to write. Maybe we can find a motility center in your area.

Val

p.s. - I got the descriptions of the first three tests above at a web site - The Association of Gastrointestinal Motility Disorders.
Posted 7/22/2013 10:12 PM (GMT 0)

Hischildvalda said...
Sonny - These are the tests I had: Gastric Emptying Scintigraphy is a test whereby the patient eats a meal of scrambled eggs, which contain a small amount of radioactivity, bread, and four ounces of water. A gamma camera, which makes images from emitted gamma radiation, will take images of the patient's stomach from the front and back for one minute every four hours.
Anorectal Manometry is accomplished by having the patient lie on his/her side and a small tube with a balloon at the end is inserted into the rectum. The catheter is connected to a machine that measures the pressure.
Balloon Expulsion Test uses a small balloon which is inserted into the rectum and then inflated with water. The patient is instructed to defecate the small balloon from the rectum.
Methane Breath Test where you fast, blow into a bag, then are given a syrup. After than you blow into a bag once an hour for three hours.
Feel free to click the envelope under my name if you want to write. Maybe we can find a motility center in your area.

Val

p.s. - I got the descriptions of the first three tests above at a web site - The Association of Gastrointestinal Motility Disorders.

 

Hey after four hous no radiaton showed in my semicolon!  Is that normal?  Had a hemicolectomy (semicolon), and constant diariah back and forth constipation, normal, and the cycle repeats for over a year, its misery.

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