Postoperative Expectations

What to Expect After Surgery

After surgery, you should expect the following:

• Abdominal pain (where the small incisions were made) will develop 6 to 9 hours after the procedure.
• Shoulder pain will usually go away in 24 to 48 hours.  The pain is caused by the carbon dioxide gas used to expand the abdomen so the procedure can be done. It is helped by lying with one's feet higher than one's head.
• The absence of any heartburn or regurgitation should be noticeable immediately, even though you will not be on any medications for reflux postoperatively.  Occasionally, people will regurgitate what they swallow but that is related to the dysphagia; that is common postoperatively and will go away.
• Burning during urination and/or an increase in frequency of urination is the result of the catheter that was placed into the bladder during the operation. It is not an infection. It will usually go away in a few days.  If you haven't urinated for 6 to 8 hours, let us know, as you may need the catheter reinserted for a few days. This is especially true in men.
• A sensation of not being able to catch your breath is not cause for any concern, though the reason for this is not known.
• Patients should only take small sips of liquids and not overdo it during the first 12 hours. You will not get any solid food until the morning after surgery. Breakfast will consist of cereal, scrambled eggs and other soft foods. At home, continue this diet of soft foods with no bread or red meat until returning to the office for a follow-up appointment. If you are doing well with the foods you are eating, you can experiment with foods of more consistency, but don't  be disappointed if you cannot eat anything solid. Dysphagia can be severe and last a few months.

Discharge from the hospital is usually 24 to 36 hours after the procedure. If you are not ready for discharge or not up to it, you will not be discharged.  Do not worry about early discharge.  Usually, patients are seen first thing in the morning by the residents and a laparoscopic surgery fellow.  They will report any problems to the surgeon. You can go home before seeing the surgeon if the resident and fellow have cleared the discharge. The surgeon will meet with you on the day after surgery if you are still in the hospital.

What to Expect at Home

Patients should feel better every day with regard to pain and discomfort. Each day should bring more freedom of movement and more activity.

Some notes for patients:

• Vicodin or Tylenol with codeine will be provided, but often only extra strength Tylenol or Advil is necessary.
  A low grade temperature (less than 101°F) is acceptable for a few days, but it should not go higher or last more than 24 to 48 hours. The patient should call the office if his or her temperature is greater than 101°F or lasts more than 48 hours.
• Incisions require nothing more than keeping them clean and covered for about one week. There may be some bruising around the incisions that can increase in size with time. The bruises may bleed a little. This is no cause for alarm unless it is excessive. If the incisions get red, painful or infected, call the office. As the sutures in the skin begin to dissolve, there may be some discharge from the incisions for about two to four weeks after the operation.
• There is no need for alarm. The patient should call the office to arrange a time to have the incisions checked. Many patients see little white strands sticking out of their incisions. Those are sutures in the skin that will dissolve. They can be removed in the office if they bother the patient.
  The patient can shower the day returning home. Band-Aids must be taken off prior to, or after, showering and be replaced with new, dry ones. 
• If pain is experienced at home that was not experienced prior to discharge, contact the office. Pain in the chest or shoulder associated with eating is not serious and will go away. If it does not go away after an hour or two call the office. It may be related to food getting stuck during swallowing. Sudden severe pain unrelated to swallowing, especially in the upper abdomen, could represent a significant problem. Call the office immediately if that occurs.
  Some patients report loose stools or constipation following surgery. These changes are related to diet and to pain medications. Over-the-counter medications can be taken if either constipation or diarrhea are a problem.
• Following surgery, the patient can do whatever feels comfortable. Patients shouldn't drive until they have full and free range of motion without pain. This will take at least a week. Although it is encouraged that patients walk and go up stairs, they shouldn't overdo it. If the patient feels tired, he or she should stop. Patients shouldn't lift anything that causes discomfort when they attempt to lift it. 

When to Call the Office

Call the office if you experience:

• Significant bleeding
• Difficulty breathing or shortness of breath
• Persistent lightheadedness
  Chills and/or fever greater that 101°F
• A temperature between 100° an 101°F for more than 48 hours
• Pus or redness at the incisions
• Food that remains stuck in the esophagus for more than one hour after eating
• Severe abdominal pain
• If you are unable to reach the office or the answering service, please call Rhode Island Hospital at 401-444-5108 and -ask to speak to the chief surgical resident on call.

Please remember that we are always available to take care of patients and to answer questions. We do not view calls as an inconvenience because we want to help make the postoperative period as easy as possible.