Pre-op & Post-op info

Dr Gandy sees all elective patients prior to consideration for surgery.  Emergency patients should consult their general practitioner or local doctor, who will be able to contact Dr Gandy’s team for treatment.  All elective patients are seen at his consultation rooms. In general, most consultations will be between 15-45 minutes depending on complexity.

It is preferable for all patients to come for consultation with a referral letter, from their general practitioner.  Your doctor will be able to provide doctor Gandy with information on your prior health and can arrange any tests required prior to consultation.  A referral letter is also required for you to attract the Medicare rebate on your consultation.

During your consultation, Dr Gandy will review your current illness and your past medical and surgical history.  A medical examination may also be performed and all relevant tests to date will be reviewed.

Dr Gandy will discuss all treatments options with you and any companions you bring to your consultation.  Every effort will be made to answer any questions you have and to inform you about your illness and treatment.

In some circumstances, it may be necessary for specialist’s tests or referral to other specialists prior to treatment.  You may also require a second appointment with Dr Gandy for further discussion.

Collaboration

Dr Gandy works alongside with some of Australia’s best surgeons, gastroenterologists, radiologists, anaesthetists, medical and radiation oncologists.  During your treatment, you may be required to have specialist tests or treatments performed by one or more of these doctors.

Health professionals who may care for you include:

• Gastroenterologist – involved in diagnosis of pancreatic cancer and treatment of bile duct obstruction
• Anaesthetist – responsible for your care during the operation and assisting in pain management following the operation
• Medical oncologist – responsible for chemotherapy
• Radiation oncologist – responsible for radiotherapy
• Nurses – support and assist you through all stages of your hospital stay
• Dietitian – supports and educates patients about optimal nutrition and diet during treatment and recovery
• Social worker - link you to support services and
• Physiotherapist and occupational therapist -  help you to get back to normal activities.

International or inter-state or rural patients

Dr Gandy can work in collaboration with your local medical team to give advice and assessment, before travelling to Sydney.  International or Interstate patients can use our contact us page, as an initial point of contact to discuss your needs or alternatively call +61-2-9398-0200.

In most cases, you will be admitted to the hospital on the morning of your operation, unless previously specified by Dr 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 peri operative nurses will do a final check of details and help you change into a surgical gown. Any valuables will be stored in a secure area and returned to you after your procedure. When the operating room staff are ready you will be taken to the anaesthetic bay or pre-anaesthetic area.  You will have time to discuss any outstanding anaesthetic or 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 outpatient 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 be cleansed 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.  We are 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 after 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 a complication occurs, it is important that it is recognised early and that the appropriate steps are taken to reduce the impact.  However, further procedures may be required or an 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 unforeseen circumstances delays can occur)
• For overnight stay or extended stay
• Comfortable clothing
• Books, IPad, DVD player with headphones
• Toothbrush, washbag, dressing gown
• 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 your condition, your 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 be disorientating and frustrating.  This may be in some part to the fact that you feel unwell, have some discomfort or are taking strong pain medications.  We ask that you help us by working with the medical and nursing staff, physiotherapists and dieticians.  The aim of the whole team is to get you feeling better, back on your feet and home, 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 your 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 stitches or 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. 

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 of surgery, take the pain medication only when needed.
2. 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.
3. 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.
4. 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.
5. Keep the dressing clean and dry to promote wound healing.
6. If you experience new or worrisome symptoms it is better to consult your doctors early, either Dr Gandy’s office or your GP.
7. Eat a healthy diet and drink plenty of non-alcoholic and non-caffeinated drinks. Everything is ok in moderation.
8. Schedule your follow up appointment with your Dr Gandy as advised, normally 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
• Increased swelling under the wound
• Foul odour
• Fever greater than 38.0 degrees C
• New vomiting
• 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 an 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

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

Morning Colonoscopy

Prior to the procedure, you will need to purchase Prepkit-C from your local pharmacy, unless otherwise instructed. Prepkit-C includes 1 sachet of Glycoprep and 2 Sachets of Picoprep. The colonoscopy prep tastes bad, cooling it in the fridge will make it more palatable. The aim of the prep is to produce water diarrhoea.

Preparation instructions for morning colonoscopy

The success of your examination depends on the bowel being as clear as possible, otherwise the examination may need to be postponed and the preparation repeated.

PLEASE FOLLOW THESE INSTRUCTIONS ONLY – IGNORE THE INSTRUCTIONS ON THE KIT.

Two days before the Examination

• Stop eating meat, brown bread, cereals, fruit, or vegetables. Do not eat foods containing seeds.
• You may eat eggs, cottage cheese, plain yoghurt, white bread, white fish, chicken well cooked and peeled pumpkin or potato. You may have clear jelly, milk, and drink plenty of approved clear liquids.
• Approved clear liquids include water, clear broth/bouillon, clear fruit juice, plain jelly (not purple/red), black tea or coffee, sports drinks (not purple/red), clear fruit cordials (not purple/red), clear salty fluids (chicken soup), Lucozade.

One Day Before the Examination

• You may have breakfast in accordance with the diet and approved clear fluids as needed throughout the day (no milk products after breakfast)
• Prior to commencing PREPKIT-C add entire contents of ONE sachet of PICOPREP in a glass of warm water (approx. 250ml) and stir until dissolved. Place in refrigerator to chill. Do the same for the second sachet of PICOPREP.
• Dilute entire pack of GLYCOPREP 70g in a litre of warm water and stir until dissolved. This can be made up in the morning or earlier in the afternoon and also placed in the refrigerator to be chilled.
• First dose – 4pm – Drink one glass of PICOPREP mixture slowly but completely. This should be followed by at least two glasses of water or approved clear liquids over the next hour
• Second Dose – 5pm – You should drink a glass of GLYCOPREP every 15 minutes. Total intake time should take 1 hour in duration. If you start to feel nauseated whilst drinking the preparation, slow down the rate of intake. A Drinking straw can be helpful.
• Third Dose – 6pm – Drink the second glass of PICOPREP. This should be followed by at least two glasses of water or approved clear liquids over the next hour.

Day of Examination

• Colonoscopy Only – Continue approved clear fluids (no more than 200ml p/hour, no milk, soup, jellies) until 5pm on the day of your procedure. Arrive at the hospital at the scheduled admission time.
• Colonoscopy & Gastroscopy – As above, but do not eat or drink anything for 6 hours prior to the scheduled admission time.

After the Procedure

You will be able to eat and drink 30 mins after your procedure and will be discharged after 1.5 hours. You will not be able to drive and will need to be collected by a friend or relative.

Should you have any questions contact Dr Gandy’s office to confirm instructions on 02 8599 4360

Click here to download the PDF

AFTERNOON COLONOSCOPY

Prior to the procedure you will need to purchase Prepkit C from your local pharmacy, unless otherwise instructed. Prepkit C includes 1 sachet of Glycoprep and 2 sachets of Picoprep. The colonoscopy prep tastes bad, cooling it in the fridge it makes it more palatable. The aim of the prep is to produce watery diarrhoea.

Preparation instructions for afternoon colonoscopy

The success of your examination depends on the bowel being as clear as possible, otherwise the examination may need to be postponed and the preparation repeated.

PLEASE FOLLOW THESE INSTRUCTIONS ONLY – IGNORE THE INSTRUCTIONS ON THE PREPKIT- C KIT

Two days before the examination

• Stop eating meat, brown bread, cereals, fruit, or vegetables. Do not eat foods containing seeds.
• You may eat eggs, cottage cheese, plain yoghurt, white bread, white fish, chicken well cooked and peeled pumpkin or potato. You may have clear jelly, milk, and drink plenty of approved clear liquids. Some suggested recipes are included in this Fact Sheet.
• Approved clear liquids are water, clear broth/bouillon, clear fruit juices, plain jelly (not red or purple). Black tea or coffee, sports drinks (not red or purple), clear fruit cordials (not red or purple), clear salty fluids (chicken soup), Lucozade.
• You may have breakfast and lunch in accordance with the diet up until 1pm. During the day, drink as many glasses of the approved clear liquids as needed (no milk products after lunch).
• Prior to commencing PREPKIT C add entire contents of ONE sachet of PICOPREP in a glass of warm water (approx. 250ml) and stir until dissolved. Place in refrigerator to chill. The second sachet of PICOPREP can then be added to a glass of warm water (approx. 250ml) and stirred until dissolved and placed in refrigerator to chill.
• Dilute entire pack of GLYCOPREP-C 70g in a litre of warm water and stir until dissolved. This can be made up in the morning or earlier in afternoon and placed in the refrigerator to chill. First dose – 5 pm Drink one glass of PICOPREP mixture slowly but completely. This should be followed by at least two glasses of water or approved clear liquids over the next hour. Second dose – 7pm You should drink a glass of the GLYCOPREP every 15 minutes. Total intake time should take 1 hour in duration. If you start to feel nauseated whilst drinking the preparation, slow down the rate of intake. A drinking straw can often be helpful.

Day of examination

• Third dose (either 6am or 7am – see below) 7am - For Colonoscopy only You should now drink the second glass of PICOPREP. This should be followed by at least two glasses of water or approved clear liquids over the next hour. You may continue approved clear liquids (no more than 200ml per hour, no milk, soups or jellies) until 11.30am on the day of your procedure. Arrive at the hospital at the scheduled admission time. 6 am –for 6am -For Colonoscopy and Gastroscopy (endoscopy via mouth) You should now drink the second glass of PICOPREP. This should be followed by at least two glasses of water or approved clear liquids over the next hour. Do not eat or drink anything for 6 hours prior to your scheduled admission time.

After the procedure

You will be able to eat and drink 30 mins after your procedure and will be discharged after 1.5 to hours. You will not be able to drive and will need to collected by a friend or relative.

Click here to download the PDF

Upper GI Endoscopy

If you are also undergoing colonoscopy and gastroscopy, please ignore these instructions and see instructions for morning or afternoon colonoscopy

General instructions

To ensure the stomach is empty to your procedure, you must not eat or drink within 6 hours of your procedure, unless you have been instructed otherwise by your doctor. You may and drink normally up to 6 hours prior to the procedure.

If you are having a morning procedure this means having nothing to eat or drink after 2am on the day of the procedure. For an afternoon gastroscopy you may eat an early light breakfast (before 7am) and then nothing to eat or drink. Your procedure may be delayed or cancelled if you have eaten or drunk within 6 hours of procedure.

After the procedure

You will be able to eat and drink 30 mins after your procedure and will be discharged after 1.5 to hours. You will not be able to drive and will need to collected by a friend or relative

What are the side effects of endoscopy?

The most common side effect is feeling bloated. Some people have nausea because of the medicines used before the procedure. If this happens to you, your doctor can give you medicine to make the nausea better. Most people can eat as usual after the procedure. Other rare side effects that can occur include:

• Food from the stomach getting into the lungs
• Bleeding, for example, after a growth is removed
• Getting a tear in the digestive tract lining
• Having redness or swelling of the skin around the IV

Should I call my doctor?

Call your doctor or nurse immediately if you have any of the following problems after your upper endoscopy:

• Belly pain that is much worse than gas pain or cramps
• A bloated and hard belly
• Vomiting
• Fever
• Trouble swallowing or severe throat pain
• Black bowel movements
• A “crunching” feeling under the skin in the neck

Click here to download the PDF

What to Expect?

Before the test, a doctor will review the procedure with you, including possible complications, and ask you to sign a consent form.

An IV line will be inserted in your hand or arm. Your blood pressure, heart rate, and breathing will be monitored during the test.

The Colonoscopy Procedure

You will be given fluid and medicines through the IV line. With sedation/analgesia provided during the colonoscopy, many people sleep during the test, while others are very relaxed, comfortable, and generally not aware. Your doctor may request an anaesthetist give you an anaesthetic agent (for example, propofol), which is a stronger sedative and will put you to sleep while you are being closely monitored.

The colonoscope is a long black flexible tube, approximately the diameter of the index finger. The doctor will gently pump air and sterile water or saline through the scope into the colon to inflate it and allow the doctor to see the entire lining. You might feel bloating or gas cramps as the air opens the colon. Try not to be embarrassed about passing this gas (it is just air), and let your doctor know if you are uncomfortable. You may feel like you have to go to the bathroom, which is a normal feeling during the procedure.

During the procedure, the doctor might take a biopsy (small pieces of tissue) or remove polyps. Polyps are growths of tissue that can range in size from the tip of a pen to several inches. Most polyps are benign (not cancerous). However, some polyps can become cancerous if allowed to grow for a long time. Having a polyp removed does not hurt.

Colonoscopy

After the colonoscopy, you will be observed in a recovery area, usually for about 30 to 60 minutes until the effects of the sedative medication wear off. The most common complaint after colonoscopy is a feeling of bloating and gas cramps. You should pass gas and not feel embarrassed doing this either during or after the procedure. This will relieve your feelings of bloating and cramping. You may also feel groggy from the sedation medications. You should not return to work, drive, or drink alcohol that day. Most people can eat normally after the test. Ask your doctor when it is safe to restart aspirin and other blood-thinning medications.

Complications

Colonoscopy is a safe procedure, and complications are rare but can occur:

• Bleeding can occur from biopsies or the removal of polyps, but it is usually minimal and can be controlled.
• The colonoscope can cause a tear or hole in the colon. This is a serious problem, but it does not happen commonly.
• It is possible to have side effects from the sedative medicines.
• Although colonoscopy is the best test to examine the colon, it is possible for even the most skilled doctors to miss or overlook an abnormal area in the colon.

You should call your doctor immediately if you have any of the following:

• Severe abdominal pain (not just gas cramps)
• A firm, bloated abdomen
• Vomiting
• Fever
• Rectal bleeding (greater than a couple of tablespoons [30 mL])

Download Gastroscopy Referral Form

Download Colonoscopy Referral Form