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| Instructions for Laparoscopic Surgery |
RECOVERY AFTER COLON SURGERY
PLEASE READ THIS INFORMATION THOROUGHLY AND TAKE IT WITH YOU TO THE HOSPITAL
This information will help you understand your hospital stay so you have realistic expectations for the first few days after surgery. Following these guidelines will help you recover from surgery as quickly as possible and may reduce the risk of some complications.
THINGS TO KNOW WHILE IN THE HOSPITAL:
- Pain control: You will probably have a mechanical system for pain relief after surgery (either a patient-controlled analgesia (PCA) pump or an epidural catheter in your back). This will make you feel comfortable so you can do your breathing exercises and walk around after surgery. Once you are tolerating liquids, you may be given pain pills instead of the PCA or epidural. The pills work best when used regularly, so ask for another dose before the pain gets too bad. Generally you can take the pills every four hours if needed. If your pain is not relieved, other medications can be prescribed. Take as much pain medicine as you need to make yourself comfortable, however taking too much pain medication can cause harm.
- Diet: Liquids may be started the night of surgery, or the following day. You may drink as much as you can tolerate but it is better not to drink too much. Avoid carbonated beverages. Flat soda is okay. Once you tolerate fluids, solid food will be started. You will be on a low fiber diet with NO fruits or vegetables. It is important not to over eat. You may pick and choose what you like off your tray. You will probably find you feel better taking small frequent meals. If you feel bloated or nauseated just stop drinking or eating for an hour or two before trying again. You may need medicine for nausea. If so, ask your nurse. It is not unusual to have a poor appetite the first two weeks after surgery.
- Bowel activity: Surgery tends to slow your bowels for different periods of time depending on the individual person. This period is minimized by being active after surgery. Standing and walking helps your bowels recover; lying in bed does not. Minimizing your use of intravenous pain medication also helps your bowels recover. Passing gas or moving your bowels will not cause pain.
- Breathing exercises: These are extremely important. You will be given a small breathing device called a spirometer to use in the hospital which you will take home. You should do these exercises every hour while you are awake, taking at least ten deep breaths each time you use it. This expands the small air sacs in your lungs and minimizes fevers and pneumonia.
- Exercise: Getting up and walking IS EXTREMLY IMPORTANT after surgery and helps your recovery in many ways. Much of the pain after major surgery is from muscle spasm. Getting out of bed, sitting and walking helps you loosen up and probably reduces pain. Exercising also helps your breathing and quickens the recovery of your bowels. Sitting, standing and walking, will not damage your wound or the surgical area in any way.
- Day of discharge: Expect to go home on the third to fifth day after open surgery, the first to third day after laparoscopic surgery, and the first or second day after closure of an ileostomy. Make provisional arrangements in advance unless instructed otherwise. Some patients may be able to leave earlier than this, and some may have their discharge delayed for medical reasons. There is no check out time. You may be released from the hospital as late as after dinner or before bedtime.
THINGS TO KNOW AFTER DISCHARGE FROM HOSPITAL
Call the office at (314) 849-1811 the first business day after your hospital discharge to arrange for a follow up office visit (usually 7-14 days after surgery). The doctor will tell you when he wants to see you again. The office is open from 8:30 am - 5 pm.
If you live alone, you may wish to make arrangements, in advance, with family or friends to stay with them for a few days to a week.
- Diet: When you go home, expect to be able to drink freely and eat a little. Drinking plenty is really more important than eating. Liquids like Gatorade and Ensure have nutritional value and can help prevent dehydration. Common sense should help you decide what to eat. For the first TWO WEEKS after surgery, you should be on a low fiber diet with NO FRUITS OR VEGETABLES. These foods can cause gas and bloating which can make you uncomfortable and possibly cause harm. It is important NOT to over eat.
- Bowel movements: You will probably be passing gas, and may have moved your bowels. You may have frequent stools or perhaps, feel constipated for the first two weeks after surgery. DO NOT take any constipating agents or laxatives during this period without specific approval from our office. Metamucil and other fiber products should NOT be taken for two weeks.
- Pain medication: If necessary, you will be given a prescription for pain pills if you have any remaining pain or discomfort. Take only what you need. You may use Tylenol, aspirin or other over the counter pain medications (Advil, Aleve, etc.) for the occasional minor discomfort you may experience.
- Exercise: We encourage you to be active. Expect to be more tired than you were in hospital. Time in bed should be limited to sleeping. If you are resting, do so in a recliner or comfortable chair. Keep walking at home to regain your strength. If you had trouble getting around before, you may benefit from a cane or walker. (If necessary, it can be arranged for you to get one before you leave the hospital). Going up and down stairs is fine. DO NOT lift anything too heavy for one month after surgery. A good rule of thumb: if you can lift the item with one hand, it is OK, but if you need both hands, it’s too heavy. Consider going to the mall around meal time. Walking before you stop to eat and walking again after you eat is good exercise.
- Driving: You should not drive a car until you are seen in the office for the first time after surgery. You may be a passenger. Your family members are usually a good judge of when you can be a safe driver.
- Staple removal: If you have staples in your wound, these may be removed before you leave the hospital. Staples not removed while you are in the hospital are generally removed at your first office visit.
- Readmission to hospital: Approximately 12-15% of patients will need to be readmitted to the hospital after major colon surgery. Research suggests patients who are well enough to be discharged early are less likely to be readmitted. About half of the patients who are readmitted to the hospital return because of symptoms of nausea, vomiting, or bloating. If you have these symptoms, you will often stop passing gas or stop moving your bowels. If these symptoms develop, stop eating and drinking, and wait one or two hours. In most cases these symptoms will go away, but if they don’t, please call the office for advice. The other half of patients return to the hospital because of new or more unusual pain, fever or other symptoms. Some of these problems can be caused by abscesses or infections in the abdominal cavity or by a leak from the anastomosis (connection) made during surgery. These may occur in approximately 1-10% of patients, depending on the operation performed and the reason for the surgery.
- Problems with your wound: Some drainage of thin yellow to red fluid is common and not a concern. Just cover the wound with gauze to protect your clothing. If you develop new pain or redness around your wound, please call the office the next day.
- Medications: All medicines you were taking prior to surgery should be resumed exactly as you were taking them before surgery, unless ANY of your doctors have told you differently.
WHAT TO EXPECT EACH DAY AFTER LAPAROSCOPIC COLON SURGERY
Day 0: the afternoon and evening of surgery
Once you wake up you should start your breathing exercises and move your legs often. You will be encouraged to sit in a chair, and take a short walk (the first time and until you are stable on your feet, a nurse or an aide should accompany you).
Day 1: the first day after surgery
You will be allowed thicker liquids and maybe solid foods today. Drink and/or eat only what you can comfortably tolerate. Avoid carbonated beverages. Flat soda is okay. If you feel nauseous, stop drinking and eating for an hour or so and try again later. If you are still nauseous, ask for medication to help your nausea.
Keep doing the breathing exercises. Get out of bed and walk at least five times (the first time and until you are stable on your feet, a nurse or an aide should accompany you). You may be started on pain pills. These work just as well as medications given into your vein, but take slightly longer to start working. Make sure to ask for pain medication as soon as you feel too uncomfortable.
Use your pain medications to keep yourself comfortable.
Day 2: the second day after surgery
If you are tolerating oral liquids, your intravenous fluids will be stopped today. You will start some solid food. You will probably be on pain pills. Keep walking and doing your exercises. You may be able to go home today. If you have a drain in your side, it will probably be taken out today
Day 3: the third day after surgery
If you are doing everything from day 2, you will probably be going home today. If not, don’t worry - these are only guidelines. Everybody is different and sometimes it takes another day or two before you are ready to go home.
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