In the days before surgery
Depending on your general health you will need to undergo a number of tests and pre-operative assessments in order to optimise your health and lower the risk of any potential complications. Most patients will need to have had routine blood tests within the last 3 months, including a Full Blood Count, Urea and Electrolytes, Liver Function Tests, glucose, clotting and a recent pregnancy test for pre-menopausal female patients. Patients undergoing major surgery or patients with any history of heart disease will need an up-to-date ECG with a cardiology or physician review and if you have a pacemaker this will need checking prior to surgery. Patients with conditions affecting the chest may need a review by a respiratory physician. Patients suffering from anaemia may need iron supplement tablets, an iron infusion and/or a blood transfusion prior to their surgery and a group and save of your blood will be required if you are undergoing major surgery.
If you are on any blood thinning medication such as warfarin, clopidogrel or abixaban you will be given advice on when to stop it and whether you need to have some blood thinning injections while you are off your tablets. Prior to your operation you need to stop eating at least 6 hours in advance of your surgery and can only drink clear water up to 2 hours before surgery. In patients undergoing major surgery the Enhanced Recovery Protocol is followed and you will be given a carbohydrate drink to have 2 hours prior to surgery. This helps maintain your energy level and potentially reduce the risk of your bowel stopping to work for a few days (ileus). If you are undergoing a colorectal procedure, depending on your procedure you will be given advice on following a special diet and when to use some strong laxatives to empty your bowel 24 hours prior to your procedure.
Smoking cessation prior to your surgery, with a healthier diet and exercise even for a short period of time prior to your procedure all help improve the surgical outcomes and reduce the risk of complications.
Day of surgery
On the day of your surgery you should be able to take most of your tablets in the morning with a sip of water. You will be advised before your surgery on which of your medication you should omit on the day of surgery. This is especially important for medication related to diabetes which should be omitted on most occasions.
On arrival to the hospital and after registration you will be reviewed by my self as well as our anaesthetist. Please ensure that you bring with you any of the test results and review letters that were requested at your clinic appointment. Depending on the type of procedure you will be undergoing the various anaesthetic options will be discussed with you and you will be given some medications to take prior to your surgery (pre-medication).
Details on most of the procedures provided can be found on other sections of this webpage. Further information will also be provided to you at an individualised level. The great majority of procedures performed are minimally invasive and mainly involve the use of laparoscopic (keyhole) surgery. The benefits of a laparoscopic procedure compared to an open procedure, is that patients have less discomfort following the procedure and return back to normal activities much faster. There is a reduced risk of bleeding and wound infections, as well as less scarring inside the abdomen with the subsequent risk of bowel obstruction, while the smaller abdominal scars offer a better cosmetic result with a smaller risk of developing a hernia at the scar site.
After your operation
After you operation you will wake up in recovery and will then be taken back to the ward or higher level care bed if you have undergone major surgery. You will be given some oxygen. Depending on the type of surgery you have, especially after major surgery, you may have several tubes attached to your body including a drip in your arm to give you intravenous fluids and any necessary medication and a catheter in your bladder to drain urine. Most of these tubes are removed after 2-3 days.
A degree of discomfort is frequent after surgery when your local anaesthetic and painkillers start wearing off. For most surgery tablet pain killers should be enough to control any pain. In major laparoscopic surgery a spinal anaesthetic is usually administered prior to surgery and is combined with oral painkillers. If open major surgery is performed epidural anaesthesia is usually administered. In a small number of patients that require more pain control a drip with painkillers controlled by you (patient controlled anaesthesia) can be provided.
The Enhanced Recovery Protocol (ERP) is followed especially after major surgery. This means that you can eat and drink as you wish starting with a light diet and if you are tolerating fluids then the intravenous drip can be stopped. This helps the bowel to recover faster. Sometimes some patients may feel nausea or sickness after eating and drinking in which case we wait longer before introducing a full diet. Mobilising as soon as possible after surgery is recommended and has been shown to enhance recovery and positively affect the bowel. If you stay in hospital unless contraindicated, you will be given some stockings to wear on your lower legs and will be given some blood thinning injections in order to prevent you from having a blood clot that can then travel to your lungs and cause a life-threatening pulmonary embolism.
You are typically expected to go home once you are eating and drinking, are able to manage the pain, you are passing urine on your own and walk unaided. You will be provided with a prescription of regular pain killers that you need to take for a few days following your operation. You will not be able to drive following your discharge from hospital so you will need to arrange for a relative or friend to take you home.
The duration of recovery and timing of return to work following your surgery will depend on the type of surgery that you have undergone and it varies from person to person depending on your general health and the nature of your work. Many people feel generally tired after major surgery for up to 2 months and may need some help with everyday meals, housework and shopping. Pain around your wound usually lasts for a few weeks and you should slowly try and wean yourself off any pain killers.
After surgery you should avoid any heavy lifting such as children, grocery or washing or doing strenuous exercise for at least 6 weeks. You may resume intercourse whenever you wish. Eating a balanced diet after your operation helps with recovery. You can shower once you have been discharged home and can take a bath after 7 days once your wounds have all healed.
If you are undergoing a day case procedure under regional or general anaesthetic you will not be able to drive for 24 hours, you need to avoid alcohol and signing any important legal documents and need to ensure that a responsible person will be with you for at least 12 hours. In more major surgery, you can resume driving once you are able to make an emergency stop fast and safely and are able to get out of the vehicle. This again will vary depending on the severity of the procedure that you have undergone.
You will normally be seen back in clinic on average within two weeks following your surgery at which point any biopsy results or a further management plan will be discussed. In the meantime if you have any questions or concerns please feel free to contact me directly or through my secretary.
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The information relating to general and colorectal disorders and their treatments given on this website is not complete and is not intended as a substitute for a consultation with your doctor. Always seek medical advice from your doctor before making a decision about any of the conditions and/or treatments mentioned on this website.
© Dr Georgios Markides
You can always contact our Clinic for booking appointments and other useful information:
Dr. Georgios Markides,
Consultant General & Colorectal Surgeon
Aretaeio Hospital, 55-57 Andreas Avraamides Str., 2024 Strovolos, Nicosia, Cyprus