You may have had surgery in the past and are already familiar with some of the “routines” surrounding a trip to the operating room. Those who have never had a major surgical procedure may find the experience quite foreign and scary. Using the latest technology most GYN surgery today is fairly straightforward and requires only an outpatient same day stay. At other times it is more complicated and requires a longer stay in the hospital and a longer recuperation period.
Typically we will call you and give you a surgery date few days after your office appointment.
Most of the time you insurance company or medical group must first approve your surgery. We will take care of this but, depending on your insurance, this can sometimes take several days to obtain.
You will always need to have some blood tests prior to your hospital admission. These will usually need to be performed within 7 days of your surgery. For most surgeries you will also need a chest x-ray and an EKG.
In rare instances some surgeries you will need to perform at least a minimal bowel prep. Sometimes only a mild laxative and a 1-day clear liquid diet is required. At the other extreme you may need a vigorous prep with very powerful laxatives and a 2-day clear liquid diet. There are good reasons for this. Evacuating your colon of gas a fecal material makes abdominal and laparoscopic surgeries technically easier to perform. It also makes potential infectious complications of all surgeries less likely.
The anesthesiologist is going to keep you pain-free during your procedure. All of the anesthesiologists we work with are top-notch physicians. We wouldn’t have it any other way. I leave decisions about the type of anesthesia to be used during your surgery to the anesthesiologist. He/she will discuss the options with you prior to your surgery.
Coming to the Hospital
You will need to come to the hospital several hours prior to your planned procedure. We will tell you approximately what time you should present yourself. In the pre-operative area Nurses will check all of your laboratory studies and make sure that all of the proper paperwork is completed. They will also start an intravenous line in one of the veins of your arm. Your family and friends can be with you during all of this.
Just prior to your surgery the anesthesiologist will again talk with you and your family and answer any questions you may have. He/she will also probably examine your mouth and neck at that time. Dr. Maslovaric will also see you at this time for any last minute questions.
You will be given an intravenous sedative prior to being taken into the operating room. One of the more common pre-operative medications given, Versed, has a powerful amnesic effect. Even though you are lucid and “awake” after receiving this drug you will probably have no memory of any events following its administration.
The Surgical Waiting Room
If you have family/friends who wish to be informed of the outcome of your procedure then it is best that they go to the Surgical Waiting Room while you are having your procedure. I would really like to speak to your family/friends after your surgery so that they can be assured that you are fine and the procedure went well. If I cannot find your family/friends in the Waiting Room after your surgery they can leave a phone number so I can contact them as soon as the surgery is completed.
We try very hard to minimize your discomfort. We have many methods to treat pain after surgery nowadays including;
Long acting intrathecal narcotics. These are administered by the anesthesiologist via a “spinal tap” just prior to your surgery. Surgical pain is almost eliminated for about 24 hours after the surgery.
Epidural narcotic infusion. This is also initiated by the anesthesiologist by placing a small tube (catheter) into a space around your spinal cord. Narcotic medication is then infused continuously for several days after surgery.
Patient Controlled Analgesia (PCA). Pain medication is given intravenously via a computerized pump after surgery. Typically a minute amount of narcotic is given continuously and you also have the option of giving yourself an additional boost of medication by pushing a button on a cord attached to the pump. The amount of medication you are allowed is rigidly controlled by the computerized pump so that you cannot ever overdose yourself.
Incisional Analgesia. The newest form of pain control consists of local anesthetic agents (eg Xylocaine, Lidocaine, etc) infused in minute quantities directly into the area of the incision. This is done by an ingenious, small pump connected to tiny catheters placed in the subcutaneous fat of the abdominal wall at the time of surgery.
We rarely need to transfuse blood during or after surgical procedures.
The risk of getting a transmissible disease from blood products (eg, HIV, hepatitis) is quite low (i.e. 1:100,000 risk). We think of blood products in the same way we would think of any drug. They should only be given if absolutely necessary and the benefit greatly outweighs any risk. When I order a blood transfusion for you it is because it really is absolutely necessary for your immediate health and safety.
We can usually predict when you will need a blood transfusion with enough time for you to designate a blood donor such as a spouse or relative. Interestingly, it turns out that the risk of contracting a transmissible disease from designated donor blood is equivalent to that of random donor units!
If you have had either a trans-vaginal surgery or a minimally invasive gynecologic surgery (e.g. laparoscopy, hysteroscopy) you can tolerate feedings immediately. Even so, until you have an appetite it is best to avoid eating a lot of solid foods – drink a lot of fluid instead.
In contrast to minimally invasive surgery, abdominal surgery with larger incisions typically causes your gastrointestinal tract “goes to sleep” for several days. If you were to eat food immediately after surgery it would not travel through your stomach and intestines normally. This would put you at risk of vomiting. Not only is this uncomfortable after surgery but it can also be dangerous and might require us to place a nasogastric tube (a tube that travels though you nose to your stomach)!
To prevent complications of early feeding we will advance your diet slowly after abdominal surgery. If you feel well, we might start you on a clear liquid diet the day after surgery. Nevertheless, we will let you eat as soon as it is safe to do so (we’re not trying to torture you!).
If you have a laparoscopic surgery you will have 2-4 tiny incisions just around area of umbilicus, and in the lower area of your abdomen. If you have had a major abdominal surgery most can be done with a “bikini” (transverse) incision but on very rare occasions a vertical up-and-down (midline) incision is required.
The skin of laparoscopic incisions and most transverse incisions can often be held together with a dissolvable suture in the skin and/or a special type of “skin glue”. The skin of most vertical incisions must be held together with little metal staples that are removed 5 – 10 days after your surgery. It “picks” a little when the staples are removed but the skin heals beautifully.
All skin incisions will heal with some degree of scarring. This is normal and expected. You can decrease the amount of scarring to some degree by applying either Mederma (a lotion available without a prescription in most pharmacies) or special wound covering strips available without a prescription at most pharmacies (eg BandAid Scar Healing strips http://www.bandaid.com/scar_healing.shtml, or ScarGuard http://www.scarguard.com ).
- American Academy of Pediatrics: aap.org
- American College of Obstetrics and Gynecology: acog.org
- Baby Center: babycenter.com
- Centers for disease control: cdc.gov
- OB-GYN.net: obgyn.net/women/women.asp
- Pelvic pain: org
- Pregnancy Weekly: parentingweekly.com/pregnancy