What should my wound look like?
Your wound may be closed with absorbable sutures and steri-strips, staples, or sutures. Steri-strips should be left in place from 7-10 days and then they may be peeled off. The adhesive may look dirty and sticky and this may require “fingernail polish remover” to get it off. Staples aren’t as painful as they look when they come out (don’t dread it). They are generally removed in 7-10 days. Sutures should be removed in 7 days except on the face and head where they are often removed sooner.
If the skin that is 1/2 inch away from the incision is red, warm, and tender, then your wound may be infected and it may require opening. You should contact the office number (336-387-8100) and make arrangements to be seen in the office.

What is the preoperative bariatric diet (rapid weight loss to shrink the liver before surgery)?

This is provided courtesy of the Moses Cone Nutrition & Diabetes Management Center. Call them at 336-832-3236.

for more information or an appointment.

I cannot urinate. What should I do?

Depending on your age and the procedure that you had, you may experience some difficulty voiding. Older men with underlying prostate hypertrophy can notice difficulty urinating with the increased fluids that they receive in the operating room. Anyone who has had surgery on their bottom (hemorrhoids, fissure, fistula, warts) or an inguinal hernia can have spasm of their pelvic floor resulting in difficulty voiding. Sitting in a tub of warm water and allowing urination to occur in the tub can relieve this condition. A warm towel applied to the bottom can relieve some of the pain associated with anorectal surgery. A warm bath is probably the best. Urinary distension can cause severe, vague discomfort in the lower abdomen. If you are still unable to urinate, then you should call the surgeon and you will need to come to the ER for Foley catheter insertion. This may need to stay in place for a few days and then be removed in the office. You may choose to contact your urologist and make other arrangements if that suits you.

I am nauseated after I take my pain medication. What should I do?
Nausea after narcotics does not represent an allergy but intolerance to some of these opiates. Sometimes patients cannot tolerate codeine but can take hydrocodone or oxycodone. If you take the prescribed drug and you develop the "heaves" then we will need to make arrangements for you to receive an alternate drug. We cannot call in to the pharmacy drugs like oxycodone. Hydrocodone can usually be called in. If you are not having that much pain, then try relying on another the counter pain reliever such as acetaminophen or ibuprofen. Try to call during the 9am-4pm window when these arrangements can be taken care of without causing a trip to the ER.

When can I remove my surgical bandage?
Generally, the dressing can be removed 24 hours after surgery. It is not uncommon to see some blood staining the dressing. Unless drains are in place, it is OK to get the incision wet 24 hours after surgery. If staples are in place, then apply Neosporin ointment along the staple line until you come back to the surgeon and have the staples removed.

I noticed some bloody fluid draining from my wound. What should I do?
If you have an abdominal incision, this can be due to drainage of a seroma. The fluid is usually blood tinged and straw colored and can saturate a dressing sponge. This fluid will escape and spontaneously stop. If the wound if red and tender and if the fluid that is draining looks gray or yellow or like pus, then you likely have a wound infection and this will need to be drained. If this occurs, you should make arrangements with the office (336-387-8100) to come in that day or the next and have your wound checked. Until then, place and dressing over it and allow it to drain.

I haven’t had a bowel movement. Can I take a laxative?
The answer is generally yes. If you have had a bowel prep (GoLytely) before your surgery, then it may take longer for you to produce feces. However, narcotic pain relievers can cause constipation and this can be prevented by taking in adequate liquids by mouth and using a laxative. Patients should use a laxative that has worked for them in the past or try a mild laxative such as Milk of Magnesia. Enemas should be avoided in patients who have had recent colon surgery or appendectomy.

Is it normal to feel tired and washed out after surgery?
Yes--General anesthesia often seems to effect the patient's stamina. This can be manifest by a sudden loss of energy, tiredness, and breaking out in a sweat. Take a rest but continue to try to increase your exercise tolerance.

How should I manage the staples that are holding my incision together?
Application of Neosporin may cut down on the redness that can occur where the staples enter the skin. A light dressing over the incision after the morning shower can keep clothing from grabbing on the staple line.

How much can I lift after surgery?
What is 20 lbs to one may be like 50 lbs to another. As a general rule, if you feel yourself tightening your abdominal muscles and straining (Valsalva), you are lifting too much during that first 4 weeks after surgery. After abdominal surgery you may want to wear an abdominal binder when working to protect your back. A sore abdomen that doesn't hold the abdominal contents in very well leaves your back vulnerable to strain.

I feel a knot in my incision?
This question comes up most often after breast biopsy or inguinal hernia when the patient feels a lump. In the early postop period, the wound will swell and feel firm. Breast biopsy cavities fill with fluid and when felt, feel firm and may feel larger than before the surgery. Hernia incisions typically also have mesh in them and this can add to the feel of a lump.

When can I have sex?
For most general surgical procedures, there is not any specified interval to avoid sexual intercourse (i.e. as in vaginal procedures, post partum, etc.) Soreness at the incision site may require more patience and time. The patient who has had the surgery should be the one “calling the shots” and should return to sexual functioning when they feel like it. If the surgery has required you to miss birth control pills, then you will need to take other precautions to avoid getting pregnant.

When can I drive? Ride?
The answer here has a lot to do with common sense. You should not be taking any narcotic or prescription pain relievers and drive. You should have good mobility of you head, neck, arms and legs. Before you embark on a trip across town, try driving around the block. Have someone with you when you try.
After surgery you may be able to travel (ride not drive) short distances (2-3 hours). You should get out and walk around the car about every 45 minutes and be sure to drive plenty of fluids. Discuss this with your surgeon before striking out on a trip.

There are blisters beneath my steri strips. Why are they there and what should I do?
Blood blisters often occur when there is swelling in an incision after surgery. These are related to traction on the skin and do not necessarily represent a tape allergy. When they rupture, apply Neosporin and a light dressing.

  I need more pain meds. When can I get my prescription refilled?
Certain prescriptions for oxycodone (Percocet, Tylox) cannot be called to the pharmacy. You may need to pick those prescriptions up at the office. The nurses will contact your surgeon and determine if more pain medications are indicated. If you wait until the weekend, then you will need to go to the Emergency Room for evaluation before pain meds can be prescribed. If you will require more pain meds over the weekend, be sure to call before Friday at 4 pm.
The pain prescription that you were provided may contain acetaminophen. Taking that pain pill along with an over the counter remedy that contains acetaminophen (like Tylenol) could produce liver damage from too much acetaminophen. Therefore it is important to follow the pain prescription guidelines on the bottle of your prescription.

When should I be worried about my temperature?
First you should have a thermometer to take your temperature. Temperatures in the morning tend to be lower and then they tend to rise in the afternoon and evening. Low-grade temperatures (99-100 F) may occur especially after general anesthesia and when the patient is not taking deep breaths. The reason for not taking deep breaths can be related to abdominal soreness from incisions. Fevers associated with burning with urination may signal a urinary tract infection.
The most significant fevers after surgery occur with shaking chills followed by temperatures over 101 degrees. You should contact us at 336-387-8100, as we may need to see you either in the office or the emergency room.

When should I call the surgeon on call?
There is always a CCS surgeon on call. Regardless of the time of day or night, the surgeon may be evaluating an emergency, operating on a patient, or asleep in bed. If you feel that you need to speak with the surgeon on call please call (336-387-8100). Assume that the surgeon does not know you and be able to tell him the procedure that you had, the date and location of your surgery, and the name of your surgeon. Be mindful that the surgeon probably has work to do the next day. If the surgeon is in an operating room then you will likely speak with the circulating nurse. If you need to be evaluated after the office is closed then you will be referred to the ER where you may be evaluated by the surgeon or the emergency room physician. ER visits may be more costly and time consuming than a visit to the CCS office.

How should I manage the drains that were left in place?
Prior to discharge from the hospital/surgical facility, you may have received instructions about emptying your drain "grenade". This should be emptied and recorded at least twice a day. You should apply Neosporin to the exit site of the drain from the skin and do not take a shower or conventional bath. Take a "bird bath" or sponge bath instead.

What can I eat after surgery?
That depends on the type of surgery that you have had. Generally after outpatient surgery, you will be instructed to take only liquids until the next morning. The more important issue after any surgery is that you are able to take down plenty of liquids (water, Gatorade). If you have had a Nissen fundoplication, then you should take noncarbonated liquids and soft foods for about 3-4 weeks after your surgery. Let your appetite be your guide after most other surgery. If you begin a high fiber diet too soon after surgery, you may have more abdominal discomfort from "gas pains".

What are the risks of having my gallbladder removed?
Removal of the gallbladder is done today using the laparoscopic technique. This involves the placement of small holes into the abdomen into which the surgeon can insert a video camera and perform gallbladder removal. This is laparoscopic or videoscopic surgery although some in the public still refer to this as "laser surgery" even though no laser is used. Sometimes we still have to make an open incision to remove the gallbladder and this is done for your safety's sake. The list of potential complications is very long and many are very rare. Some complications have to do with being put to sleep (general anesthesia) and basic surgery--bleeding, infection, pneumonia, urinary tract infection, pulmonary embolism. However, gallbladder removal has some very specific potential complications that should be mentioned. These include: 1. common bile duct injury requiring drainage of the bile into the small bowel; 2. trocar injury to the bowel; 3. bile drainage or collection that may occur because of direct openings from the liver to the gallbladder bed; 4.delayed leakage of bile from the cystic duct; 5. retained stones within the common bile duct requiring ERCP; 6. postoperative pancreatitis; 7. wound numbness or pain; 8. late wound hernia formation or bowel obstruction from herniated bowel; 9 hepatic artery injury. Fortunately the complication rate from this surgery is low.

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