Perioperative Other Laparoscopy Surgery Instructions

TWO WEEKS PRIOR TO YOUR OPERATION:

1. If you are taking aspirin or Plavix or other newer types of blood thinners, you need to check with your primary care doctor or cardiologist or neurologist to see if you can go off of them completely before surgery OR when can you safely discontinue them, if at all
2. If you are taking Coumadin (warfarin), you need to inquire similar to above and if necessary, be given instructions for a Lovenox bridge.
3. All other NSAIDS (ibuprofen (Motrin, Advil), Aleve, Indomethacin, etc) must be stopped now prior to surgery. Please make sure your surgeon is aware of any other blood thinning medicines or over the counter supplements such as fish oil and garlic. In general, avoid all herbal type supplements for the few weeks before surgery. Tylenol (acetaminophen) is OK if taken upto safe daily dose.

ONE DAY PRIOR TO YOUR OPERATION:

1. No special dietary changes are needed prior to the surgery. It is recommended to eat lightly a day before and do not eat or drink anything after midnight the night before surgery except your medications with a sip of water. You are not to eat or drink anything after midnight the day prior to your surgery.
2. Shower the night before with soap and water.
3. Do not shave anything. We will do it for you on the day of surgery.

DAY OF THE SURGERY:

1. If you are on regular medications like blood pressure medicines, you should take these with a sip of water only. Please do not take oral diabetes medicines and talk with your primary care doctor as to how much insulin you should take if you are on insulin.
2. You are to come to the facility at the designated time to be prepared for surgery. You will have a chance to meet with your surgeon in the holding area prior to the surgery.

POST-OP INSTRUCTIONS AND CARE:

1. Regardless of whether your surgery is done laparoscopically or through an open operation, the incisions will be closed with either staples or sutures (covered with glue or steri-strips). In either case, leave the outer most dressing for 24 hours.
2. If you had open surgery, it will be very helpful if you keep an icepack on it as much as possible for the first 24-48 hours. After that, heat pads will be helpful. Don’t burn yourself!!
3. If there is glue or steri-strips (butterfly strips), expect that they will fall off on their own, but if they remain after 8-10 days, you may remove them. They are easiest to remove in the shower. Don’t touch any staples. We will remove them in office.
4. If you do not have a drain after your surgery, you may shower two days after your surgery once the outer dressing has been removed. Do not soak in a tub or go to a pool or jacuzzi etc. If you have a drain after the operation, you need to protect the site from water and then can shower.
5. Swelling or bruising may occur after all surgeries. You are to contact your surgeon if the swelling continues to worsen within the first few days or if you notice increasing redness.
6. There are no true dietary restrictions after the surgery unless instructed otherwise. Some component of bloating may exist after the surgery. It is usually easier to stick to light, bland foods and even liquids for the first few days after surgery. Once intestinal function returns (marked by passage of gas and stool) you may eat anything that you feel you can tolerate but greasy foods may continue to bother you. Do avoid getting constipated. Some diarrhea is normal as well.
7. Everyone will be given a prescription for pain medication and stool softeners to take after the operation. The prescription can be requested prior to surgery so that you have it at home after your operation. The medication is usually a narcotic and can cause some constipation. We usually recommend taking a stool softener with the narcotic to help with this. Some examples are Colace. You may also take ibuprofen (if this does not upset your stomach) or Tylenol if you do not need something as strong as the narcotics, or even as an adjunct to them. We recommend switching to a combination of Ibuprofen and Tylenol as soon as possible. Please note that the narcotic prescription WILL NOT be refilled without an office visit.
8. Regardless of whether your operation is done open or laparoscopically, you need to limit your activity after surgery. There is no heavy lifting or straining (no more that 10 lbs) for 10 days after laparoscopic and 4 weeks after open surgery. This includes sex. Sorry! Most patients can return to work or school within one week surgery date. You should be walking. Going up stairs is OK. Do not drive while taking narcotics.
9. Very often times a foley catheter is placed in the bladder for the surgery. The catheter is always placed after you are put to sleep and taken out before you wake up so that you do not feel it. There may be some burning or difficulty the first time you urinate. If you are going home the day of your surgery, you are encouraged to remain at the facility till you are able to urinate. Once at home, if you are still having difficulties, try sitting in a shallow bath of warm water. Relax, it will come. If you cannot urinate and are uncomfortable, you need to go to your local ER and have a foley placed.
10. There are certain things to expect after the operation. Shoulder pain can be a part of any laparoscopic surgery. This is referred pain to the shoulder from the gas used during the surgery. It is most often the left shoulder, but may be the right side too. It can be felt in the shoulder blade are as well. It usually goes away in the first 24-36 hours and is best managed with anti-inflammatories like ibuprofen and activity (walking). Feeling “gassy” or “crampy” may also be seen after surgeries. The small intestines can sometimes react to the surgery by “going to sleep”. As they return to function, you may feel bloated. This will pass in the first few days.
11. Most patients will be given an appointment to follow-up in the office after surgery, when they are given their surgery date. If you were not given an appointment, please call the office to make one for 10-14 days after the surgery; earlier if you have a serious concern. The office number is (805) 379-9796.
12. There is a physician on call for you 24 hours a day. In case of an emergency, such as chest pain or shortness of breath or passing out, you should call 911. You should notify your surgeon if:
    1. You have fever over 101 degrees F
    2. You have worsening pain, not relieved with the pain medications
    3. You have nausea or vomiting that persists
    4. You have redness around the incisions that is worsening or drainage from the incisions