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How is surgery safely performed on the rectum and its connected piping?
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this post was submitted on 24 Mar 2024
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Patients are asked to clean their guts before major rectum and colon surgery,similar to what you do when you get a colonoscopy. Ideally that removes most if not all fecal matter and a significant portion of the bacteria.
Furthermore of course the colon is rinsed before the actual surgery and often during the surgery as well if necessary, if necessary with disinfecting solutions (but far less than one would think - it's actually important to do so to the least amount possible,see below). Additionally wound closures are done with techniques that allow extremely easy healing in the most problematic parts and often multiple sutures are made to adapt tissue borders on multiple layers and in multiple ways. And during and after the surgery strong iV antibiotics are given to prevent infection. But it's actually not a good idea to totally get rid of all bacteria. Especially the guts need a healthy bacterial flora to function and,and this is important here, to avoid "bad bacteria" to take over the space. There is more and more focus to make the right bacteria grow back on the colon/and to some extent the rectum, so there are some procedures that are now done with direct faecal transplants afterwards. Nevertheless often patients will not be allowed to eat for quite some time after an operation and are fed with intravascular solution during that time. Not a pleasant experience but sadly necessary. For more external operations (rectum) patients are also given stool softeners (medication that makes the passing of faecal matter easier) and advised to do disinfecting baths often, sometimes three times a day.
And of course the body is quite good at fighting bacteria and the colon and rectum - it is built to do so,the end of the whole "waste producing" system is outside the actual abdomen inside the pelvic sack,separated by a barrier. And the whole area is heavily supplied with blood (which is actually a good thing for infection control).
And last but not least for major operations there is always the option to create an enterostoma - an artificial opening/shortcut for people to get rid of fecal matter through it. These are usually done through the abdominal wall. After everything has healed up (usually after 6 months+x) the now healed colon and the small intestine/unaffected large intestine are connected back together and the artificial opening is closed.
(Sadly this is not always possible - then patients are getting a "Barbie Butt" - a behind without an opening. Mostly for cancer.)
Aren't those bacteria important for gut health? I remember reading "Gut" by Julia Enders and keeping those bacteria balanced plays a huge role in digestion.
Absolutely and their role is getting recognised more and more. That's why fecal transplants and special "gut bacteria growth diets" are becoming more and more important.
Could the patient save some poop (like in the freezer) to avoid having to do a poop transplant from someone else?
Yeah, Autotransplantation is far more common, actually.
That's a little scary as I'm reaching the age where I should soon start getting colonoscopies. I don't want to screw anything up by killing all the bacteria. Though I guess it beats not knowing if something is seriously wrong down there.
I also spent years cultivating these bacteria eating stuff all over the world.
Getting a colonoscopy doesn't involve ridding the colon or rectum of bacteria.
Normal colonoscopy will not kill your gut bacteria - just don't eat garbage after it. Amongst others your Appendix will help.
I forgot about the appendix. I feel better now knowing my bacteria have a safe place to hunker down. :)
FWIW, colonoscopies are no big deal. Sucks drinking the potion and blowing your guts out, all while starving for a day, but the procedure is kinda fun.
They lay you down, pump some pasty white in your IV. And you wake up stoned as balls and ready for mass food intake! (Yes, someone has to drive you home, I really mean you'll be stoned.)
And for anyone who's read this far alone: Do NOT shave your asshole. I was trying to make a presentable ass, like medical pros give a fuck, and shaved my hole and cheeks quite nicely.
And then the shitting potion hit. My. Gods. I was naked in bed, holding my burning cheeks apart, shaking all over. Picture working your crack over, all the way to the taint, with 220-grit sandpaper. Nothing too crazy, just enough to skin that top layer down to the pink.
Wife: What can I do?!
"Get Michelle! Fucking go get MICHELLE NOW!!!"
Wife: But you're naked and sweating..."
"NURSE NOW!"
Michelle was the nurse next door. She got me some Boudreaux's Butt Paste. Works for diaper rash, worked for me.
Follow up question. To keep one's gut bacteria (assuming you didn't have a c difficile infection etc but were doing very well with your microbiome) wouldn't it be practical to just kinda... Poop a sample or two in the week before the surgery, freeze it, put it back at the end of the surgery? Assuming that washing/disinfecting will affect different kinds of bacteria differently and different growth rates and so on, it seems like a big gamble to assume that the right bacteria will grow back in the right ratio.
Poop is sadly not the right kind of bacteria, there are different kinds of bacteria depending on the location and the flora in the upper colon is the more interesting - Actual poop is not what you need/want as it is mostly "leftovers".
Understandable, makes sense. Meanwhile, most gut microbiome analyses in science come from stool samples... Ironic. It also reminds me of the DIY fecal transplant guy on youtube who used his son's stool sample