Preoperative and postoperative management

At the outset the surgeon should discuss the goals of the proposed intervention. The type of incision, the extent of the wounds to be created, and the anatomy involved should be outlined in addition to various aspects of normal wound healing. Where appropriate, the possibility of a laparoscopic approach should be included. When anticipated, the possibility of decision making at the time of operation should be mentioned. The surgeon also should be willing to discuss potential complications. The patient should be afforded the opportunity to ask questions regarding potential risks of the operation as well as alternative therapy. A forewarning that substantial postoperative pain will be experienced will prevent the patient from believing that something has gone wrong. At the same time the patient should be reassured that every effort will be made to relieve pain with the liberal use of analgesics and that considerate and empathetic nursing care will be offered. Realistic expectations should be given regarding the functional results after “reconstructive” colorectal operations, such as ileoanal procedures, coloanal anastomoses, and anal sphincter repair.