Performing surgery as an outpatient procedure is an emerging trend. The day after surgery, most of the recovery period occurs at home, and the patient is responsible for recovery. Postoperative recovery refers to ERAS (Enhanced Recovery After Surgery) and typically focuses on pain management, rapid recovery of bowel function, diet, and patient mobility. A patient undergoing gynecological surgery for benign indications can be discharged within 1-2 days after surgery.
There are various care and recovery option available after open or Laparoscopic surgeries. Laparoscopic hysterectomy, myomectomy, and ovarian tumors are the most routine surgeries that need recovery. Surgical stress induces a catabolic state, resulting in increased cardiac demands, relative tissue hypoxia, increased insulin resistance, impaired coagulation, and altered lung and gastrointestinal function.
What are ERAS or Post-OP Recovery?
The Enhanced Postoperative Recovery (ERAS) pathway was developed to maintain normal perioperative physiology, thereby improving patient outcomes without increasing postoperative complications or readmissions. Eras` basic principles include:
- Preoperative counseling and nutritional strategies include avoiding prolonged fasting before and after surgery.
- Also, perioperative considerations include attention to local anesthetics and non-opioid analgesics, fluid balance, and normothermia maintenance.
- Early mobilization and appropriate anticoagulation prophylaxis include in surgical post-recovery strategies.
The goal of reducing surgical stress and helping the body lessen the consequences of such stress through the ERAS pathway is achieved by implementing a combination of components that, when combined, constitute a comprehensive perioperative management plan.
Benefits Of ERAS (post-op recovery)
Benefits of the ERAS pathway include shorter hospital stays, reduced postoperative pain, and analgesia requirements, rapid restoration of bowel function, reduced complication and readmission rates, and improved patient satisfaction. Implementing the ERAS protocol has not increased readmission, mortality, or readmission rates.
Organizations considering an ERAS program should consider their infrastructure and patient flow during the preoperative and postoperative care phases.
For an ERAS program to be sustainable, it must be integrated into the health care delivery system as a standard of care model.
Enhanced postoperative recovery is a comprehensive program with data showing success when multiple components of the ERAS pathway are implemented together. Internal use of the ERAS pathway should be strongly encouraged.
These benefits have been replicated across the spectrum of gynecological surgery, including open, minimally invasive, benign, and oncological procedures. Implementing the ERAS program requires the cooperation of all surgical team members. Enhanced postoperative recovery is a comprehensive program with data showing success when multiple components of the ERAS pathway are implemented together. Successful implementation of the era path in gynecological care teams has the potential to improve patient care and healthcare delivery systems.
Post-Operative Recovery For Laparoscopic Vaginal Surgery
Avoid heavy lifting, strenuous activity, and driving for 7-10 days until narcotic pain medication is discontinued.
- You can take a shower or bathtub.
- Avoid sex, douching, or tampons until the surgeon sees them after surgery.
- Milk of magnesia for constipation.
Post-Operative Recovery After Laparoscopic Abdominal Surgery
Get out of bed, be active but not strenuous, and avoid heavy lifting (20 pounds or more).
- Avoid driving for 7-10 days without even using narcotic pain relievers. Until then, you may have been a passenger in the car.
- If you are constipated, use a stool softener and milk of magnesia.
- The bath and shower are good.
Just tap the wound lightly. If you have staples, call the office 5-7 days after surgery to have them removed. If you have derma bond, the glue will start peeling off within 7-10 days (you can peel it off at this point).
Avoid sexual intercourse, vaginal douching, and other vaginal behavior until your doctor recommends it.
Postoperative Recovery For L.A.V.H. And L.A.S.H. Procedures
- One must avoid heavy lifting, vigorous activity, and driving for 7-10 days.
- Avoid sex, tampons, and washing until the surgeon sees them after surgery.
- Use a stool softener and milk of magnesia for constipation.
- The skin glue on the incision will peel off within a few weeks, at which point you can peel off the rest. The suture underneath will dissolve on its own.
Post-Operative Recovery for D&E or D&C
- You may bleed for 7-10 days. Sanitary pads or tampons are fine.
- Pain medication prescribed by the doctor.
- Follow-up 2-3 weeks after surgery.
- Avoid sexual intercourse for two weeks.
Postoperative Recovery forLaparoscopic Thermal Ablation Procedures
Expect to go home on the day of surgery, take pain medication, and be instructed to take a day off.
Nonsteroidal drugs (ibuprofen) are usually better than narcotics for pain relief.
You can drive, work or exercise the next day as long as you are no longer taking narcotic pain relievers.
You can expect vaginal discharge for up to 14 days. At first, it may be red or pink, then gradually becomes lighter and watery. You can use pads or tampons, but remember to change them frequently throughout the day.
Avoid intercourse until the discharge has decreased and returned to normal.
It is best to schedule a postoperative visit 2-3 months after surgery to assess the menstrual cycle after ablation better.
Post-Operative Recovery After Bowel Surgery
Depending on the type of surgery, you may be asked to undergo "bowel preparation."
The goal is to empty as much stool as possible from the lower GI tract to facilitate the surgeon`s procedure while reducing the risk of infection when the bowel is perforated, an uncommon but well-known abdominal risk.
To perform bowel prep, follow the directions below unless your doctor has prescribed otherwise.
The day before surgery, reduce fluid and broth intake.
In the afternoon or evening before surgery, take a magnesium citrate bottle available at a pharmacy.
Be prepared to stay home immediately after taking magnesium citrate, as it works quickly.
Use Fleets enemas 1-2 times late in the evening or first thing in the morning before going to the hospital to ensure complete patency of the lower digestive tract. For some vaginal procedures, your doctor may order 1-2 quick enemas before going to the hospital instead of the whole bowel prep described above.
Postoperative Recovery For Robotic Hysterectomy
- Avoid lifting or straining heavy objects for the first two weeks
- Don`t drive until you`ve used up all your painkillers
- Stool softener if GI recovery is slow; milk of magnesia if there is no bowel movement on day 3 or 4 after surgery.
- A shower or bathtub is fine
- Dry the cracks.
You will need two appointments after surgery. The first time the incision will be checked 1-2 weeks after surgery. The second visit was for the first postoperative vaginal examination six weeks after surgery.