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Surgical Procedures
MAJOR OPERATIONS
Patient Information about Major Colorectal Surgery It is natural to have many concerns and questions about "major surgery". We feel that the more you know about the process, the less you will worry about the steps necessary to return you to a state of good health. The following are some general guidelines which we hope will help you understand the steps in this process. BEFORE SURGERY When you speak with our Surgical Scheduler, she will make arrangements for your surgery at the appropriate hospital, and coordinate the schedules of your surgeon, anesthesiologist, the operating room, and your requested time. She will also verify your insurance coverage, inform you of the date and time of the procedure and tell you where and when to arrive. She will also be sure you have appropriate information on diet, medications, and any necessary laxative bowel preparation. If you have not had a complete physical examination within the last year, it is recommended that you make arrangements to visit your Primary Care Physician prior to surgery to have this done. Approximately a week before surgery, a nurse from the Hospital Admitting Department will call you to review your health history, and will schedule you for the necessary pre-operative lab tests, x-ray, and/or electrocardiogram. If you have had any of these studies in the 3 months prior to your scheduled surgery, you should inform the nurse at this time and these tests may not need to be repeated. We encourage you to plan ahead for some help at home after surgery. While people are generally able to walk, climb stairs, ride in a car, and have an unlimited diet when they leave the hospital, some activities will still be somewhat uncomfortable, and we ask that you not lift anything heavier than 10 pounds for 6 weeks. Therefore, some assistance with groceries and meal preparation may be advisable. THE DAY BEFORE SURGERY On the day before surgery, people who are undergoing a major abdominal operation on the colon are generally asked to confine their diet to clear liquids, and to take two doses of a laxative preparation in the afternoon and early evening to be sure that the colon is as free as possible of fecal material, in order to diminish the chance of infection and other complications at the time of surgery. Otherwise, all normal activities can be pursued on that day. THE DAY OF SURGERY Before the Operation: When you arrive at the hospital, after you register, you will be taken to a private area where you will be allowed to change into a hospital gown, talk further with the Nursing personnel, have an intravenous line started, and receive any necessary medications. These may include antibiotics and a small amount of blood thinner medicine, given under the skin, to diminish the risk of post-op complications. You should have had nothing to eat or drink after midnight on the day of surgery (unless otherwise instructed by the Surgery Scheduler or your physician). You may also be instructed at this time in the use of an "incentive spirometer", which will help you to exercise your lungs and take deep breaths after surgery. In the Operating Room: When you are transported to the Operating Room, you will then meet your anesthesiologist, and he or she will discuss your health history with you, and plan with you for the appropriate type or types of anesthesia for surgery. When you are transported to the Operating Room itself, small electrocardiogram pads will be placed on your chest and back, as well as other monitoring equipment necessary for maximizing your safety during surgery. You will then receive medication which will put you to sleep. After you are completely anesthetized, a catheter will be placed in the bladder, a small amount of the abdomen will be shaved and the operation will begin. After the Operation: When you wake up from the surgery, you will be in the Recovery Room, and you will likely have very little discomfort. You will generally stay in the Recovery Room for 1 to 2 hours before being taken to your room. No visitors are permitted in the Recovery Room area. Once you are transported to your hospital room, you will be placed in a bed, and made comfortable with either an "epidural catheter", which is a small tube that allows the administration of pain medicine just outside your spinal cord, or a "patient-controlled anesthesia" device, which allows you to push a button and obtained an instantaneous dose of pain reliever given intravenously. You will also be given fluids intravenously, and have a catheter in the bladder to drain off urine, so that you will not have to leave your bed to urinate. Even on the same day you have had surgery, you may get out of bed, with the assistance of the nursing personnel. FIRST POST-OPERATIVE DAY On this day, you will be offered a full liquid diet (e.g. milk shakes, custards, cream soups), and you may also have jello or other clear liquids. You should not force yourself to eat, but let your appetite guide you as to what you feel is appropriate. Also on this day, it is very important that you be out of bed walking in the halls with the assistance of the nursing staff. In some situations, the bladder catheter can be removed on this day, whereas in others, it should be retained for 1 or 2 more days. It is also important on this day to use the "incentive spirometer" to take deep breaths. Small inflatable "socks" will be attached to your calves while you are in bed, to intermittently squeeze the calf in order to keep the blood flowing in this area, again to diminish the chance of post-operative complications. SECOND POST-OPERATIVE DAY If you have done well with the full liquid diet on the first day, you will be offered a regular diet on the second day. Again, there is no need to force yourself to eat, but you may eat what you like if you are hungry. Once you are eating, you will be offered pain medicine to be taken by mouth, and once you are taking enough liquids to avoid dehydration, we can get rid of the intravenous fluids. Also, if the bladder catheter was not removed on the first post-operative day, it may be removed on this day. Again, it is very important to walk in the halls a minimum of 3 or 4 times on this day, despite the fact that it will be somewhat uncomfortable in your incisional area. There is no harm or danger to the incision by doing this. THIRD POST-OPERATIVE DAY During this day, recovery continues. If you are able to take pain medicines by mouth, do not require intravenous fluids or other intravenous medication, and are able to get around reasonably well, you may feel well enough to go home and continue your recovery there, in more familiar surroundings. There is no need to wait in the hospital to have a bowel movement, which usually does not occur until the fourth, fifth, or sixth day after surgery. FOURTH POST-OPERATIVE DAY For those patients who were not able to go home the third post-operative day, this is the general day of discharge. AFTER YOU GO HOME We ask that you not lift anything heavier than 10 pounds for 6 weeks following the day of your surgery, to minimize the chance of developing a hernia in the area of your incision. When you go home, you can generally eat anything or drink anything that appeals to you, without restriction. You will be on one or two types of pain medications, and will be able to climb stairs, ride in a car, and as soon as you feel comfortable and are off pain medication, to drive a car. When your bowels start to move, they generally are quite loose for a day or so initially, and then they become firmer as you resume a more normal diet. During this time, when you are thirsty, it is good to minimize your intake of water, but use Gatorade, soft drinks, or other fluids instead. The surgeon will generally request that you return to the office in 1 to 2 weeks for a post-operative check. People with occupations which do not require them to lift more than 10 pounds can often return to their jobs in 2 to 4 weeks, whereas if heavy lifting is required, 6 weeks is a more reasonable figure. If at any time before or after your hospitalization, you have questions about your care, please do not hesitate to call our office and speak with your surgeon or the Fellow assisting in your surgical care. back to top |
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