Preparation for Colonoscopy and Colonic Surgery

Preparation the evening before the scheduled procedure Usually give oral fluids only on the day of preparation

• Start with mechanical prep at about 4 pm the evening before with Kleen prep 3-4 liters as per instruction.

• Elderly patients may not tolerate this so 2 sachets of picolax are used instead.

• Metoclopramide 10 millegrammes 20 minutes before prep is optional.

• Monitor pulse and BP hourly. Discontinue if patient feels faint or gets chest or abdominal pains. Use Clinifeed tube if patient has difficulty in swallowing.

For Left Colonoscopy - Phosphate Enema the morning of procedure is enough

Certain Colonic Surgery does not require full prep, check with senior member of the team before charting bowel preparation. Regime should be individualized to suit different categories of patient.

Patient that has bowel obstruction going for surgery should not get bowel prep unless instructed by senior member of the team.

Complications of bowel resection -

1. Any such operation may result in possibility of stoma formation
2. B supplement is required after gastrectomy and small bowel resection (terminal ileum)
3. Right or Left Hemicolectomy may result in injury to the ureter, spleen, duodenum and inferior vena cava.
4. Anterior resection or AP-Resection may cause impotence due to nerve injury
5. There may be a lot of third-space lost, iv fluid regime needs careful monitoring
6. Massive pre-sacral venous bleeding can occur, this should be closely monitored with regular observations and Hb checks postoperatively. Inform senior member of the team if massive bleed is suspected.