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Postoperative Instructions

When am I discharged from the hospital?
Most patients spend a few hours in recovery waking up from anesthesia. When you’re able to walk with assistance, take something by mouth (juice, crackers, etc), and your pain is controlled, you will be discharged from the recovery room. Almost all patients are able to go home the same day of surgery. If something unusual occurs, we always have the ability to admit you overnight. In general, though, you’ll be more comfortable in your own bed than in the hospital.
Recovery time depends, of course, on many factors—the individual and her current state of health, the reason for surgery, the type and duration of the procedure, etc. But, in general, for laparoscopic surgery, most consider recovery a week or two. We inflate the abdomen with gas (carbon dioxide) during the surgery, which leads to feeling a bit swollen and bloated for the first few days, but it’s more soreness and discomfort than sharp pain. Minor aches and pains may occur intermittently thereafter, but usually not enough to prevent most normal activities. For open surgery (laparotomy), recovery is typically around 4 weeks.
You can generally go back to work whenever you wish. Depending on the surgery, you may feel up to it as soon as a few days or a week. Some patients need more like 2, 3, or 4 weeks before returning to work.
We prescribe Ibuprofen (Advil, Motrin) at 800mg, Acetaminophen (Tylenol) at 1000mg, Docusate (Colace, a stool softener), Senna (helps with constipation), and a narcotic pain medicine (Oxycodone). Ibuprofen, Tylenol, Docusate and Senna are also available over the counter. We will send the medications prescriptions to your preferred pharmacy before the surgery.
If you are prone to nausea after surgery (or easily get motion sickness), a scopolamine patch can help. The anesthesiologist will place the patch on the skin behind your ear the morning of surgery and it lasts for three days. Most take it off after the car ride home, though, because it can make your eyes dry and your vision a little blurry. We can also prescribe anti-nausea medications such as Ondansetron (Zofran) or Metoclopromide (Reglan).
ERAS is well-studied set of guidelines for optimizing patient care before, during, and after surgery. Studies have shown that these protocols leads to a reduction in complications and hospital stay, reduced narcotic pain medication needs, earlier return of bowel function and earlier resumption of normal activities. Part of the protocol lessens the typical fasting requirement for surgery. Medical evidence has shown it is safe for a patient to have small amounts of clear liquid up to two hours before surgery and that this recommendation does not increase risk of aspiration above other standards. However, the liquid must be clear as previously noted.
There are no dietary restrictions after surgery and you can eat as soon as you are hungry. Avoiding foods that cause gas or constipation is a good idea, though.
Constipation can be helped by staying hydrated, eating healthy food, walking, drinking morning coffee, and limiting narcotic pain medicine (Norco/hydrocodone, Percocet/oxycodone). If those measures aren’t sufficient, you may use over the counter products such as Miralax (polyethylene glycol), milk of magnesia, mineral oil, magnesium citrate, Dulcolax suppositories, or an enema. Below is a thorough video created by one of our gastroenterologists at Cedars about how to prevent and manage constipation:
We think photographs can be very helpful and try to take them whenever possible. We will give a copy to your loved one or have the recovery room nurse send them home with you. If you bring them with you to your post-op visit, we will review and explain them in detail.
Call the office at (310) 388-1955 to schedule a post-op visit. You can also set up a date for post-op in advance. Most post-op visits can be done virtually.
We send any tissue removed from your body to be evaluated by a pathologist. He or she looks at it under a microscope to determine exactly what it is (e.g. benign vs. cancerous). We will send you a message on CS-link when the results are available, which is usually also a good time to check in and answer any questions about recovery you might have.

01

What if I have a question or a problem after surgery?

Call (310) 388-1955. During daytime hours, our nurses will help you. After hours, an answering service will send the medical team a message and we will call you back. You may use CS Link to ask questions if they are not urgent.

02

What symptoms are concerning after surgery?

You should call if you experience fever (>100.5 by thermometer), vomiting (if it happens just once it’s probably ok, but call if it persists), shortness of breath, or severe pain.

03

What if I can’t urinate after surgery?

Sometimes bladder muscles can take a while to wake up after anesthesia. It may be hours before you urinate for the first time and you may experience some discomfort as a result of the catheter or if you’re dehydrated. If you feel like your bladder is completely full but you can’t empty, call us at (310) 388-1955. Urinary retention is rare but serious. If it occurs, we’ll need to put a catheter back in and let your bladder rest for a few days.

04

Will I experience bleeding after surgery?

Bleeding or discharge is common after gynecologic procedures. Call if you soak through a pad an hour for more than two hours in a row. Even after a hysterectomy, the top of the vagina must heal. Light to moderate bleeding, spotting, or discharge is normal until the stitches fully dissolve at 12 weeks.

05

Why does it hurt in my chest and shoulder?

The gas and fluid introduced into your body can irritate a nerve under the diaphragm, which refers up to your shoulder. For some patients, this can be intense, but it isn’t serious and it goes away after a day or two.

How should I manage post-op pain?
We recommend taking 800mg of Ibuprofen (Motrin, Advil) and 1000mg of Acetaminophen (Tylenol), together, every eight hours for the first two days after surgery. This helps stay ahead of pain and reduces inflammation. Celecoxib (Celebrex) is a good alternative for those that have gastrointestinal problems and can’t take Ibuprofen. Oxycodone can be used in between those every-eight hour doses as needed.
Ibuprofen should not exceed 3,200mg per day and Acetaminophen should not exceed 4,000mg per day.
Narcotic pain medicines have addictive potential so we try to not over-prescribe them. Most patients don’t need narcotics after the first few days and many don’t use them at all. If you feel like you are going to need more than the prescribed amount, call early so you or a loved one isn’t trying to fill a prescription at night when not all pharmacies are open or stocked with what you need.
Heating pads are fine. Just be careful not to fall asleep while it’s on or it can burn the skin. Warm and cold compresses are fine.
You may shower whenever you wish. It is OK for your bandages to get wet. If you’ve had a hysterectomy, wait six weeks before taking a bath or getting in a swimming pool.
For laparoscopy, we typically hide one incision in the belly button. There can be between 2 and 4 additional incisions, 5mm in size (about the size of the tip of your pinky finger). Once healing is complete, these incisions are barely noticeable in most.
Generally, leave the bandages on for 7-10 days. If they are bothering you or you notice a reaction, you may remove the outside bandage the day after surgery. The steri-strips should stay on for longer if possible—on the order of 7 to 10 days. You can remove the steri-strips in the shower after 7-10 days. If your steri-strips come off early, don’t worry – simply keep the wound dry and place a band aid over it. You will be surprised at how quickly it heals!
Rest is important, but it’s also important to move around. Walking helps with circulation, bowel function, energy, and overall recovery. Getting out of the house is good for you.
A good rule of thumb is: “if it doesn’t hurt, it’s OK to do; if it hurts, don’t do that activity.” You’re probably not going to want to do a lot of strenuous activity in the first few days after surgery, but as soon as you feel up to it, you may exercise. You are not going to damage anything internally. Use your comfort as a guide of what you are ready to do. You can walk stairs. You can lie on your abdomen if it’s comfortable to do so.
If you’ve had a hysterectomy, there is an internal incision at the top of the vagina that we want to protect. So avoid anything that would put strain on that incision—yoga, pilates, squats with weights, horseback riding, intercourse. We don’t want water to get through that incision into your abdomen, so hold off on taking a bath or getting in a swimming pool
for six weeks. Significant bright red bleeding could be a sign of a problem with the vaginal incision so call us if that occurs.If you’ve had a hysterectomy, there is an internal incision at the top of the vagina that we want to protect. So avoid anything that would put strain on that incision—yoga, pilates, squats with weights, horseback riding, intercourse. We don’t want water to get through that incision into your abdomen, so hold off on taking a bath or getting in a swimming pool
For most procedures you can have sex, including intercourse, as soon as you wish after surgery.
If you had a hysterectomy, you need to wait at least 6 weeks before having intercourse so we can be sure the internal incision is healed. Other forms of sex are completely fine as soon as you wish, just nothing inside the vagina. If you have bleeding after surgery, wait until all bleeding is resolved before having sex.