Pain

After surgery you can expect some pain in your abdomen where the small incisions are. Although we put local anesthetic in them during the procedure, pain will develop at these sites 6 to 9 hours later. How much pain you experience usually depends on the individual and not on the operation itself.

Once home you should feel better every day with regard to pain and discomfort. Each day should bring more freedom of movement and more activity. You received a prescription for a narcotic: hydrocodone (Vicodin) or acetaminophen (Tylenol) with codeine. You can take one or two tablets every 4 to 6 hours. Call the office if you have trouble swallowing pills and a prescription for liquid pain medicine will be provided. If you experience itching or rash with the medication, stop it immediately and call the office. If you do not like the drowsy feeling associated with these medications or need less pain relief, try aspirin, extra strength Tylenol or ibuprofen (Advil). The dosages are ibuprofen 600 mg every 6 hours, two extra-strength Tylenol every 6 hours, or two aspirins every 6 hours. Call the office if your pain is not controlled by these medications. It is helpful to take some type of pain medicine (narcotic or over the counter) before getting out of bed in the morning and before going to sleep for the first few days after surgery.

You may have shoulder pain for the first few days after surgery. This is from the carbon dioxide gas used to insufflate your abdomen during surgery. That pain usually goes away in 24 to 48 hours. It helps to lie with your feet higher than your head when you have the pain.

It is important to let us know if you experience pain postoperatively that was not present prior to discharge. Pain in you chest or shoulder associated with eating is usually not serious and will go away. If it does not go away after an hour or two, call the office. This relates to food becoming stuck during swallowing. Sudden severe pain unrelated to swallowing, especially in the upper abdomen, however, is important as it could represent a significant problem. Call the office if that occurs.

Difficulty Breathing

Occasionally some patients will have a sensation that they cannot catch their breath. While the reason for this is not known, it is not cause for any concern. It probably relates to micro-collapse of air sacs in your lung during the operation from the pressure placed on your diaphragms by the gas. The resultant sighs and deep breaths you take are the means to re-expand these areas. However, if you are truly having difficulty breathing, call the office immediately or go to the emergency room.

Diet

Patients are usually allowed liquids immediately after surgery. You should only take small sips and not over do it during the first 12 hours. You will not get any solid food until the morning. Breakfast will consist of cereal, scrambled eggs, and other soft foods. When you go home you should continue this diet of soft mechanical foods without breads or red meats until you are seen in the office. However, you can experiment with foods of more consistency, if you are doing well with the foods you are eating. Don't be disappointed if you cannot eat anything solid. Dysphagia can be severe and last 2-3 months. Swallowing may not only be difficult but also painful. It may be associated with pain in the shoulder as well as the chest and back. Although liquids usually go down without any difficulty, some people experience problems with them, especially if hot or cold.

Remember that the early satiety occurs because the capacity of your stomach is reduced. Since part of the stomach is wrapped around the stomach to create the valve, there is less stomach to hold food and liquids that are ingested. Even a few bites can give you the sensation of being full. This takes a few months to resolve but does so in essentially everyone. Meal size should be normal by six months.

During the period of reduced intake because of dysphagia and early satiety (getting full quickly), be sure to take a multivitamin with iron and drink high calorie and protein supplements such as Sustacal, Carnation Instant Breakfast, egg nog etc., to minimize your loss of weight and energy.

Temperature

A low grade temperature to less than 101° is acceptable for a few days after surgery but it should not go higher nor last more than 24 to 48 hours. Call the office if your temperature is greater than 101° or lasts more than 48 hours.

Incisional Care

Your incisions require nothing more than keeping them clean and covered for about one week. You may notice some bruising around your incisions that can increase in size with time. It is common for this bruising to only become apparent 2-3 days after surgery as any blood in the tissues moves to the surface. This is normal and there is no cause for alarm. You may also notice a little bleeding from them. Unless excessive, there is no need to worry or call. Just change the Band-Aids as needed.

You can take a shower the day you get home. Take the Band-Aids off prior to or after your shower and replace them with new dry ones. If your incisions get red, painful or purulent, call the office. You received antibiotics in the operating room prior to surgery to reduce your risk of infection. You do not need antibiotics after surgery unless you have an artificial joint, artificial heart valve or organ, heart murmur, mitral prolapse, blood vessel graft or it was specifically discussed with you your need to take them.

Occasionally there may be some discharge from the incisions two to four weeks after the operation. This represents the sutures in the skin dissolving. There is no need for alarm. Just call the office and we will check it at a convenient time. Many people see little white strands sticking out of their incisions with time. Those are sutures in the skin and will dissolve with time. They can be removed in the office if they bother you.

Bladder and Bowels

Some patients may experience burning and or frequency of urination. That usually results from the catheter placed into your bladder during the operation. Do not be concerned that you have an infection. It will usually go away in a few days. Let us know if you cannot void, however, as you may need the catheter placed back for a few days. This is especially true in men.

Patients variably report loose stools or constipation following antireflux surgery. These changes relate to diet and to pain medications. You can take over the counter medications if either constipation or diarrhea are a problem. Metamucil, Amphogel or yogurt are good for diarrhea and Hailey's MO or Milk of Magnesia for constipation.

Remember that most people undergoing an antireflux procedure will experience more flatus postoperatively than they did before the operation. This is not surprising, since all the air swallowed and carbonation ingested, which before surgery was released by belching, must now be passed via flatus. Although this can be annoying at times, most people gradually accommodate to this and no longer find this problematic. Any over the counter anti-gas product such as activated charcoal or GAS-X can be used if it is a problem.

You will not vomit and belching will be significantly diminished because the valve stops the regurgitation of material from your stomach into your esophagus. To avoid bloating, limit your intake of carbonated beverages during the first few months and then gradually increase them. Should you get food poisoning, get the flu, or over imbibe, you will feel sicker longer than others and may have more epigastric abdominal pain that you would otherwise. Although this should do you no harm, contact the office so we can prescribe medications to help you during that brief period of time.

Activity

Following surgery you can do what ever feels comfortable, including sexual activity. You can not cause any serious damage by your activities after surgery. Nonetheless, common sense tells you not to drive until you have full and free range of motion without pain. That will take at least a week. Furthermore do not drive or do anything potentially dangerous while taking narcotic pain medication.

Although we encourage you to walk and go up stairs, do not over do it. Gradually build up your stamina and strength. If you feel yourself becoming tired, stop. Finally, do not lift anything heavy. What is heavy? Anything that causes discomfort when you attempt to lift it. Again use your judgement but 15 to 20 pounds should be the limit for most. Remember pain is the body's way of letting you know not to do something.

Your thought processes may take 24-96 hours to return to normal because of anesthesia. Do not make any important, personal or business decisions during this time. You can return to work when you feel comfortable, and you can perform your job safely and at the level you and your employer expect. Usually this is a minimum of one week. Most people find themselves easily fatigued during the second and even the third week. This is compounded by the degree to which your caloric and protein intakes are reduced by dysphagia and early satiety. When you do return to work, do not overload your schedule. Do not return to exercise or strenuous activity until your first follow-up visit in the office.

Follow-Up

Call the office after you get home to make arrangements for follow-up and to let us know how you are doing. Unless you were instructed otherwise, your first appointment should be in one to two weeks from your discharge from the hospital.

Call the Office if You Experience

• Significant bleeding.
• Difficulty breathing or shortness of breath.
• Persistent lightheadedness.
• Chills and/or fever greater that 101°F.
• Temp between 100° an 101°F for more than 48 hrs.
• Pus or redness at the incisions.
• Severe abdominal pain.
• Severe chest pain unrelated to eating.
• Food that remains stuck in your esophagus for more than one hour after eating.
• Any worrisome change.

If you are unable to reach the office or the answering service, please call Rhode Island Hospital at (401) 444-4000 and ask to speak to the Chief Surgical Resident on call.

Please remember that we are always available to take care of you and answer your questions. Do not view your calls as an inconvenience or bother to us. We want to help make your post operative period as easy as possible.