OPERATION PREPARATION

Undergoing surgery, however minor, could be a frightening experience at least for the first time. And not knowing how to adjust yourself to your normal routine following surgery adds to the anxiety. Here MediScene's Melanie Amarasooriya talks to Dr. Nalitha Wijesundera, Consultant Surgeon at the National Hospital Sri Lanka, about how to prepare for surgery and post operative management.

With proper information on the procedure and its pros and cons, the choice of whether or not to undergo surgery is an informed decision made by the patient himself. "We give options and educate the patient on each one and the patient consents to the best method for him," says Dr. Nalitha Wijesundera, explaining how the decision is made. At this time you can clarify any doubts you may have on the side effects and the procedure.

After getting a date scheduled for the surgery, you need to prepare for it. You may have to withhold certain medications you are on, a few days prior to surgery. For instance, if you are on an oral contraceptive pill you may need to switch to another family planning method. Aspirin or other blood thinning agents should also be stopped after discussing with your doctor. But you can continue your medication for asthma or for high blood pressure. Your doctor may start you on insulin for a few days if you are diabetic. "Thus tell your surgeon and anaesthetist about all the medications you are on," advises Dr. Wijesundera.

Then you need to admit yourself to the hospital. Usually you need to admit yourself at least the previous day. This is very important as you should be assessed by an anaesthetist, and also it is necessary to perform some investigations to assess your fitness for surgery. However for a few major surgeries which need intense preparation your doctor will advise you to get admitted a few days earlier. But if your surgery is a minor one like an excision of a skin lump you can come in on the same day provided that your doctor advises so.

You need to be fasting for 10 hours before the surgery. That means if you are to undergo surgery at 8 a.m. tomorrow, you should not eat from 10 p.m. today. But you can have a small amount of clear liquids like water, until 6 hours prior. After that you cannot take anything orally. "True, it will make you uncomfortable, but this is done to prevent the stomach contents getting aspirated during surgery," Dr. Wijesundera explains. "You will be given medication to prevent aspiration, and also an anxiolytic drug if you are anxious."

You will be dressed in a special dress when you are taken to the operating theater. Remember to remove all jewellery, dentures, and any make-up or nail polish. You are also not supposed to wear any undergarments.

At the operating theatre, you will be anaesthetized, depending on the surgery. Sometimes medication will be given to make you unconscious, or else surgery can be done while you are awake, after giving an injection to make the site numb. You will not have pain at all.

Following surgery

Once you have recovered from the anaesthesia, you will be sent to the ward. Following very complicated surgical procedures you will be sent to the intensive care unit to be monitored more frequently and thoroughly.

Being admitted to the ICU does not mean your condition is bad. Following major surgery, the patient should be in a place where he could be monitored frequently.

It is normal to have pain on the site of operation for a few days, and you will be given pain killers. Gradually the pain will go off and once you are sent home you can take paracetamol 2 tablets 6 hourly if there is pain.

Resuming daily activities

You will be allowed to drink once you recover from anaesthesia, that is once you are not drowsy and nauseated. Food will be given in about six hours when the doctors decide that your bowels are functioning well. The first meal should be a light one.

But if you underwent surgery involving the stomach or intestines, you will be given specific instructions regarding your diet by your surgeon

Following surgery for hernias and minor procedures the patient can walk around immediately after he recovers from anaesthesia. If you have undergone abdominal surgery like removal of part of the intestine, you may still be able get down from the bed the next day and walk a small distance. "Early mobilization is always better to prevent blood clotting within the vessels in the legs," Dr. Wijesundera added.

Sometimes a catheter will be inserted to the urinary passage during the surgery. This will be removed once there is good urine output and you can go to the toilet.

You can even go to work the next day if it is a minor procedure like an excision of a small lump, if you are pain free.

But after a major procedure it takes time to resume your normal daily activities. Usually the wound should heal in about seven days. After that you can gradually get on with your work.

"If you underwent surgery for hernia, avoid lifting heavy weights for two months. Anything that strains you should be avoided like cycling or heavy exercises," Dr. Wijesundera explained. But that should not prevent you from attending to your daily activities. You can lift small objects that do not strain you. Also there are no restrictions on your sexual life. Once the wound is healed, it is not going to cause any problems. Avoiding constipation though, is important and straining at stools should also be avoided.

You can drive a vehicle once you are fit to apply the brakes without pain, but the time to achieve this may vary depending on the surgery.

Unless you are having a cancer where the disease is not totally eradicated you should be completely normal in two to three months from surgery.

Sutures will be removed within seven days in any surgery. On the face and scalp it takes only about three to four days because those wounds heal quicker. Removing sutures is not painful, but there will be mild discomfort. Following suture removal you can have a shower. Baths are better avoided for 2 to 3 weeks.

Nowadays, for most surgeries, suture removal is not necessary. "For cosmetic reasons we do not put the usual stitches but sutures underneath the skin, which get absorbed once the wound is healed. That way the surgical scar will be much less prominent," Dr. Wijesundera clarified.

It is always best for the patients not to touch the wound. Therefore patients should not change the dressings themselves. The surgeon will examine the wound while you are in hospital and will advise the nursing staff to change dressings if necessary.

Once the sutures are removed, the wounds should be healed and do not need any dressings or antiseptics.

But after a bath you can touch the wound with a little surgical spirit just to remove the moisture. Keeping the wound dry is important.

In most surgeries like hernias, varicose veins, and removal of gall bladder, patients do not need to be seen by the surgeon after the sutures are removed. If there is fever, severe pain or discharge from the wound, however, it is necessary to seek medical advice. Otherwise your doctor will tell you whether another visit is necessary. After two to three months, your surgery can hardly cause you any problem.