There are a few postoperative complications to be aware of following colorectal surgery. These can be classified into general and specific complications:

Stomas

Bowel diversion surgeries. (Image credit: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, source)

Differences between Ileostomy and Colostomy.

Loop ileostomy, end ileostomy & mucus fistula:

Colostomy vs Ileostomy. (Image credit: Keenan Motley, via Wikimedia Commons, license)

For a loop colostomy or ileostomy, the surgeon stitches the cut edges of the colon or ileum to the skin on the abdomen to make a stoma with 2 openings.

For an end colostomy or ileostomy with mucous fistula, the other cut end of the colon or ileum is attached to another part of the abdomen to make a second stoma.

Postoperative gastrointestinal dysfunction/ileus

You will be interested to hear that the primary driver of length of stay after bowel surgery, particularly colorectal surgery, is the time to return of gastrointestinal (GI) function.

This is a common problem you will face in the POCU and patients will often complain of not being able to pass wind or faeces following their abdominal surgery. Historically, it had been the case that this was to be expected and was a ‘normal’ part of colorectal surgical recovery. However, in more recent years, evidence and further research has been proved incorrect with the introduction of enhanced recovery protocols.

It has taken a long time to come to a consensus as to what we mean by the term ‘ileus’ and how we can define and manage it. But Hedrik et al. brought together a group to devise some consensus recommendations from which many of our recent guidelines have grown.

This has now become much more embedded in our practice and you may already be using these recommendations in your practice as part of an enhanced recovery bundle.

For example:

• Minimising the use of opioids to encourage good gut mobility
• Early resumption of enteral feeding is now standard practice
• Early mobilisation following surgery
• Reducing the use of nasogastric tubes following surgery
• Maintenance of euvolaemia

The I-FEED scoring system was created out of the need for a consistent objective definition of impaired postoperative GI function.

I-FEED Scoring System. (Image source)

The ‘Go, Slow, Stop’ initiative has been fantastic at simplifying postoperative nutrition and can empower nursing staff to ensure patient-centred postoperative feeding schedules in a bid to reduce the incidence of ileus.

The Go, Slow, Stop Initiative. (Image source)

It is important to highlight here that if you have any concerns regarding a patient, then it is always important to escalate your concerns to the nurse in charge or the responsible doctor looking after the patient, as soon as possible.

In the next section we will, look at some simple case scenarios, to illustrate this brief overview of the colorectal patient coming to POCU.