Surgery & ostomy
Surgery is the most common treatment for bowel cancer. Here's what it involves, how to prepare, and what recovery looks like.
Types of surgery
The type of surgery depends on where in the bowel the cancer is and how advanced it is. Your surgeon will explain which operation they recommend and why. Most bowel surgery is now done using keyhole (laparoscopic) techniques, which means smaller incisions and faster recovery.
Right hemicolectomy
Removes the right side of the colon. Used for cancers in the caecum, ascending colon, or hepatic flexure. The remaining bowel is joined back together.
Left hemicolectomy
Removes the left side of the colon. Used for cancers in the descending colon or splenic flexure. Again, the remaining sections are reconnected.
Anterior resection
Removes part of the rectum. The colon is joined to the remaining rectum. Sometimes a temporary stoma is created to allow the join to heal, which is reversed in a later operation.
Abdominoperineal resection (APR)
Removes the rectum and anus completely. This is used when the cancer is very close to the anal sphincter. A permanent colostomy is needed after this surgery.
Local excision or polypectomy
For very early cancers or large polyps, the growth may be removed during a colonoscopy without major surgery.
Before surgery
Preparing for surgery can feel stressful, but your team will guide you through each step. Here's what typically happens:
- •Pre-admission clinic– you'll meet the surgical team, have blood tests and an anaesthetic assessment, and go through what to expect
- •Bowel preparation – you may need to drink a bowel prep solution to clear your bowel before surgery (not always required)
- •Stoma marking– if there's a chance you'll need a stoma, a stoma nurse will mark the best position on your abdomen while you're standing, sitting, and lying down
- •Prehabilitation – staying as active and well-nourished as possible before surgery helps recovery. Your team may recommend specific exercises or dietary advice
- •Fasting– you'll need to stop eating and drinking for a set period before the operation
After surgery and recovery
Recovery varies depending on the type of surgery and whether it was done by keyhole or open surgery. Here's a general guide:
In hospital (3 to 7 days typically)
- • You'll be encouraged to get up and walk as soon as possible
- • Pain relief will be managed by the team – let them know if it's not enough
- • You'll start with fluids and gradually return to eating
- • If you have a stoma, the stoma nurse will teach you how to care for it
At home (first few weeks)
- • Take things slowly – most people need 4 to 8 weeks to recover from major bowel surgery
- • Avoid heavy lifting for at least 6 weeks
- • Your bowel habits will likely change at first – more frequent, looser stools are common
- • Eat small, frequent meals and drink plenty of water
- • Gentle walking helps your recovery – build up gradually
When to call the hospital
- • Fever or temperature above 38°C
- • Increasing pain, redness, or discharge from your wound
- • Vomiting that won't stop
- • No bowel movements for several days (or no output from your stoma)
Living with a stoma
If you need a stoma (also called an ostomy), it's natural to feel worried or overwhelmed. But many thousands of people live full, active lives with a stoma. It takes time to adjust, but most people find it becomes part of their routine.
What is a stoma?
A stoma is an opening on your abdomen where a section of bowel is brought to the surface. Waste passes through the stoma into a bag that sits flat against your skin. The bag is discreet under clothing and is changed regularly.
- •Colostomy – made from the colon. Output is usually formed (solid)
- •Ileostomy – made from the small bowel. Output is usually liquid
- •Temporary – many stomas are reversed after a few months, once the bowel has healed
- •Permanent – some surgeries (like APR) require a permanent stoma
Adjusting to life with a stoma
It's completely normal to find it difficult at first. Here are things that help:
- •Your stoma nurse is your best resource – they can help with fitting, products, and troubleshooting
- •Stoma supplies are fully funded in New Zealand through your DHB or Te Whatu Ora
- •You can swim, exercise, travel, work, and wear your normal clothes
- •Connecting with others who have a stoma can make a real difference – ask about local support groups or online communities
- •Give yourself time and grace. Most people say it gets much easier with practice
Next steps
Learn more about other treatments, or find support for your recovery:
Questions about surgery or stomas?
Our nurse support line can help you prepare and connect you with a stoma nurse or support group. Call 0800 226 968.