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| Abdominal - Gastrectomy |
These notes give an overall guide to your stay in hospital. You may see some differences in the details of your treatment, since it is tailored to suit your own condition.
WHAT IS THE PROBLEM? Removal of part or all of the stomach can be needed for several reasons. There may be an ulcer which will not heal with drugs or the ulcer has recurred. There is bleeding from part of the stomach. There may be a growth in the stomach.  A cut is made in your tummy above your navel. Inside, the problem is fully assessed by the surgeon as to what particular procedure is required, and then part of the stomach is taken out and the ends are joined up. The wound is then closed. WHAT HAPPENS BEFORE THE OPERATION? Reception When registering at reception your medical aid details will be required. Your medical aid may require that you obtain an authority number from them for the hospital. Please check this. If you are not on a member of a medical aid you will be required to pay a deposit or to sign an indemnity form. As far as possible we will try to advise you about hospital costs before your admission. Welcome to the ward You will be welcomed to the ward by the nurses or the receptionist and will have your details checked. Some basic tests will be done such as pulse, temperature, blood pressure and urine examination. You will be asked to hand in any medicines or drugs you may be taking, so that your drug treatment in hospital will be correct. Please tell the nurses of any allergies to drugs or dressings. The surgeon will have explained the operation and you will be asked to sign your consent for the operation. If you are not clear about any part of the operation, then read this again and then ask for more details from the surgeon or from the nurses. Visit by the anaesthetist The anaesthetist who will be giving your anaesthetic will interview and examine you. He will be especially interested in chest troubles, dental treatment and any previous anaesthetics you have had. He may want to use a spinal or epidural anaesthetic. This helps with pain control after the operation. He will talk to you about this Diet You will have your usual diet until 6 hours before the operation when you will be asked to take nothing by mouth. This will let your stomach empty to prevent vomiting during the operation. Shaving The operation area will be shaved to remove excess hair. Timing of the operation The timing of your operation is pre-arranged so that the nurses will tell you when to expect to go to the operating theatre. Do not be surprised, however, if there are changes to the exact timing. Transfer to theatre You will be taken on a trolley to the operating suite by the staff. You will be wearing a cotton gown, rings will be fastened with tape and removable dentures will be left on the ward. There will be several checks on your details on the way to the operating theatre where your anaesthetic will begin. The operation is then performed. WHAT HAPPENS AFTER THE OPERATION? Coming round after the anaesthetic Although you will be conscious a minute or two after the operation ends, you are unlikely to remember anything until you are back in your bed on the ward. Some patients feel a bit sick for up to 24 hours after operation, but this passes off. You will be given some treatment for sickness if necessary. You will have a plastic tube in an arm vein to give you a blood transfusion or salt solutions. You will have a fine plastic tube down the back of your nose for a few days to keep your stomach empty. Will it hurt? There is some discomfort on moving rather than severe pain. You will be given injections or tablets to control this as required. Ask for more if the pain is still unpleasant. You will be expected to get out of bed a day or two after operation despite the discomfort. You will not do the wound any harm, and the exercise is very helpful for you. After a week you should be able to walk slowly but relatively comfortably. By 10 days the wound should be virtually painfree. Drinking and eating Depending on the extent of the operation you may be able to start drinking small amounts of water within 48 hours but this will depend on the surgeon who will see you each day after the operation. The amounts will be increased when it is clear that liquids will pass through the operation area down into the gut without any problem. You should be moving to a normal diet in 10 days or so. Because the narrow outlet of the stomach has been lost in the operation you should avoid stringy foods such as fruit pith and nuts which may lodge further down the gut. You will be able to eat any other food. Small meals 4 or 5 times a day are probably best to stop you feeling overfull. You will probably need to eat as often as you can to keep your weight up. Opening bowels It is quite normal for the bowels not to open for a day or so after operation. If you have not opened your bowels after 2 days and you feel uncomfortable, a laxative may be needed. Sometimes diarrhoea follows the operation at first, but this settles down in time. Ask the surgeon if you are troubled by it. Passing urine You may have a small tube passed into the bladder during the anaesthetic so that the bladder empties without you having to get up immediately after the operation. If there is no tube It is important that you pass urine and empty your bladder within 6-12 hours of the operation. If you find using a bed pan or a bottle difficult, the nurses will assist you to a commode or the toilet. If you still cannot pass urine let the nurses know and steps will be taken to correct the problem. Sleeping You will be offered painkillers or sleeping pills to help you to sleep. If you cannot sleep despite the painkillers please let the nurses know. Physiotherapy The physiotherapist will check that you are clearing your lungs of phlegm by coughing and that you are helping your circulation by continuous movement of body and limbs. The wound and stitches The wound has a dressing which may show some staining with old blood in the first 24 hours. The wound will be checked and the stitches removed after about 10 days. Sometimes dissolving stitches are used. There is no need for a dressing after this unless the wound is painful when rubbed by clothing. There may be some purple bruising around the wound which spreads downward by gravity and fades to a yellow colour after 2 to 3 days. It is not important. There may be some swelling of the surrounding skin which also improves in 2 to 3 days. Occasionally minor matchhead sized blebs form on the wound line, but these settle down after discharging a blob of yellow fluid for a day or so. Washing You can wash the wound area as soon as the dressing has been removed. Soap and warm tap water are entirely adequate. Salted water is not necessary. You can shower or take a bath as often as you want. How long in hospital? Usually after 5-8 days you will feel fit enough to leave hospital, provided there is someone to look after you. We will talk to you about your home arrangements so that a proper time for you to leave hospital can be arranged. You will be provided with an appointment to visit your surgeon for a check up within 1 to 3 weeks after you leave hospital. Sick notes Please ask the surgeon for sick notes, certificates etc. After you leave hospital You are likely to feel tired and need rests 2 to 3 times a day for a month or more. You should be back to normal activity within 2 months. Lifting At first discomfort in the wound will prevent you from harming yourself by too heavy lifting. After 3 months you can lift whatever you like. Driving You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about 4 weeks. What about sex? You can restart sexual relations within 2 to 3 weeks, when the wound is comfortable enough. Work You should be able to return to a light job after about 6 weeks, and any heavy job within 3 months. Complicationsns Sometimes there is a delay in the recovery of the gut after the operation which means that you do not start drinking so soon. This settles down. Sometimes there is infection in the wound or less often inside the abdomen. You are given antibiotics to prevent this. Rarely there may be a leak from the join between the stomach and the bowel or this area may become narrowed as a result. This will delay discharge from hospital and may require re-operation. Sometimes the loss of part of the stomach causes problems with eating and digestion. This will be discussed with you if the problem occurs. Sometimes vitamins and iron are needed in the years following the operation. You will need blood checks each year for this. If you notice other problems, please tell the surgeon. GENERAL ADVICECE The operation is a major one, but you may well be surprised how quickly you get over the effects. If you have any problems or queries, please ask the nurses or doctors. |
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