You have been scheduled to have surgery on your abdomen. This may involve removal of a portion of your bowel. Your procedure will either be performed by a keyhole (laparoscopic) operation, or a traditional open operation involving one large incision. To ensure your body is as optimised as possible to tackle the stresses put upon it by an operation, you must carefully read the information below and follow the instructions. There has been significant research into the preparation of patients before an operation to help minimize the physiological stress and complications on the body that occur during and after surgery. Using this information will help prepare your body to be in the best shape it can be before your operation.
Activity and diet
It is important to remain as active as possible before your surgery. This should include a 20-30 minute walk every day or two if possible. In general, the more active your body is before the operation, the quicker your recovery will be afterwards. Physical activity helps your circulation and also keeps your heart and lungs in good condition. Try and do gentle weights to increase your muscle mass in the weeks leading up to your surgery, as your body will use this as fuel in the recovery process after your operation.
Maintain a healthy diet beforehand. You may be required to modify your diet in the day or two prior to your operation, especially if you are to have a bowel preparation to clean the bowel. In the week or two before your operation, however, eat as healthy as you can and keep your fluid intake up.
Pre-admission clinic
Depending on which hospital your operation is booked in, you may be required to attend a pre-admission clinic. Here, a junior doctor or nurse will ask you questions regarding your general state of health and take routine blood tests and swabs for screening of a particular bacteria (MRSA). You may also be seen by an anaesthetist if there are any concerns regarding your anaesthetic.
If a stoma has been discussed with you by Dr Jamnagerwalla, you will have a separate appointment to see our stoma specialist nurse, who will talk to you about having a stoma and teach and advise you on how to care for it after surgery. If a stoma is performed as part of your operation, the stoma specialist nurse will see you soon after your surgery when you are recovering on the ward.
Bowel preparation
Certain operations on the bowel require you to have some form of bowel preparation to clear the bowel. This can be in the form of an enema, or a full bowel preparation. If you are to have an enema, this will be given to you at the hospital when you arrive on the day of your operation. If you are to have a full bowel preparation, you will be required to commence this the day prior to your operation. The form of bowel preparation you are required to have will have been discussed with you at your initial consultation with Dr Jamnagerwalla.
Antibiotics
Research has shown that taking certain antibiotics within 24 hours of your operation may reduce certain serious complications. You will be given a script for your antibiotics at your initial consultation with Dr Jamnagerwalla. There will be two different antibiotics given, metronidazole and erythromycin.
Metronidazole
- On the day before your operation, take 400mg in the morning and 400mg in the evening.
- On the day of your surgery, take 400mg in the morning.
Erythromycin
- On the day before your operation, take 500mg in the morning and 500mg in the evening.
- On the day of your surgery, take 500mg in the morning.
You do not need the remaining tablets in the packs therefore either discard them or give them back to the pharmacist.
Eating and drinking
If you are not required to have a full bowel preparation, or are to have an enema on the day of surgery only, you can eat solid food up until 6 hours prior to your admission time to hospital. If you are having a full bowel preparation, follow the specific bowel preparation instructions given to you.
For ALL procedures, you may drink clear liquids up to 2 hours before your operation. It is extremely important to remain well hydrated before your procedure.
You will be given special carbohydrate drinks called PreOp at your initial consultation. These drinks are specially formulated to provide the required kilojoules of carbohydrate energy your body requires to prepare for surgery. You will be given a total of 6 PreOp drinks.
Instructions for drinking PreOp drink:
- Drink 4 bottles (each bottle is 200mls) of PreOp in the evening as late as possible the day before your operation
- Drink 2 bottles of PreOp two hours before your surgery. For morning operations, complete drinking your drinks by 6am. For afternoon operations, complete drinking your drinks by 11am.
The day of your operation
When you arrive into hospital before your operation, a nurse will complete your admission paperwork. You will also be visited by the anaesthetist who will discuss the anaesthetic with you and what type pain relief you will receive after your operation to control any pain. Elasticated stockings will be placed on your legs to help prevent clots during your hospital stay. If you are to have an enema, this will be administered to you when you have settled into your hospital bed.
What to expect after your operation
After you come back to the ward from your operation, you will be feeling quite drowsy. Nursing staff will regularly monitor all your vital signs. You will have a drip in your arm for receiving fluids through the vein. You will have a tube in your bladder draining urine (urinary catheter) and may also have a drain in your abdomen draining off any excess fluid your body produces after surgery. You may also have a pain machine (PCA) which you can self administer to control any pain or discomfort. You may have a sore throat when you wake up. This is from the tubes that were inserted down your throat to help you breath during the operation. This will settle after a few days.
You will be recovered using the Enhanced Recovery Protocol. This regime has been well-proven to speed your recovery up so you are able to be discharged from hospital sooner. Unless otherwise stated, you will be allowed to eat and drink when you return to the ward from your operation and are awake. You will not feel like eating big heavy meals, however try and keep your fluid intake up and just eat what you feel like eating. Until your bowels start working again, you may feel bloated and slightly nauseas, so don’t push yourself. Rather, just pick & choose what you feel like eating. Other reasons you may feel nauseous are from the anaesthetic itself and the pain medications given to you. You will be given regular medications for nausea for the first 48 hours after your operation.
You urinary catheter and drip will be removed within 24 hours if you are drinking enough fluid. Your “push-button” pain control will be replaced with a tablet form within 48 hours. You must spend as little time in bed during the day as possible. You will be encouraged to walk as soon as possible. This helps your whole body recover and prevents you from developing blood clots in the legs and chest infections. When not walking, sit in a chair out of bed. When in bed, keep your feet and toes moving as much as possible - these all help prevent blood clots or deep venous thrombosis. You will also be given injections to help prevent clots.
Your bowels will not work for a few days after your operation. This is normal. It occurs because they have been handled and in most cases, you have had a section of bowel removed and joined back together. Passing wind is a very sensitive sign that your bowels are coming back “online” and things are happy inside your abdomen after your surgery. In general, you will pass wind approximately 2-3 days after your surgery. A bowel motion may take longer and everyone is different. In general, your first bowel motion may occur anywhere from 3-4 days after surgery. Sometimes it may take longer, and this is normal so do not worry. Laxatives are not needed or given after your surgery. Things will work when they are ready to, so just be patient.
Going home
You can expect to be in hospital for 5-7 days, sometimes even less. You will be ready to go home when you are walking comfortably and independently, your pain is managed with tablets, your bowels have worked, and you are keeping your food down and drinking enough fluids. If you have a stoma, you will need to be confident in managing this at home, and this will be determined by our stoma care specialists nurses, who will be seeing you regularly after your operation and when you go home. You will be given scripts for any medications that you require to go home with, a discharge summary of your hospital stay and your follow-up arrangements with Dr Jamnagerwalla and your stoma care nurse, if required. Shortly before going home, or once at home, read the section on "Going Home After Bowel Surgery" in this section of the website for information on what to expect during your recovery. It is also a good idea to see your GP within 2 weeks, so they are up to date on your progress.
Remember…
Having an operation can be a stressful experience, physically and emotionally. When you first go home you are likely to feel tired and unwell for a while. Things will get better. It will take three to six months to feel completely back to normal. It is common to feel a bit low in the first weeks and to become frustrated that you cannot do everything that you would like to do. Please be patient.
