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 occasionally need routine preoperative tests done prior to surgery (bloods, X-ray, ECG, echocardiogram, etc). This will vary depending on age, fitness and type of surgery. Please discuss with Dr Dodd and the team.
Weight loss surgery patients will need to undergo a very low calorie diet (VLCD), with the assistance of our dietician team, 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. Smoking cessation and alcohol minimisation (<10 units/week) are essential for good outcomes.
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. This concept can be applied to all other types of surgery, reducing anaesthetic risk for all procedures.
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 VLCD. Please arrange an appointment with our dieticians.
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 7. Steri-strips (paper strips over the wound) will peel off in the shower after this. Absorbable sutures leave a lump or thread under the skin until they dissolve fully at 10 – 12 weeks..
- Showering is okay, but swimming/bathing should be avoided until day 7.
Driving
- Driving should be avoided for 1 week after surgery, depending on your procedure. You must be able to perform an emergency stop (slam foot on the brake) and not be taking any opiates.
Activities
- Low-intensity activities (walking, daily activities) are usually okay after discharge. Heavy lifting should be avoided for at least 6 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. Your dietician will guide you through this period. There is a risk of scarring causing narrowing/partial blockage after all procedures. If you are having problems, please contact us promptly.
- Please focus on eating protein first at each meal.
Medicines
- You will need to take a multivitamin 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 6 months after surgery. These are usually used for reflux/heartburn. They are used after Weight Loss Surgery to minimise the risk of reflux and anastomotic ulcers early after the surgery.
- You will be given anti-inflammatories (‘NSAIDs’, e.g.: ibuprofen, celecoxib) for 1-2 days 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 minimise their use other than that prescribed at discharge.
Activity
- Increasing activity is an important part of the weight loss process. Walking is great to improve fitness. Sitting/standing, slowly, multiple times is great for muscle building. As soon as you go home please start incorporating these into your daily activities. It will greatly improve your body composition and weight loss.
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.
Activities
- Please avoid heavy lifting for at least 4 weeks to minimise the risk of hernias forming at your wounds.
- Normal daily activities and walking are okay.
