Preoperative Instruction for Brisbane-Based Treatments

Wide Range of Surgical Treatments

Support for Enhanced Recovery After Surgery (ERAS)

Non-Judgemental Practitioners

Preoperative Instructions

Patients will generally have to attend the Wesley or St Andrew’s Hospital Pre-Admission Clinic prior to surgery. This is necessary to have routine preoperative tests done (bloods, X-ray, ECG, etc). This requirement will vary depending on your age, fitness and what surgery you are having done. Please discuss with Dr Dodd.

Weight loss surgery patients will need to undergo a low carbohydrate diet, with the assistance of Dietician Nicola Fox, for between 2 and 4 weeks before surgery. This will help you lose 5 – 10kg, shrinking your liver and abdominal fat, making your surgery much safer.

All patients undergoing major cancer surgery (oesophagectomy, gastrectomy) should undergo a period of ‘prehabilitation’ during their preoperative chemotherapy. This involves losing fat, building muscle mass and improving cardiorespiratory (heart/lung) fitness, substantially decreasing your risk of complications.

Any antireflux and hernia surgery patients with a BMI (body mass index) over 25 will also achieve much better results if they can lose some weight, both preoperatively and in the longer term. This is best achieved through a low carbohydrate diet. Please discuss with Nicola Fox, Dietician.

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A Bunch of Surgical Instruments are Sitting on a Table — Brisbane Upper GI Surgery in Chermside, QLD

A Doctor is Sitting at a Desk Talking to a Patient — Brisbane Upper GI Surgery in Chermside, QLD

Postoperative Instructions

Your recovery will obviously depend on the magnitude and type of procedure you have had.

Any patients who feel severely unwell should go to the Wesley Hospital Emergency Centre (privately insured patients) or the Royal Brisbane and Women’s Hospital (uninsured patients).

Wounds

Dressings can be removed on day 5. Steri-strips (paper strips over the wound) will fall off in the shower after this. Absorbable sutures under the skin take 10 – 12 weeks to dissolve fully and leave a temporary lump under the wound until they dissolve.
Showering is okay, but swimming/bathing should be avoided until day 10.

Driving

Driving should be avoided for at least 1 week after surgery, depending on your procedure. You must be able to perform an emergency stop (slam foot on the brake) safely before returning to driving.

Activities

Low-intensity activities (walking, daily activities) are usually okay after discharge. Heavy lifting should be avoided for at least 4 weeks, particularly after hernia surgery (including antireflux / hiatus hernia surgery).

Weight Loss Surgery

Diet

For both sleeve gastrectomy and gastric bypass, post-operative swelling and learning to eat again will limit your food consistency initially. You should stick to 1 week each of liquids, purées then soft foods for this period. Once you get out to week 4, small mouthfuls of well-chewed solids should be achievable. There is a risk of scar tissue formation causing narrowing / partial blockage after all procedures. If you are having problems, please page Dr Dodd.
Please focus on eating protein first at each meal.

Medicines

You will need to take 2 multivitamin tablets each day until advised otherwise. This, along with adequate protein intake and regular blood testing, keeps weight loss surgery safe.
You will be given acid decreasing medicines (PPI’s) for 3 months after surgery. These are usually used for reflux/heartburn. They are used after Weight Loss Surgery to minimise the risk of temporary side effects (reflux, chest pain, ulcers, scarring of bowel joins) after the surgery.
You will be given anti-inflammatories (‘NSAIDs’, e.g.: ibuprofen / Nurofen, diclofenac / Voltaren) for 24 hours after surgery. However, if taken regularly for many days on end, these medicines have a high risk of complications (stomach ulcer, anastomotic leaks, scarring). For these reasons, please generally try to avoid them after discharge and for the first 12 months after surgery.

Activity

Increasing activity is an important part of the weight loss process. Walking is fantastic fat burning exercise. As soon as you go home please start incorporating more walking into your daily activities. It will greatly improve your weight loss.

A Group of Surgeons are Performing Surgery on a Patient in an Operating Room — Brisbane Upper GI Surgery in Chermside, QLD

A Surgeon and a Nurse are Operating on a Patient in an Operating Room — Brisbane Upper GI Surgery in Chermside, QLD

Anti-reflux surgery

Diet

Hiatus hernia repair and fundoplication is always calibrated over a plastic tube (‘bougie’) to ensure the repair / wrap / new valve is not too tight. Post-operative swelling will limit your food consistency initially. You should stick to 1 week each of liquids, purées then soft foods for this period. Once you get out to week 4, small mouthfuls of well-chewed solids should be achievable. Mild nausea, bloating, chest discomfort and some difficulties burping can also be expected for the first few weeks. These symptoms almost always settle down after 4–6 weeks. Focus on how much better you feel without that awful reflux!

Activities

Please avoid heavy lifting for at least 4 weeks to minimise the risk of your fundoplication/new valve slipping up into the chest.
Normal daily activities and walking are okay.

Anti-reflux medicines / PPIs

These can be taken for a few days after surgery, if you feel you need them. Most patients notice an instantaneous improvement in their reflux symptoms and can avoid doing this.

Oesophagectomy / Gastrectomy

Diet

You will need to learn to eat again. Because of the different way food now travels through your body, you will initially feel less hungry and also feel full more quickly when eating. You will need to focus on eating small amounts more frequently for the first few months at home. Most patients notice their weight drops further when they return home. This is to be expected after such major Upper GI cancer surgery and will improve over time. Focus on adequate protein (meat, eggs, cheese, yoghurt).
Nutritional supplement powders can be of use. Please remember, they are not as good as real food and are often very high in sugar.

Medicines

It is advisable to take a multivitamin after discharge, for at least the first 6 months. This helps to counteract your difficulties eating enough good food. Large ones can be cut up or crushed.
You will be given acid decreasing medicines (PPI’s) for 3 months after surgery. These are usually used for reflux/heartburn. They are used after Upper GI cancer surgery to minimise the risk of temporary side effects (reflux, chest pain, ulcers, scarring of bowel joins) after the surgery.