Patient Frequently Asked Questions about Colorectal Surgery
What is minimally invasive surgery?
Minimally invasive (or laparoscopic) surgery involves performing surgical procedures using several small incisions (about an inch) to allow your surgeon to place specialized devices called “ports” through the abdominal wall. A small television camera is used for visualization is then placed through one of these incisions. An additional 2-5 small incisions are made to carry out the procedure using specialized instruments. There are a number of benefits, including reduced pain, earlier return of bowel function, quicker discharge and return to normal activities. It is safe and effective way to perform most procedures and has significant advantages. Sometimes one of these incisions is enlarged slightly to allow removal of a piece of intestine. Use of the minimally invasive or laparoscopic technique has dramatically reduced the amount of time our patients spend in the hospital, the amount of pain patients experience, and overall satisfaction with surgery. We use it whenever possible for appropriate surgical candidates. We have in place an enhanced recovery protocol which has further reduced the amount of time patients need to spend in the hospital. There are some people who may not be candidates for the laparoscopic approach. These include those who: have had extensive abdominal procedures before, have large tumors, or have a variety of other limiting factors. For more information on expectations regarding laparoscopic surgery, see the forms and downloads section of our website.
How long will my surgery be?
It depends. Most laparoscopic surgeries last between 1.5 and 3 hours. This does not include the time it takes to go to sleep, wake up, insert IV’s etcetera, so the actual time you spend in the operating room may be longer than this. Once the procedure is complete, your doctor will talk to your family in the waiting room.
What is the recovery time after my surgery?
Most patients spend between 1 and 5 days in the hospital. A typical average for laparosocopic procedures is 1-3 days, which is slightly longer (3-5 days) for open procedures. You will be discharged when you have evidence of bowel function (flatus or bowel movements), can tolerate a diet without needing IV fluids, and your pain is reasonably controlled on pain pills. At home, most patients need between 2-4 weeks before they are back doing everything they could do before surgery. The most common complaint is easy fatigue or feeling tired easily. This improves with time. There may be events that occur after surgery that prolong your hospital stay. These include but are not limited to infections, ileus (paralysis of the intestines after surgery), a problem healing a connection in your intestines, or anesthesia-related problems (e.g. heart/lung issues). There is no way to predict or prevent these occurrences. They are known risks of surgery.
When can I return to work?
It all depends on the type of work you do and what you feel comfortable doing. A basic rule is if it hurts, don’t do it. It is best to ease back into activities and ramp up slowly rather than going back full time. This allows you to see what your tolerance is without overstretching yourself. After minor surgery, most people take 2-5 days off. For more extensive anorectal procedures, up to a month may be required before one can comfortably sit for extended periods of time. For laparoscopic surgery, 2-4 weeks may be required before full return to work, though some people may return earlier. After open procedures, this time may be slightly longer (4-6 weeks). You should avoid heavy lifting for at least a month after abdominal surgery, regardless of type.
What can I eat / not eat after surgery?
There are no major restrictions after surgery. In the early time after your surgery (1-2 weeks), be sure to chew your food well. Avoid spicy or adventuresome foods until your intestines are functioning more regularly.
Will my bowel habits change after surgery?
It depends. After rectal surgery in particular, it is not unusual to go through an adjustment phase where patients report diarrhea, leakage of stool or gas, urgency to use the toilet, or incomplete evacuation. These are symptoms of spasticity of the rectum that is getting used to its new role. Often these symptoms improve with time, though it may take 6 months to a year for this to fully happen. Be patient, and consult with your doctor. There are medications to speed up, slow down, or change the consistency of your stool that can be used to help you through this adjustment phase.
Do I need to take a laxative or stool softerner?
No, but if you are taking narcotic pain medication (vicodin, oxycodone, Norco, etc), this may prevent constipation as a side effect of these medications. You should be sure to drink plenty of liquid and keep your stools soft. If you find your bowel movements are very hard, you may need to take a short-term over-the-counter medication such as Colace, milk of magnesia, or Miralax.
What activity am I allowed?
We encourage that you maintain regular daily activities soon after surgery. Limit lifting over 10 pounds for approximately 4-6 weeks after surgery as per your surgeon’s instructions will minimize the risk of a hernia or other complication occurring. Running, walking, climbing stairs and other activities are ok, provided you have enough help to do it safely.
How do I get disability forms or a return to work letter filled out?
We are unable to fill out these forms in the clinic due to time constraints. Call our office and fax over the forms to be completed. Disability or return to work forms requests can be faxed to our office at (323) 865-3671. We will fill out the appropriate sections and mail, email or fax back to the requesting party.
How do I take care of my incision?
Care of your incision does NOT require excessive scrubbing or washing. Simply let some soapy water run over the incision in the shower daily. Dry the area thoroughly. It is not necessary to cover the incision with a gauze unless you have a small amount of drainage (to protect your clothes). If you have a clear plastic dressing in place, you may remove this after 10 days. If you have an open incision, pack the area lightly with gauze. You do not need to shove this down deep into the incision. Over time, it will fill in from the bottom up (similar to how a scab heals). This may take about a month, depending on the size of the incision.
When is my first follow up appointment after my surgery?
This is typically scheduled 4-6 weeks after your procedure. You should call the office soon after being discharged from the hospital to arrange this appointment. You can always come earlier if you have any problems at home. Our office is happy to answer any questions, and one of our physicians or physician extenders will return your call within 24 hours.
Who do I call if I am having problems or questions after my surgery?
Call our office at 323-865-3690. Routine questions can be answered during the day, during business hours (8am-5pm). For emergency questions or after hours, you will be directed via our answering service to the physician on call, who can provide further assistance. We are happy to help you, and provide a 24 hour a day service for those in need.
Who will perform my surgery?
Your surgery will be performed by a board certified, fellowship trained physician who you met in the office. He or she may be assisted by individuals at varying levels of training (from medical students to fellowship trainees who have completed general surgery training). The help of these individuals is essential and surgery cannot be done without them. Due to the logistics of surgery, they serve as an extra set of hands required to perform the procedure. At all times, your attending surgeon is directing their efforts and is responsible for the conduct of these assistants.
What are the current oncology trials?
Oncology trials are designed to test various forms of chemotherapy for advanced cancer. At USC, we have an extensive network of oncology trials. You will need to schedule an appointment with an oncologist to discuss these options. We are happy to arrange that through our office or at the time of your clinic visit, should it be appropriate in your case.
Do you use botox?
Yes. Botox is an injectable medication that relaxes muscles. While it has gained popularity for use in plastic surgery as a treatment for wrinkles, it can also be used as a treatment for some anorectal problems including fissures. It is just one form of treatment, and may or may not be appropriate for you. Ask your surgeon at the time of your consultation to find out more.
Do you work with the robot technology?
Robotic technology is available at Keck Medicine of USC. The robot provides many of the benefits of laparoscopic surgery (smaller incisions, less pain after surgery). The majority of our surgeries can be performed either with the robot or conventional laparoscopic equipment. We are also trialing a new 3-dimensional camera, similar to the one the robot uses, to improve visualization during minimally invasive procedures.
Do you use laser technology?
Laser technology is available. There are a number of other treatments that may work more effectively than the laser for conditions such as hemorrhoids. Your surgeon can decide what treatment modality is best for you.
What pain medicine will I be using after my surgery?
After abdominal surgery, patients receive a number of medications in the hospital and are discharged with a similar regimen. These medications are part of an enhanced recovery protocol, which has been researched extensively in the national literature. Specific medications include extra-strength Tylenol (or acetaminophen), Neurontin (or gabapentin), and possibly ibuprofen (Motrin, Aleve, etc…). These non-narcotic pain medications are designed to be taken on a regular schedule every six to eight hours. They prevent the buildup of pain over time. You may be prescribed a narcotic medication for breakthrough pain (oxycodone or Vicodin). Be sure to read all warning labels or consult with a pharmacist regarding any potential drug interactions and take medication only as directed by your physician. For more information, contact our office.
When should I have a bowel movement after my procedure?
It depends. After colon surgery, most patients have a bowel movement within 4-5 days. Although you may not have eaten food, your intestine still produces mucous and other material that allows you to have a bowel movement despite the lack of a steady diet. There is no “normal” when it comes to bowel movements. Every patient is different. Some people use the toilet once every three days and others go multiple times a day. It can take 4-6 weeks or longer after surgery for your bowel habits to settle down to a regular, more predictable pattern. Do not become frustrated. After anorectal surgery, you may have some associated discomfort with bowel movements, particularly if they are hard. It is therefore important to keep your stools soft by drinking plenty of liquids and taking a stool softener as needed.
Is bleeding normal after my colonoscopy?
A little bleeding can be normal after a colonoscopy, especially if there was a biopsy or procedure performed. Usually, this bleeding is self-limited and stops without any treatment. It only takes one drop of blood to turn the toilet completely red. If you are experiencing bleeding, it is best to check with our office. Signs suggestive of a larger amount of bleeding include dizziness, lightheadedness, or rapid heart rate.
How do I get results for my biopsy/procedure/diagnostic test?
It typically takes 3-5 days for any pathology results to become available. Diagnostic test results (CT scans, other imaging) are usually available within 24 hours. Our office will call you once these results become available. You may also call to inquire about the results as well, and we will return your call at our earliest convenience. It is important for us to keep you informed about your condition and communicate this information as clearly as possible.
How do I get prescription refills?
You can request a refill by calling the office. Your doctor will have to authorize a refill. This may require a return visit to the clinic to re-evaluate your symptoms. We will not refill prescriptions initially given by other physicians and have strict limits on the refilling of narcotic prescriptions.
How do I get stoma supplies?
Call our office to get in touch with either an enterostomal therapist or someone who can organize this service.
How do I get my medical records?
Contact the hospital medical records division at 323-442-8784 and request a copy of your chart records. You are entitled to view copies of your record. Our office can facilitate this process for you.
Where do I park?
At Norris (clinic), there is complimentary valet parking located at the main entrance to the clinic (off Eastlake Ave). At Keck Hospital, you may either valet park or park in the structure (off San Pablo). Go up the drive to the cul-de-sac by the fountain and you will see the parking. In Pasadena, enter off Fair Oaks Avenue. Parking is available at a structure located between the North and South Pavillion. Our office is located on the 4th floor of the South Pavillion.