Before surgery care

You’ll be contacted to attend the Pre-admission Clinic (PAC) at the hospital. An assessment of your perioperative risk and how this can be best managed will be undertaken by the anaesthetist. You’ll also be interviewed by a nurse to discuss your admission and discharge planning.  You’ll be sent to pathology for blood tests. The potential need and options for an iron infusion and pain management and your medication instructions (including blood thinners) will be discussed if applicable. Further referrals may be needed.

This visit also serves as an education session regarding the aspects of ERAS.

If you smoke it’s extremely important that you stop. Your GP can assist you in this regard. It is advisable that you also minimise alcohol intake prior to surgery.

Exercise regularly to improve your general health – walking is a very simple form of exercise to improve your heart and lung health in preparation for surgery. Walk as much as you can.

Talk to your GP about improving any chronic conditions that you may have, such as diabetes or asthma before the surgery.

Synbiotics are a combination of prebiotics and probiotics. Probiotics are the good gut bacteria and prebiotics are the substances that promote the growth of those good bacteria. It’s recommended that synbiotics are used for two weeks prior to the surgery. No script is required.

For the three days prior to your operation you are required to consume a low fibre diet. ERAS Low Residue Foods include tender meat, fish, poultry and eggs. They also include low-fibre breads, biscuits, pasta, white rice and some vegetables such as peeled potato, zucchini, onions, mushrooms, lettuce and asparagus. Avoid seeds and pulp. Increase your fluid intake except if advised otherwise by your doctor(s).

Except if advised otherwise, daily ‘Movicol-Half’ is also recommended for the three days prior to surgery. No script is required. Your surgeon will tell you if further bowel preparation is required.

At the PAC, you will also be given six x 200ml tetra packs, containing flavoured carbohydrate drink. You must drink four packs the evening before surgery and the last two packs, two hours before your arrival time.

No solid foods, chewing gums/ lozenges should be consumed from midnight, the night before surgery. Clear fluid drinks such as water, black coffee or tea (without milk) and clear (not cloudy) apple juice are encouraged up to two hours before the surgery.

Skin preparation includes clipping (not shaving) abdominal hair when required. Please don’t attempt to shave your abdominal hair. Shower with a pre-op wash one night before surgery and the morning of surgery.  Before admission but do not apply creams, powder or deodorant. Keep warm this is very important.

Bring all recent x-rays and scans with you on the day of admission. Make sure you bring all your prescribed medications with you.

This is a good time to ask any questions or raise concerns.

You’ll change into a theatre gown and firm stockings (TED’s). Your skin will be prepared and you may be given an enema.

You’ll then be transferred to the anaesthetic bay where the anaesthetist, anaesthetic technician or nurse will insert a drip. You’ll receive some of the anaesthetic medicines through that drip. The drip is usually required to remain in place for two or three days after the surgery.

The Surgery takes about two to four hours. When you wake up, you’ll receive oxygen through a mask on your face, or via small nasal clips, and you’ll be connected to an intravenous drip and to a urinary catheter. Wound drains and nasogastric tubes are only used under certain circumstances but not routinely. You’ll spend about an hour or two in the recovery room.

Pain relief may be achieved by using an epidural catheter, a wound soaking device, injections and/or a patient-activated device for an average of three days as well as medicines such as panadol. The use of opioids (drugs such as morphine, which have a number of side effects) is reduced to a minimum in order to encourage bowel recovery.