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Enhanced Recovery
Programme
Following major abdominal surgery, patients have traditionally
remained in hospital for somewhere between 1-2 weeks. Recently it has
been shown that by altering how patients are managed both before and
after surgery they can be safely discharged home in 4-5 days. This has
a number of benefits including, reducing the risk of post operative
complication such as chest infection, blood clots, improved mobility
and reduced muscle wasting leading to an earlier return to normal
activity. Patients are not expected to undergo surgery whilst
completely starved and dehydrated following bowel preparation and are
encouraged to walk around and eat and drink as normally as possible
directly after their operation. It should be remembered that not all
patients are able to complete the enhanced recovery programme due to
one of many reasons. Should this be the case they should be allowed to
recover more slowly at a pace that best suits them.
The following is a summary of what patients can typically expect from
an enhanced recovery programme in conjunction with colorectal
operation;
Before surgery:
No bowel preparation (enemas for those undergoing rectal cancer
surgery)
Eating and drinking normally up to 6 hours before surgery
4 high calorie drinks to be taken the night before surgery
2 high calorie drinks to be taken up to 2 hours before surgery
On the day of surgery:
You will have an epidural for pain control
You will have a catheter placed into your bladder
Undergoing a laparoscopic procedure may be beneficial
You will be encouraged to sit in a chair
You will be encouraged to drink immediately including 2 protein drinks
On the First day after your
operation:
You will have an epidural and catheter
You will be encouraged to drink 2000mls of fluid and drink 4 high
protein drinks
You will be able to eat normal food
You will be out of bed for 8 hours and take 3 walks of 50 meters each
with help from the physiotherapists
On the second day after your
operation:
The epidural and catheter will be removed
You will be switched to tablets for pain control
You will be encouraged to eat and drink normally and drink 4 high
protein drinks
You will be out of bed for 8 hours and take at least 3 walks of 50
meters each with help from the physiotherapists
On the third day after your
operation:
Discharge will be considered provided you are happy and your pain is
well controlled
Are dinking and eating without any nausea
You have passed gas or had your bowels open
You are passing urine
You have adequate support at home
After discharge:
Your well being is of paramount importance and you should not go home
if you have any doubts. Once at home should you feel unwell or become
anxious in any way you should be able to make immediate contact with
the colorectal specialist nurse or your colorectal team. Most studies
have shown that some people who have been discharged need to come back
into hospital for a short time, however the vast majority are well and
do not have any problems.
Light work and driving can be resumed after 2 weeks and heavy work
(lifting more than 10 lbs) can be commenced after 3-4 weeks.
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