Post Operation Instructions

Recommendation before Surgery
(Suggested for all operations/endoscopies Dr Harald Puhalla performs, except instructed otherwise)

Diet:

Please fast 6 hours prior to your surgery, you can have sugary, not fizzy drinks (e.g. Gatorade or Powerade) with a maximum of 200mls, 2 hours before surgery and from then onwards nothing to eat or drink for the following 2 hours prior of your surgery. If you are diabetic the drinks should be sugar free.

Medications:

You should take your regular medications including the morning of your surgery.

But there are some exceptions:

Blood thinners (e.g. Plavix, Xarelto, Brilinta, Warfarin, Aspirin, Fish oil) reduce the ability to form blood clots, which during and after surgery increases the risk for bleeding. They usually need to be stopped days before your surgery, please discuss this with us.

Diabetic medications & Insulin. If you take tablets to control your blood sugar you should not do that on the day of surgery, since you fast on that day. Otherwise your blood sugar levels may become very low during the operation. In case you take Insulin, on the day of surgery you might be asked to reduce your usual Insulin dose or not to take insulin on that day at all. All diabetic patients will have their blood sugar checked just before and after surgery.

Some oral diabetic medication (called Sodium-glucose co-transporter-2 (SGLT2) inhibitors) can interfere with your anaesthetics and need to be stopped 3 days before your surgery (e.g. Forxiga, Jardiance, Xigduo, Jardiamet). During these 3 days they may have to be replace by a different medication or other glucose lowering agents have to be increased. Metformin should be paused 2 days before surgery. Please talk to your GP.

Recommendation after Surgery

(Includes information for all different procedure types)

The following information should help you during your recovery after surgery. You may organise someone to pick you up and try to have a friend or family member help you for the first few days so that you can avoid bending over or lifting. Having some groceries ready at home after surgery can also avoid unnecessary trips to the supermarket.

Pain relieve:

Pain medication will be ordered for you as needed on discharge. You are encouraged to take the prescribed pain medication in order for you to be comfortable during your recovery. Pain may prevent you from doing the activities that help with your recovery. If you have concerns about your pain management, please contact us or talk to your GP. Please report any new, increasing, or unrelieved pain.

As required on discharge anti-nausea medication will be ordered.

Laxatives:

Constipation after surgery is not unusual since anesthesia, pain medications or surgery in the abdominal area can slow down the movement of the intestine. On discharge we will order some laxatives for you to be taken for the first few days after surgery. In case you develop very loose bowel motions please reduce the laxative. If the very loose motions continue you may stop this medication.

Care of your Incisions:

We often use a purple glue covering the incisions (especially for keyhole surgery). Please do not remove the purple glue, it will come off by itself in the next weeks. There are no stitches to be removed.

If an incisions at your umbilicus is necessary we may use a dressing. Please remove the dressings on the 7th day after surgery. In case the dressing starts to come off before day 7 after surgery, please replace it.

After an umbilical hernia repair (belly button) there is a larger pressure dressing (green gauze) covering the small dressing. The pressure dressing with the green gauze should be removed 24h after surgery.

In case of a larger incision (open surgery) we often use dressings to cover it, they can be removed on day 7 after surgery. In case the dressing starts to come off before day 7 after surgery, please replace it. The skin may has been closed with staples. They need to be removed after day 10 – you will be advised in this regard.

Watch for any separation, bleeding, or signs of infection which include:

• Redness
• Pain
• Swelling
• Drainage of fluid or puss
• Heat at the incision site
• Fever (which is usually a temperature of 38 ºC or higher)

If you notice any of these problems, call us or your GP.

You can shower using soap and water with the glue or dressings on (also after you have removed the dressing on day 7 after surgery). Only use water and no soap around the wound site and be gentle in this area. In case shower water collects behind the dressing please remove the dressing, let the incision dry up and replace the dressing.

Exercise:

Generally, you should not lift objects heavier than 5 kg for 2-3 weeks. Lifting heavy objects too soon may weaken your incision. Plan your daily activity so that you can rest often. Do not expect your energy level to be the same as it was before surgery. Your body needs more energy to heal, and this may cause you to feel weaker and sometimes tired. Different surgeries require different limitations on activity. However, at your follow up appointment 2 weeks after surgery the further increase in activity will be discussed.

Medications:

If not advised otherwise you should continue your regular medication as you have taken it before your operation. If you had to stop a blood thinning medication before surgery you need to restart it after surgery when it is considered to be safe. You will be advised on discharge. Diabetes medication should be restarted once you are back on a normal or soft diet.

After weight loss surgery your blood sugar levels are usually lower than before the operation due to very low calorie diet before and after surgery. Some type of operations may also reduce your blood sugar without having lost substantial amount of weight yet. To avoid hypoglycaemic episodes you should monitor your blood sugar regularly after surgery when discharged and follow up with your GP if there are concerns or at least about a week after surgery to discuss if any diabetes medication needs to be restarted.

Blood clots:

Blood clots (deep vein thrombosis – DVT) can form after surgery and prolonged rest. These blood clots can travel to the lung (pulmonary embolism – PE). The best way to prevent DVTs is to mobilize early after surgery, wearing TEDs (Anti-embolism stockings) and while in hospital we will give a medication that helps prevent these clots; in some instances it might be necessary to continue this medication in the first weeks at home. The medication is injected just under the skin.

Diet:

The diet recommendations after surgery vary and depend on the type of surgery you had. After hernia surgery patients can continue their usual diet without any changes.

We suggest after removal of the gallbladder to aim for a low fat diet for the first 2 weeks after surgery and then if desired you may introduce more fat into your diet.

We suggest after weight loss surgery to follow the instructions of your dietitian which usually involves a fluid diet (e.g. shakes or soups) and good hydration (about 1-2 L of fluid – depending on built). Aim for about 80-100ml per hour. You should have a follow up appointment with your dietitian 10-14 days after surgery, which gives you the opportunity to discuss any diet specific questions and to be upgraded to a pureed diet.

Driving:

Depending on the operation but most patients especially after key whole surgery are ok to do short drives about one week after the operation in a private vehicle. Never drive while taking narcotic pain medications (e.g Targin, Oxycodone) and make sure you are able to do an emergency breaking, fasten seatbelts and can visualise traffic as you did before the surgery.

Follow-up:

Your routine follow up will be about 2 weeks after surgery. This might be booked already before surgery or the ward in hospital will organise this for you on discharge.

If you have any concerns in between the time of your discharge and follow-up appointment call us or your GP; after hours you can contact the ward where you have been a patient.