Surgical
Guidelines: Frequently Asked Questions
I had a
gastric bypass operation. I have questions about. . .
.?
I am nauseated after I take my pain
medication. What should I do?-
I cannot urinate. What should I do?
When can I remove my surgical bandage?
What should my wound look like?
I haven’t had a bowel movement.
Can I take a laxative?-
I noticed some bloody fluid draining
from my wound. What should I do?
I need more pain meds. When can I get
my prescription refilled?-
How should I manage the staples that
are holding my incision together?
I
have just been diagnosed with cancer and I have many questions.
I would like more information.
How much can I lift after
surgery?
When can I have sex?-
I feel a knot in my incision. What is it?
When can I drive?
There are blisters beneath my steri
strips. Why are they there and what should I do?
When should I call the surgeon on call?-
When should I be worried about my
temperature?-
How should I manage the
drains that were left in place?
What can I eat after surgery?
What happens
to the gallbladder when you have a gallbladder attack--acute
cholecystitis?
What
are the risks of having my gallbladder removed?
Nissen fundoplication: What should I eat
after surgery?
What is the preoperative bariatric diet (rapid weight loss to shrink liver before surgery)? This is provided courtesy of the Moses Cone Nutrition & Diabetes Management Center. Call them at 336-271-4936 for more information or an appointment.
What should
my wound look like?
Your wound may be closed with absorbable sutures and steri-strips,
staples, or sutures. Steri strips should be left in place
from 7-10 days and then they may be peeled off. The adhesive
may look dirty and sticky and this may require “fingernail
polish remover” to get it off. Staples aren’t
as painful as they look when they come out (don’t
dread it). They are generally removed in 7-10 days. Sutures
should be removed in 7 days except on the face and head
where they are often removed sooner.
If the skin that is 1/2 inch away from the incision
is red, warm, and tender, then your wound may be infected
and it may require opening. You should contact the
office number (336-387-8100) and make arrangements to be
seen in the office.
I cannot urinate.What
should I do?
Depending on your age and the procedure that you had, you
may experience some difficulty voiding. Older men with underlying
prostate hypertrophy can notice difficulty urinating with
the increased fluids that they receive in the operating
room. Anyone who has had surgery on their bottom (hemorrhoids,
fissure, fistula, warts) or an inguinal hernia can have
spasm of their pelvic floor resulting in difficulty voiding.
Sitting in a tub of warm water and allowing urination to
occur in the tub can relieve this condition. A warm towel
applied to the bottom can relieve some of the pain associated
with anorectal surgery. A warm bath is probably the best.
Urinary distension can cause severe, vague discomfort in
the lower abdomen. If you are still unable to urinate, then
you should call the surgeon and you will need to come to
the ER for Foley catheter insertion. This may need to stay
in place for a few days and then be removed in the office.
You may choose to contact your urologist and make other
arrangements if that suits you.
I am nauseated after I take
my pain medication. What should I do?
Nausea after narcotics does not represent an allergy but
intolerance to some of these opiates. Sometimes patients
cannot tolerate codeine but can take hydrocodone or oxycodone.
If you take the prescribed drug and you develop the "heaves"
then we will need to make arrangements for you to receive
an alternate drug. We cannot call in to the pharmacy drugs
like oxycodone. Hydrocodone can usually be called in. If
you are not having that much pain, then try relying on another
the counter pain reliever such as acetaminophen or ibuprofen.
Try to call during the 9am-4pm window when these arrangements
can be taken care of without causing a trip to the ER.
When
can I remove my surgical bandage?
Generally, the dressing can be removed 24 hours after surgery.
It is not uncommon to see some blood staining the dressing.
Unless drains are in place, it is OK to get the incision
wet 24 hours after surgery. If staples are in place, then
apply Neosporin ointment along the staple line until you
come back to the surgeon and have the staples removed.
I noticed some bloody
fluid draining from my wound. What should I do?
If you have an abdominal incision, this can be due to drainage
of a seroma. The fluid is usually blood tinged and straw
colored and can saturate a dressing sponge. This fluid will
escape and spontaneously stop. If the wound if red and tender
and if the fluid that is draining looks gray or yellow or
like pus, then you likely have a wound infection and this
will need to be drained. If this occurs, you should make
arrangements with the office (336-387-8100) to come in that
day or the next and have your wound checked. Until then,
place and dressing over it and allow it to drain.
I haven’t had a bowel
movement. Can I take a laxative?
The answer is generally yes. If you have had a bowel prep
(GoLytely) before your surgery, then it may take longer
for you to produce feces. However, narcotic pain relievers
can cause constipation and this can be prevented by taking
in adequate liquids by mouth and using a laxative. Patients
should use a laxative that has worked for them in the past
or try a mild laxative such as Milk of Magnesia. Enemas
should be avoided in patients who have had recent colon
surgery or appendectomy.
Is it normal to feel tired and
washed out after surgery?
Yes--General anesthesia often seems to effect
the patient's stamina. This can be manifest by a sudden
loss of energy, tiredness, and breaking out in a sweat.
Take a rest but continue to try to increase your exercise
tolerance.
How should I manage the staples that are holding
my incision together?
Application of Neosporin may cut down on the redness that
can occur where the staples enter the skin. A light dressing
over the incision after the morning shower can keep clothing
from grabbing on the staple line.
How much can I lift after surgery?
What is 20 lbs to one may be like 50 lbs
to another. As a general rule, if you feel yourself tightening
your abdominal muscles and straining (Valsalva), you are
lifting too much during that first 4 weeks after surgery.
After abdominal surgery you may want to wear an abdominal
binder when working to protect your back. A sore abdomen
that doesn't hold the abdominal contents in very well leaves
your back vulnerable to strain.
I feel a knot in my incision?
This question comes up most often after breast biopsy or
inguinal hernia when the patient feels a lump. In the early
postop period, the wound will swell and feel firm. Breast
biopsy cavities fill with fluid and when felt, feel firm
and may feel larger than before the surgery. Hernia incisions
typically also have mesh in them and this can add to the
feel of a lump.
When can I have
sex?
For most general surgical procedures, there is not any specified
interval to avoid sexual intercourse (i.e. as in vaginal
procedures, post partum, etc.) Soreness at the incision
site may require more patience and time. The patient who
has had the surgery should be the one “calling the
shots” and should return to sexual functioning when
they feel like it. If the surgery has required you to miss
birth control pills, then you will need to take other precautions
to avoid getting pregnant.
When can I drive? Ride?
The answer here has a lot to do with common sense. You should
not be taking any narcotic or prescription pain relievers
and drive. You should have good mobility of you head, neck,
arms and legs. Before you embark on a trip across town,
try driving around the block. Have someone with you when
you try.
After surgery you may be able to travel (ride not drive)
short distances (2-3 hours). You should get out and walk
around the car about every 45 minutes and be sure to drive
plenty of fluids. Discuss this with your surgeon before
striking out on a trip.
There are blisters beneath
my steri strips. Why are they there and what should I do?
Blood blisters often occur when there is swelling in an
incision after surgery. These are related to traction on
the skin and do not necessarily represent a tape allergy.
When they rupture, apply Neosporin and a light dressing.
I need more
pain meds. When can I get my prescription refilled?
Our office nurses (336-387-8100) will be glad to take your
calls after 9am and before 4pm Monday through Friday. Certain
prescriptions for oxycodone (Percocet, Tylox) cannot be
called to the pharmacy. You may need to pick those prescriptions
up at the office. The nurses will contact your surgeon and
determine if more pain medications are indicated. If you
wait until the weekend, then you will need to go to the
Emergency Room for evaluation before pain meds can be prescribed.
If you will require more pain meds over the weekend, be
sure to call before Friday at 4 pm.
The pain prescription that you were provided may contain
acetaminophen. Taking that pain pill along with an over
the counter remedy that contains acetaminophen (like Tylenol)
could produce liver damage from too much acetaminophen.
Therefore it is important to follow the pain prescription
guidelines on the bottle of your prescription.
When should I be worried
about my temperature?
First you should have a thermometer to take your temperature.
Temperatures in the morning tend to be lower and then they
tend to rise in the afternoon and evening. Low-grade temperatures
(99-100 F) may occur especially after general anesthesia
and when the patient is not taking deep breaths. The reason
for not taking deep breaths can be related to abdominal
soreness from incisions. Fevers associated with burning
with urination may signal a urinary tract infection.
The most significant fevers after surgery occur with shaking
chills followed by temperatures over 101 degrees. You should
contact us at 336-387-8100, as we may need to see you either
in the office or the emergency room.
When should I call the surgeon
on call?
There is always a CCS surgeon on call. Regardless of the
time of day or night, the surgeon may be evaluating an emergency,
operating on a patient, or asleep in bed. If you feel that
you need to speak with the surgeon on call please call (336-387-8100).
Assume that the surgeon does not know you and be
able to tell him the procedure that you had, the date and
location of your surgery, and the name of your surgeon.
Be mindful that the surgeon probably has work to do the
next day. If the surgeon is in an operating room then you
will likely speak with the circulating nurse. If you need
to be evaluated after the office is closed then you will
be referred to the ER where you may be evaluated by the
surgeon or the emergency room physician. ER visits may be
more costly and time consuming than a visit to the CCS office.
How should I
manage the drains that were left in place?
Prior to discharge from the hospital/surgical
facility, you may have received instructions about emptying
your drain "grenade". This should be emptied and
recorded at least twice a day. You should apply Neosporin
to the exit site of the drain from the skin and do not take
a shower or conventional bath. Take a "bird bath"
or sponge bath instead.
What can I eat after surgery?
That depends on the type of surgery that
you have had. Generally after outpatient surgery, you will
be instructed to take only liquids until the next morning.
The more important issue after any surgery is that you are
able to take down plenty of liquids (water, Gatorade). If
you have had a Nissen fundoplication, then you should take
noncarbonated liquids and soft foods for about 3-4 weeks
after your surgery. Let your appetite be your guide after
most other surgery. If you begin a high fiber diet too soon
after surgery, you may have more abdominal discomfort from
"gas pains".
What are the risks of having my
gallbladder removed?
Removal of the gallbladder is done today
using the laparoscopic technique. This involves the placement
of small holes into the abdomen into which the surgeon can
insert a video camera and perform gallbladder removal. This
is laparoscopic or videoscopic surgery although some in
the public still refer to this as "laser surgery"
even though no laser is used. Sometimes we still have to
make an open incision to remove the gallbladder and this
is done for your safety's sake. The list of potential complications
is very long and many are very rare. Some complications
have to do with being put to sleep (general anesthesia)
and basic surgery--bleeding, infection, pneumonia, urinary
tract infection, pulmonary embolism. However, gallbladder
removal has some very specific potential complications that
should be mentioned. These include: 1. common bile duct
injury requiring drainage of the bile into the small bowel;
2. trocar injury to the bowel; 3. bile drainage or collection
that may occur because of direct openings from the liver
to the gallbladder bed; 4.delayed leakage of bile from the
cystic duct; 5. retained stones within the common bile duct
requiring ERCP; 6. postoperative pancreatitis; 7. wound
numbness or pain; 8. late wound hernia formation or bowel
obstruction from herniated bowel; 9 hepatic artery injury.
Fortunately the complication rate from this surgery is low.
Return to the top of this page