Surgical
Guidelines: Frequently Asked Questions
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?
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?
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 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.
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