Like a knife through hot butter

So I saw my surgeon this morning who advised me that 18th March is the big day for surgery. “That’s all very well and good”, I hear you say, “but what are they actually going to do to you?”. Well, read on and find out. I apologise in advance as there will be some measure of detail, some diagrams, and maybe even a picture of a rectum or two just for shits and giggles.

The official name of my operation is a Total Mesorectal Excision (TME) performed by Low Anterior Resection (LAR). Sounds fancy eh. For some time now it has been the gold standard of curative surgical intervention for advanced (read lymph nodes involved, not metastatic) rectal cancer, and when combined with neoadjuvant chemoradiation, reduces the incidence of local recurrence (i.e. the cancer coming back in my ass) to <5%. That’s a good thing, because my pelvis is already irradiated to buggery and as much fun as I had with Zeus, I’d like to never see him again.

Unfortunately, because my tumour is ‘bulky’, and notwithstanding that it has shrunk and will likely continue to shrink, my surgery will be a combination of ‘open’ and ‘laparoscopic’. The diagram below shows the difference in terms of the incisions and ultimate scars. At best it’ll look like a snake going down to my man bits, and at worst it’ll look like I have an ass crack on my stomach. Anyways, better to have two asses than be dead. On a positive, I’ll be sure to shave the pubes:

Wounds

A quick anatomy lesson

The image below shows the large intestine, or colon. You can see that it is made up of various parts, with the rectum being the poo warehouse before dispatch, and the anus being the turd-cutter.

The colon’s principle job is to remove water from waste, and to move the turd along until it’s time to drop the kids off at the pool. The large intestine is pretty big, measuring about 5ft long, but is dwarfed by the small intestine, which measures on average, 20ft long.

The dark shaded part is what is removed in a LAR, although, as is the case in every instance, the actual bits removed will vary:

LAR.png

My tumour is more towards the top of my rectum and so they may not remove as much of my poo warehouse. The trade-off is that the surgeon will probably take a little bit more of my sigmoid/descending colon just to be on the safe side.

Because it looks like some lymph nodes have been compromised, they will also take out a large portion of surrounding tissue (read: fat) called the mesorectum. The image below shows the approximate plane of tissue that will be removed:

TME

The final part of the operation is to take a medieval looking torture implement and staple the healthy part of my colon, to the healthy part of my rectum, a procedure called ‘anastomosis’. The device itself looks like some sort of demonic dildo that has double rows of staples within it which creates a double seal, reducing the risk of a leak. They then flood my abdomen with water and pump CO2 up my ass like a reverse fart, to test for leaks, just as you would when repairing a bike inner tube.

Below is the ass stapler:

Ass-Stapler

Hopefully, my surgeon can read Japanese(?) and he knows that the bit on the left goes up the date and not the handle. The cap on the far left is stitched into the healthy part of my colon and the rod part from it marries up with a bracket in the long bendy part. Once they are paired up, the handle is pulled and a double row of staples are fired, creating a perfect (hopefully) seal.

Unfortunately, the fact that I will have an open wound in my sewer canal means that I will have to have a stoma while the anastomosis heals. Fortunately, it will only be temporary, and will be reversed after I finish my post-surgery chemotherapy. After that I’ll be able to poo again, albeit a little bit differently.

What is a stoma

A stoma is basically an opening of an internal organ to the outside world. The most common, and relevant ones in terms of this type of surgery, are colostomy’s and ileostomy’s. A colostomy comes from the colon itself and is more often than not permanent. The waste it removes is more like the turds you are used to seeing when you check to see whether you did a phantom or a floater.

I will be having what is called a ‘loop ileostomy’ which is where they remove the final part of my small intestine, the ‘ileum’ out through my stomach and sew it to my stomach creating an opening through which liquid waste can be expelled into my ‘bag’. I will have to have it for at least 3 months but in light of the fact that my chemo will go for at least 4 months, and my surgeon isn’t keen on digging around in my insides while there is poison in there…I know, what a pussy right, I will have my bag for c 6 months.

Below are two images. The first is roughly what a stoma looks like and the second shows what I will look like with my bag:

Stoma1

Stoma3

I am trying to think of a name for my stoma/ileostomy bag. At this stage I am leaning towards naming it after a defence solicitor who, given he is full of shit, lends his name quite well. I will refrain from naming him here but those who know and work with me will have a pretty good idea who I’m talking about.

Will I ever be able to poo normally again?

The short answer is ‘sort of’, the long answer is ‘probably not really’. As explained, the large intestine’s main job is remove water from the stool, making it more solid. It then travels through to the rectum where it is stacked and stored until it is time to ship out.

The result of losing a portion of both my colon and rectum is that there will be less water removed and less storage space. That combination means that I will need to have a pretty good idea where the nearest bathroom is, and at least at first, there may/will be times when I may not make it. In the meantime, I will be investing investing in double strength undies and mission brown slacks.

How am I feeling about it all?

With all puns intended, I’m shitting myself. The surgery will take 3-4hours and I’ll be in hospital for over a week. I’ll have 4-6 weeks recovery time before returning to work, but it is more than likely that I’ll be back having chemo within a couple of weeks of going under the knife.

Visitors will be most welcome, but in small doses, and preferably only if you have boring stories because apparently it hurts to laugh.

It’s also while I’m in hospital and for at least a couple of weeks afterwards that Lyndell and I will need the most help, and in that regard I’m (read: we’re) so grateful for everything that you wonderful people have done for us so far. It is a huge thing for me to ask for help but in light of the fact that I’ll be a cripple with two asses but who can’t fart, I need to suck up my pride and ask for a little assistance.

So now we’re all up to date. I’ve finished my treatment and will now be focusing on giving the body a rest from the rigours of treatment, and getting strong and fit so that surgery is smooth and my recovery is smoother.

Until next time folks, be kind to your colon’s, and each other…

 

 

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