Last updated: 02/17/2009

Mortality has been decreased from nearly 28% to under 6% through the use of prophylactic antibiotics prescribed before and after surgery. Strong indicators of survival outcome or increased complications from surgery for elderly patients are underlying medical conditions. Therefore, the underlying medical conditions of at-risk patients should be controlled prior to a colorectal surgery.

Even among higher risk patients, mortality is about 16%. This rate is greatly reduced (between 0.8% and 3.8%) when the ostomies and resections for cancer are performed by a board-certified colon and rectal surgeon.

The physician and the nursing staff monitor the patient's vital signs and the surgical incision, alert for:

• excessive bleeding
• wound infection
• thrombophlebitis (inflammation and blood clot in the veins in the legs)
• pneumonia
• pulmonary embolism (blood clot or air bubble in the lungs' blood supply)
• cardiac stress due to allergic reaction to the general anesthetic

Symptoms that the patient should report, especially after discharge, include:

• increased pain, swelling, redness, drainage, or bleeding in the surgical area
• flu-like symptoms such as headache, muscle aches, dizziness, or fever
• increased abdominal pain or swelling, constipation, nausea or vomiting, or black, tarry stools

Stomal complications can also occur. They include:

• Death (necrosis) of stomal tissue. Caused by inadequate blood supply, this complication is usually visible 12–24 hours after the operation and may require additional surgery.
• Retraction (stoma is flush with the abdomen surface or has moved below it). Caused by insufficient stomal length, this complication may be managed by use of special pouching supplies; elective revision of the stoma is also an option.
• Prolapse (stoma increases length above the surface of the abdomen). Most often this results from an overly large opening in the abdominal wall or inadequate fixation of the bowel to the abdominal wall; surgical correction is required when blood supply is compromised.
• Stenosis (narrowing at the opening of the stoma). Often this is associated with infection around the stoma or scarring. Mild stenosis can be removed under local anesthesia; severe stenosis may require surgery for reshaping the stoma.
• Parastomal hernia (bowel-causing bulge in the abdominal wall next to the stoma). This occurs due to placement of the stoma where the abdominal wall is weak or an overly large opening in the abdominal wall is created. The use of an ostomy support belt and special pouching supplies may be adequate. If severe, the defect in the abdominal wall should be repaired and the stoma moved to another location.