Post Operative Instructions

Following gallbladder surgery, it is common to have pain around the incision sites or pain in the shoulder (caused by the gas introduced into your abdomen). It is also uncommon experience some reflux symptoms or some loose-ish bowel motions. Try to avoid large fatty meals for the first few weeks as these may make these symptoms worse.

1. Apart from the specific instructions given to you depending on the type of surgery you have undergone, the basic general instructions that you should follow after surgery are as follows:
2. Take pain relieving and other medications as advised. Pain relieving medication should be taken with food (normally regular Panadol and ibuprofen taken in combination). After the first 72 hours of surgery, take the pain medication only when needed.
3. Do not drink alcohol, drive a vehicle, operate any machinery, or sign a legal document for the first 24 hours after the surgery as the effect of the sedative and/ or the aesthesia administered during the surgery may last for the first 24 hours of the surgery.
4. Dressings should be removed after 5 days (unless otherwise instructed). It is not uncommon for a small amount of blood to be visible under the dressing, this is not of concern and the dressing should be left sterile and intact.
5. Avoid strenuous activity, as advised. Remember that it is easier to prevent developing pain rather than managing it once it has already developed. Try to keep mobile and take regular short walks. If you do something that causes pain try and avoid it, this is your body telling you you’re not ready.
6. Keep the dressing clean and dry to promote wound healing.
7. Return to work when you are comfortable, not requiring strong painkillers and able to perform your work tasks unaided (usually 7- 14 days).
8. Eat a healthy diet and drink plenty of non-alcoholic and non-caffeinated drinks. Small amounts of alcohol are ok. 9. Schedule your follow up appointment as advised, usually 2 to 3 weeks after surgery.

PLEASE CONTACT DR GANDY’S OFFICE OR CONSULT YOUR DOCTOR IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING SYMPTOMS:

• Increased drainage from the incision
• Increased redness around the operated area
• Foul odour from the wound.
• Temperature over 38.degrees
• Sudden calf pain or shortness of breath
• A bulge through one of your incisions

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Apart from the specific instructions given to you depending on the type of surgery you have undergone, the basic general instructions that you should follow after your surgery are as follows:

• Take pain relieving and other medications as advised. Pain relieving medication should be taken with food. After the first 72 hours of surgery, take the pain medication only when needed.
• Underwear that provides support to the area will help reduce swelling and pain.
• Do not drink alcohol, drive a vehicle, operate any machinery or sign a legal document for the first 24 hours after the surgery as the effect of the sedative and/ or the aesthesia administered during the surgery may last for the first 24 hours of the surgery.
• Dressings should be removed after 5 days (unless otherwise instructed). It is not uncommon for a small amount of blood to be visible under the dressing, this is not of concern and the dressing should be left sterile and intact.
• Avoid strenuous activity, as advised. Remember that it is easier to prevent developing pain rather than managing it once it has already developed. Rest for a few days after the surgery is advisable, but keep mobile.
• Keep the dressing clean and dry to promote wound healing.
• If you experience pain on performing a particular activity, this is your body telling you that it is not quite ready. Try to avoid painful activities until further healing has occurred.
• Eat a healthy diet and drink plenty of non-alcoholic and non-caffeinated drinks. Everything is ok in moderation
• A small amount of swelling in the genital area is expected. There may also be bruising or discolouration caused small amounts of blood tracking to the scrotum or labia.
• Schedule your follow up appointment with your doctor as advised.

Please consult your doctor immediately if you experience any of the following symptoms:

• Increased drainage from the incision
• Increased redness around the operated area
• Large amount of swelling under the wound or in the scrotum
• Foul odour
• Fever greater than 38.0 degrees C.
• Suspected recurrence of your hernia.
• Sudden calf pain or shortness of breath
• Chest pain

Click here to download the PDF

Apart from the specific instructions given to you depending on the type of surgery you have undergone, the basic general instructions that you should follow after your surgery are as follows:

1. Take pain relieving and other medications as advised. Pain relieving medication should be taken with liquids and may need to be crushed is you are having difficulty swallowing. After the first 72 hours of at home, take the pain medication only when needed.
2. Try to avoid carbonated fluids (fizzy drinks) or beer as this will cause bloating. If you feel you need to take these drinks let them go flat first.
3. Follow the dietary advice from your doctor or dietician. First week fluids only. Weeks 2 and 3 soft mushy food and fluids, avoid meat, chicken and bread. After week 3 cautiously reintroduce normal diet and chew well.
4. Dressings should be removed after 5 days (unless otherwise instructed). It is not uncommon for a small amount of blood to be visible under the dressing, this is not of concern and the dressing should be left sterile and intact.
5. Avoid strenuous activity, as advised. Remember that it is easier to prevent developing pain rather than managing it once it has already developed. Rest for a few days after the surgery is advisable, but keep mobile.
6. Keep the dressing clean and dry to promote wound healing.
7. If you experience pain on performing a particular activity, this is your body telling you that it is not quite ready. Try to avoid painful activities until further healing has occurred.
8. Small amounts of caffeine and alcohol are ok, if a particular food or drink makes you feel bloated or unwell, try and avoid it
9. Schedule your follow up appointment with your doctor as advised, usually at 4-6 weeks after discharge.

Please consult your doctor immediately if you experience any of the following symptoms:

• Increased drainage from any of the incisions
• Increased redness around the incisions
• Unable to tolerate fluids or swallow any required pain killers
• Experiencing severe reflux symptoms
• Fever greater than 38.0 degrees C.
• Sudden calf pain or shortness of breath
• Chest pain

Click here to download the PDF

Apart from the specific instructions given to you depending on the type of surgery you have undergone, the basic general instructions that you should follow after your surgery are as follows:

1. Take pain relieving and other medications as advised. Pain relieving medication should be taken with food. After the first 72 hours at home, take the pain medication only when needed.
2. Wear the abdominal binder, that provides support to the area. It will help reduce swelling and pain. The binder can be removed to wash and shower, but should be worn at night and day. If causing skin irritation can be worn over a T shirt or vest.
3. Do not drink alcohol, drive a vehicle, operate any machinery or sign a legal document for the first 24 hours after the surgery as the effect of the sedative and/ or the aesthesia administered during the surgery may last for the first 24 hours of the surgery.
4. Dressings should be removed after 5 days (unless otherwise instructed). It is not uncommon for a small amount of blood to be visible under the dressing, this is not of concern and the dressing should be left sterile and intact. After the dressings are removed you may shower and bathe normally. Avoid picking at the wounds or applying creams, the scab is the body’s natural dressing.
5. Avoid strenuous activity, as advised. Remember that it is easier to prevent developing pain rather than managing it once it has already developed. Rest for a few days after the surgery is advisable, but keep mobile.
6. Keep the dressing clean and dry to promote wound healing. The dressings are waterproof so you can shower and pat them dry afterwards.
7. If you experience pain on performing a particular activity, this is your body telling you that it is not quite ready. Try to avoid painful activities until further healing has occurred.
8. Eat a healthy diet and drink plenty of non-alcoholic and non-caffeinated drinks. Everything is ok in moderation
9. There may also be bruising or discolouration around the wound.
10. Schedule your follow up appointment with your doctor as advised, usually 2-3 weeks

Please consult your doctor immediately if you experience any of the following symptoms:

• Increased drainage from the incision
• Increased redness around the operated area
• Large amount of swelling under the wound
• Foul odour
• Fever greater than 38.0 degrees C.
• Suspected recurrence of your hernia.
• Sudden calf pain or shortness of breath
• Chest pain

Click here to download the PDF

What is pain? – Pain is the unpleasant sensation caused by illness or injury.  It is how your brain interprets the signals from your body.  It is easier to prevent pain than treat it when it occurs.

How much pain will I feel after my surgery? — If you're having surgery, you probably wonder how you're going to feel afterwards. The amount of pain you will have, and how long it will last, depends partly on what kind of operation you are having. For example, you might not have much pain at all after having a small growth removed from your skin. But you might have quite a bit of pain after a more major surgery, liver or pancreas surgery. How you feel after surgery also depends on your age, health, and other medical problems.

How is pain prevented? — Doctors use different medicines to make sure you do not feel any pain during your surgery. This is called an anaesthetic and can be general (fully asleep), regional where a large area of the body is made numb (an example is an epidural used for birthing) or local anaesthetic where small areas of the body are made numb (like used by dentists perform surgery). For some operations, a combination of methods is used.

During surgery, doctors can do different things to help control the pain you might have later. Patients undergoing surgery are expected to have some pain, so medications are given to prevent this before you come around.  These are some of the things doctors can do:

• An injection (shot) of numbing medicine near where the surgeon is operating – This can help reduce pain around your incision (the cut in your skin).
• A "nerve block" – For a nerve block, a doctor gives medicine as an injection (shot) near certain nerves. This stops the pain signals the nerves normally send, so you don't feel as much pain in that area. The nerve block can last for several hours after surgery is over. Sometimes, the medicine is given through a small tube (called a "catheter") that stays in place during surgery and for a while afterwards.
• Pain medicines given through an "IV" – An IV is a thin tube that goes into a vein. There are different kinds of pain medicines that are given through an IV.
• Pain medicine given with spinal anaesthesia – For some operations, you might need spinal anaesthesia. For this kind of anaesthesia, a doctor puts a small needle in your lower back. Then he or she injects medicine to numb the nerves in your spine. The doctor can also give pain medicine this way.
• Medicines given through an "epidural" – This is a small tube (catheter) that goes into your back, near the nerves in your spine. The tube stays in during the surgery. It can also be left in after surgery, to help with pain while you are in the hospital. Doctors can use it to give both numbing medicines and pain medicines.

How is pain treated after surgery? — following your operation you will receive regular pain killers (whether you have pain or not) to prevent severe pain.  If you can swallow and absorb tablets this is the best option.  Tablets can be slow release to produce pain relief over several hours, whereas injections do not last so long.  Injectable pain relief is usually delivered via a drip in your arm or leg.

Types of painkillers

Paracetamol (Panadol) – this is a fantastic drug that most people use at home.  Paracetamol is quite a strong painkiller, if used in the correct way.  At home, most people will experience pain or a headache, before they take Panadol, which means you already have the unpleasant feeling of pain.  In hospital, Panadol if given before the onset of pain and works very well to stop pain starting or to greatly reduce the number of other painkillers required.  If taken at suggested doses, Panadol is very safe.  It also reduces a fever.

Non-steroidal (brufen, neurofen, advil, diclofenac, Mobic, etc.) – these medications treat pain, reduce fever and treat inflammation.  They can be taken in combination with Panadol in the form of a tablet.  They are usually used for short periods of time as can cause some impairment of wound healing and ulcers.  They cannot be used by people with kidney problems or asthma.

Opioids (morphine, endone, oxycontin, panadeine, targin, etc.) – Opioid medications are some of the strongest pain killing drugs we have and work very well.  They have several side effects including drowsiness, constipation and dependence.  Ideally they should only be used for short periods of time during your recovery.

How long will I have pain? — It depends. After a minor operation, you might feel fine a few hours afterwards. After major surgery, you might need pain medicine for days or even weeks. Your doctor or nurse will work with you to make sure your pain is treated properly.

What will happen after I go home from the hospital? — Your doctor will tell you what kind of pain to expect after your surgery. A prescription for pain medicines to take after you go home will be prescribed and can be renewed with your GP.

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In most cases, you will be admitted to the hospital on the morning of your operation, unless previously specified byDr Gandy or his anaesthetic team. An admissions clerk will check your details and admission paperwork is order(they will already have this) From there one of the perioperative nurses will do a final check of details and help you change into a surgical gown. Any valuables will bestored in a secure area and returned to you after your procedure. When the operating room staff are ready you will taken to the anaesthetic bay or pre anaesthetic area.You will have time to discuss any outstanding anaestheticor surgical issues with our team. From there the process of anaesthetic will begin.

Assessment

Prior to your admission to hospital you may need to attend a pre anaesthetic clinic to assess your fitness for surgery. This may include a heart trace and chest x ray.

Preparation

In most cases very little preparation is required after all the necessary investigations are completed at your out patient visits. It is advisable to continue to exercise as possible and keeping weight off will help the surgeons performing your procedure.

Patients undergoing complex surgery and cancer surgery may be advised to take some vitamin and nutritional supplements prior to surgery

Preparation for colonoscopy requires the bowel to becleansed with ‘bowel prep’ Please follow link to Bowel preparation for colonoscopy for specific details.

Unless otherwise instructed patients should remain Nil By Mouth for 6 hours prior to Surgery. Fasting instructions are confirmed in a telephone call from the admitting hospital in the days prior to your procedure.

Procedure

If you have any questions regarding your procedure the best place for this discussion is the consulting rooms. Weare happy to arrange repeat appointments or even a second opinion. Minor questions can be dealt with over the telephone or in the anaesthetic bay prior to your procedure. Dr Gandy will call your Next of kin or specified contact at the conclusion of the procedure.

Complications

The risks of expected adverse effects of surgery or the risks of complications will be discussed prior to surgery. While every effort is made to prevent complications,some patients will experience complications. When acomplication occurs it is important that it is recognise dearly and that the appropriate steps are taken to reduce the impact. However, further procedures may be required oran extended stay in hospital.

What to bring

• Medicare card
• Private insurance details (if applicable)
• Referral letter or admission form
• Reading materials / tablet / reading glasses (due to unforseen circumstances delays can occur)
• For overnight stay or extended stay o Comfortable clothing o Books, IPad, DVD player with headphones o Toothbrush, washbag, dressing gown o Mobile phone (cannot be used in Intensive care theatre complex)
• Supportive underwear (for groin hernia operations)

During your stay

Your hospital stay may range from overnight observation in a hospital bed to a period of intensive care monitoring.You will be seen by your doctor, or his team, one or two times daily and will have regular contact with the nursing team. Should there be any concern regarding you condition you medical team will be contacted immediately. For major surgery diet will be restarted slowly to avoid vomiting and pressure on sutures where the bowel has been reattached. A hospital stay can bedisorientating and frustrating. This may be in some partto the fact that you feel unwell, have some discomfort orare taking strong pain medications. We ask that you helpus by working with the medical and nursing staff,physiotherapists and dieticians. The aim of the wholeteam is to get you feeling better, back on your feet andhome, as soon as is safe and appropriate.

Day of discharge

On your day of discharge you will be given a discharge letter, highlighting the care you have received and any changes to you medications. You will not be able to drive following surgery and will need to make arrangements to transport you home. In special circumstances or for patients from regional areas the hospital will assist. You will also be given instructions for the removal of stitchesor dressings, see our operation specific post-operative instruction sheets.

Ongoing support

Following discharge, you may need additional support from family or friends. If you have limited support, a social work review can be organised to help in the immediate post-operative period. For some patients a period of rehabilitation may be required before discharge home. A surgical follow up appointment will be scheduled, usually 2-3 weeks after discharge. Should you experience difficulties please contact Dr Gandy’s consulting rooms during office hours. If you experience severe symptoms, you should attend the Prince of Wales Emergency department, who will contact the surgical team.

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