Gallbladder Surgery - MUHC Patient Education

A Guide to
PRET
Gallbladder Surgery
DM-4031 (REV 2014/02/24) CUSM repro MUHC
SURE
Parcours de rétablissement chirurgical du CUSM
MUHC Surgery Recovery Program
This booklet will help you understand
and prepare for your surgery.
Please review it with the nurse and your family.
Please bring it with you on the day of your surgery.
This document was developed by The MGH Patient Education Clinical Care
Pathway Working Group, the Post Anesthesia Care Unit nurses, the nutritionist
and physiotherapist and reviewed by the surgeons.
We would like to recognize the MUHC Patient Education Office for their support
throughout the development of this booklet, the design and layout, as well as for
the creation of all the images.
This document is copyrighted. Reproduction in whole or in part without express
written permission from patienteducation@muhc.mcgill.ca is strictly prohibited.
© Copyright 24 February 2014, February 2013, December 2011.
McGill University Health Centre
3rd Edition
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IMPORTANT: PLEASE READ
Information provided by this booklet is for educational purposes.
It is not intended to replace the advice or instruction of a
professional healthcare practitioner, or to substitute medical
care. Contact a qualified healthcare practitioner if you have any
questions concerning your care.
This material is also available on the
MUHC Health Education Collection (http://infotheque.muhc.ca/)
and MUHC Patient Education Office (www.muhcpatienteducation.ca).
PRET
SURE
Parcours de rétablissement chirurgical du CUSM
MUHC Surgery Recovery Program
Table of contents
Introduction4
What is the gallbladder?4
What are gallstones?5
What is gallbladder surgery?
6
Before Your Surgery
Preparing for your surgery
7
Preoperative visit 8
Cancelling 9
Instructions10
Things to bring to the hospital
13
Day of Surgery
At home14
At the hospital15
Waiting room16
After your Surgery17
Pain control
18
At Home
19
Pain19
Diet19
Incision20
Activities20
Call your surgeon if... 21
Follow up21
Important Resources
22
Stop Smoking23
Pain Diary24
Help Us, Help Others
25
Reference Image26
Notes27
Map of the Montreal General Hospital28
3
Introduction
The day of your surgery you will be taking part in a fast recovery program called a
care pathway. The goal of this program is to help you recover quickly and safely.
What is the Gallbladder?
The gallbladder is a pear
shaped organ found under
the right side of your liver.
The gallbladder stores
extra digestive liquid (bile)
made by the liver.
After eating the gallbladder
releases bile. The bile
travels through narrow
tubes (bile ducts) into the
small intestine to help with
food digestion.
4
Gallbladder
Liver
Stomach
Pancreas
What are Gallstones?
Introduction
Gallstones
Bile ducts
Gallstones are formed from cholesterol and bile salts. They
can vary in size from a few millimeters to few centimeters.
The most common reason to have the gallbladder removed is
the blockage of bile flow causing pain, nausea and vomiting.
Food can still be digested without a gallbladder.
5
What is gallbladder surgery (Cholecystectomy)?
The surgery can be done 2 ways, laparoscopic or open. This booklet however,
is for patients having laparoscopic surgery and that are supposed to go home the
same day.
2. Open
1. Laparoscopic
OR
The surgeon makes four small cuts
in your belly. A camera helps to see
and the instruments act as hands
to help the surgeon remove your
gallbladder.
6
The surgeon makes one longer
cut in your belly to remove your
gallbladder.
Before your surgery
Preparing for your surgery
Exercise will help make sure your body is as fit as possible
before your surgery. If you are already exercising, keep up the
good work. If you are not, start slowly adding exercise into your
day.
• Exercise does not need to be strenuous to be helpful; in fact,
a fifteen-minute walk is far better than not exercising at all.
Stop smoking:
We strongly suggest you stop smoking completely before
surgery to reduce your risk for lung problems. Your doctor
can help you stop smoking by prescribing medication.
Stop alcohol:
Do not drink alcohol for 24 hours before surgery. Alcohol can
interact with some medicines. Please let us know if you need
help decreasing your alcohol use before surgery.
Plan ahead:
You may need help with meals, laundry, bathing or cleaning,
when you first go home from the hospital. Make plans with
your family and friends so you will have the help you need.
Arrange to have a responsible adult with you to take
you home from the hospital and stay with you for the
first 24 hours after your surgery.
You will not be allowed to leave the hospital alone.
You CANNOT take a taxi home by yourself.
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Your surgery will be cancelled if you do not have someone
to take you home and to stay with you for 24 hours.
7
Before Your Surgery
Preoperative visit
During your preoperative visit, you
will:
• Have blood tests.
•• Have an ECG
(electrocardiogram).
•• Meet with a nurse who will tell
you how to get ready for your
surgery and what to expect on
the day of your surgery.
•• Meet with a doctor who will
ask you questions about your
health. If you have medical
problems, you may be referred
to another doctor (a specialist)
before surgery.
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Some medications or herbal products should be
stopped before surgery. Please bring a list of your
medications to the Preoperative clinic. The clinic doctor
will explain which medications you should stop and
which ones you should keep taking. Your pharmacist
can give you a list of your medications or can fax the
list to us at 514-934-4446
If you have any questions, you may contact the Preoperative clinic nurses
at (514) 934-1934, extension 43778, Monday to Friday, 1:00 p.m. - 3:00 p.m.
8
Before Your Surgery
Cancelling your surgery
If you get a cold or other illness, or become pregnant, please call your surgeon’s
office as soon as possible. If it is not possible to reach your surgeon, call the
Admitting Department (514) 934-1934 ext. 42190.
Call to reschedule if:
Su
You are not well.
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You need to cancel.
Please keep in mind that the Montreal General
Hospital is a Trauma Centre. This means that your
surgery may need to be delayed or cancelled because
of an emergency. Your surgeon will reschedule your
surgery as soon as possible.
9
Before Your Surgery
Instructions: Day before surgery
The Admitting Department will
phone you to tell you what time
to come to the hospital. (If your
surgery is scheduled on a Monday,
the hospital will phone you the
Friday before).
You will be asked to arrive 1½ to
2 hours before your surgery is
planned to start.
The time of surgery is not exact. It
may be earlier or later than planned.
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If you do not receive a call before
2:00 pm, you may contact the Admitting
Department at (514) 934-1934 ext. 42190
Date of surgery:
!
Time of arrival at the hospital:
Room: Surgical Admission Services (D10-124) on the 10th floor of the main
building.
If you have any questions, you may contact the nurses of the
Preoperative Clinic at (514) 934-1934, extension 43778, Monday to Friday,
1:00 p.m. - 3:00 p.m.
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Before Your Surgery
Can I eat or drink before my surgery?
STOP
All patients need to stop eating at
midnight.
Some patients may drink
carbohydrate drinks up until
their expected time of arrival at
the hospital. The Preoperative
nurse will let you know if you are
allowed to have these.
There are benefits to drinking clear fluids. If the Preoperative nurse asks you
to drink please choose one of the liquids on the next page. Drink the amount
shown on the evening before and on the morning of your surgery. You do not
need to choose the same drink for the evening and the morning.
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Before Your Surgery
Try to drink the
amount shown
No diet drinks please
P
apple juice
2CUPS
1 34
1 12
114
12oz
1CUP
8oz
34
12
OR
16oz
4oz
1 2 Qt
OR
1 23 CUP
1 13 CUP
1 CUP
23 CUP
evening before: 1000ml
morning of: 500ml
evening before: 850ml
morning of: 425ml
commercial
iced tea
evening before: 1100ml
morning of: 550ml
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orange juice
(no pulp)
OR
cranberry
cocktail
evening before: 650ml
morning of: 325ml
OR
lemonade
evening before: 1000ml
morning of: 500ml
You may drink clear liquids until your expected
time of arrival at the hospital. For example, if you
have to arrive at the hospital at 11AM, do not drink
fluids after 11AM.
Exception: if your time of arrival is between 6 and
6:30 in the morning you should stop drinking at
5:30 in the morning.
Before Your Surgery
Before going to bed, take a shower or bath
using one of the sponges given to you in the
Preoperative clinic. Wash your body and belly
button, and wear freshly washed clothes to bed.
Things to bring to the hospital
□□ This booklet.
□□ Your Medicare card.
□□ If you wear glasses, contact
□□ If you do not speak French or
lenses, a hearing aid or
dentures, please bring the
appropriate containers with your
name on them.
□□ If you use a cane, crutches or
walker at home, please bring
them to hospital with your name
on them.
English, please bring someone
to translate for you.
□□ Please leave all jewelry, credit
cards and objects of value
at home. The hospital is not
responsible for any lost or
stolen articles.
□□ Your medication in their original
containers.
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Day of Surgery
At home
P □□ Take a shower or bath using the second sponge
given to you to wash your body and belly button
and wear freshly washed clothes
□□ Do not put on any creams, lotions or perfume.
□□ Do not wear make-up or nail polish.
□□ Do not shave the area to be operated.
□□ Remove all jewelry including body piercings and
leave it at home.
□□ Wear loose comfortable clothing. Many patients
are bloated after this surgery.
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At the hospital
Day of Surgery
Report directly to the Surgical Admission Services (D10-124) at the time given.
In the Preoperative admitting area, the nurse will:
• Ask you to change into a hospital gown
• Make sure your personal belongings are in a safe place
• Complete a Preoperative checklist with you
You may be asked to put on tight elastic stockings to help blood circulate better
and prevent blood clots from forming. You should wear them until you get change
to go home.
When the operating room is ready, an orderly will bring you there.
In the operating room you will meet your anesthesiologist and the other members
of the surgical team.
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Day of Surgery
Waiting room
Family and friends may wait for you in the waiting room located in the D wing on
the 10th floor (D10-117).
The space is small so we ask that you limit the number of people coming with
you. The nurse from Post Anesthesia Care Unit (PACU) will call for your escort
when you are ready to go home.
16
After your surgery
You will wake up in the Post Anesthesia Care Unit (PACU).
There are no visitors in the PACU
intravenous
You will have:
• An intravenous, to give you fluid and medications
• An oxygen mask
oxygen mask
Your vital signs (pulse, blood pressure) will be checked often. Your nurse will
check your bandages and ask you about your pain.
You will stay there until you are well enough to go home (about two hours). This
period of time varies with each patient.
I
Remember you must have someone to take
you home and to stay with you for the first
24 hours after your surgery.
17
After your surgery
Pain Control
Pain relief is important because it helps you:
• Breathe more easily
• Move more easily
• Sleep better
• Recover faster
• Eat better
• Do things that are important to you
Pain Intensity Scale
No pain
0
1
2
3
4
5
6
7
Pain as bad as
you can imagine
8
9
10
You will be asked to rate your pain on a scale from 0-10. The nurse will give you
medicine if you have pain. Our goal is to keep your pain score below 4/10.
You may have neck and shoulder pain for the first few days after your surgery
due to the gas put into your belly. This will go away by itself.
Do not wait until the pain gets too bad before telling us.
You will not become addicted to pain medication given to you for surgical pain.
Nausea
Some patients have nausea after their surgery, medications can be given to help this.
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Always tell the nurse if your pain is more than 4 on the
pain scale (where 0 is no pain and 10 is pain as bad as
you can imagine.) This will help your nurse decide how to
best manage your pain.
At Home
Abdominal Pain
You may have some pain during the first few days following surgery.
Please track your pain levels at home using the Pain Diary found on page 24
You will receive a prescription that includes:
• acetaminophen (Tylenol),
• a medication against pain and swelling (anti-inflammatory) and
• a stronger pain medication (Narcotic).
Tell your surgeon if you are allergic to any of these medications or if you are
already on aspirin or anti-inflammatory medication.
Take acetaminophen (Tylenol) and the anti-inflammatory first to relieve your pain.
Add the narcotic if your pain is not relieved by acetaminophen (Tylenol) and the
anti-inflammatory.
If the anti-inflammatory and pain medicine cause burning or pain in your
stomach, stop taking them right away and call your surgeon.
Diet
You can eat anything you want. If you are
nauseous start drinking clear fluids and gradually
increase your intake according to your tolerance.
Some pain medications can cause constipation. If
this becomes a problem, increase the amount of
fluids you drink, and add more whole grains, fruits
and vegetables to your diet.
Do not drink any alcohol for 24 hours after anesthesia or while you are
taking pain medication.
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At Home
Your incision
You may notice some pink on your
belly. This is the disinfectant used in
the operating room. It will wash off
once you shower.
You will have 4 small plastic bandages
on your belly. The bandages are
waterproof so you can take a shower
after your surgery if you wish to do so.
Remove the bandages 2 days after
your surgery. Each small cut will be
covered with thin pieces of tape.
If after 7 days the pieces of tape have not peeled off, you may remove them
yourself.
You can continue taking showers once the bandages are off.
Tell your surgeon if your incision becomes warm, red, and hard or you see pus or
drainage coming from it.
Activities
You may feel more tired after your surgery, so rest. You may begin all your normal
activities once you feel ready (including work, exercise and sexual activity).
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You are not allowed to drive for the first 24 hours after
anesthesia or while you are taking pain medication.
At Home
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Complications do not happen very often
but it is important that you know what is
normal and what is not.
Seek medical attention if you have any of the following
symptoms:
• Your incision(s) become warm, red, you see pus or any
drainage coming from it.
• You have a fever (greater then 38˚C/100,4˚F)
• You cannot drink fluids or keep them down.
• You are having more pain that is not relieved by the
medications
Follow up
You may receive a phone call from the recovery room nurse the day after your
surgery. He/she will be phoning to see how you are doing.
About 3 weeks after your surgery, you will need to see your surgeon.
Once at home, call the clinic to set up an appointment.
For patients operated at the Montreal General Hospital the number of the
clinic is 514-934-8025
21
Important Resources
If you have any questions, please contact us.
Dr. Feldman: Dr. Fried: Dr. Khwaja: Dr. Vassiliou: Dr. Chaudhury Dr. Paraskevas Dr. Metrakos: Dr. Tchervenkov:
Dr. Deckelbaum Other surgeon:
(514) 934-1934 extension 44337
(514) 934-8044
(514) 934-1934 extension 44334
(514) 934-1934 extension 44330
(514) 934-1934 extension 31951
(514) 934-1934 extension 36522
(514) 934-1934 extension 31600
(514) 934-1934 extension 34042
(514) 934-1934 extension 44334
____________________________________
Montreal General Hospital
Day Surgery Unit
(514) 934-8064
(7am to 3pm)
Montreal General Hospital
Preoperative Clinic
(514) 934-1934 ext. 43778
(1pm to 3pm)
Admitting office
(514) 934-1934 ext. 42190
Montreal General Surgery clinic
(514) 934-8025
22
Suggestions to help you stop smoking
There are four phases of quitting
1. Preparing to quit
2. Choosing a quit date
3. Coping with withdrawal
4. Fighting relapses
Stop smoking now and you will already be on your way to quitting.
Take it one day at a time. Think of yourself as a non-smoker. Be
proud of what you have already done.
Ask your family and friends not to smoke around you.
Get a family member or a friend to stop smoking at the same time.
Join a stop-smoking group and kick the habit with other people.
Speak with your doctor about aids to help you quit such as the
nicotine patch.
Get more information from:
Montreal Chest Hospital
(514) 934-1934 extension 32503
www.muhc.ca
Quebec Lung Association
(514) 287-7400 or 1-800-295-8111
www.pq.lung.ca
23
Pain Diary
For example:
Using the Pain Intensity
Scale and table below,
enter the level of pain
you feel during the day.
Days After
Surgery
Morning
Noon
Evening Night
1
4 / 10
4/10
3 /10
2
3
Pain Intensity 4Scale
No pain
0
1
Days After
Surgery
1
2
3
4
5
24
2
3
4
5
65
7
Pain as bad as
you can imagine
8
9
10
Morning
Noon
Evening Night
__ /10
__ /10
__ /10
__ /10
3/10
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patients and families everywhere.
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Notes
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L10-401
Clinique Préopératoire
Preoperative Clinique
D-10-124
Service d’admission chirurgie
The surgical admission services.
Entrées / Entrances
D
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es
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Rd
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Hôpital Montreal General Hospital
1650 Ave. des Cedars / Cedar Ave. Montreal, H3G 1A4.
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Stationnement/
Parking
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da
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/C
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Av
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