Information for Patients about Haemorrhoidectomy (Day Surgery) Department of Surgery Information for Patients i University Hospitals of Leicester NHS Trust
Introduction We are looking forward to seeing you on the Day Surgery Unit, and want to make sure that your visit is comfortable and successful. To help us do this, please read the following important information: If you are ill, or cannot keep your appointment, please let us know as early as possible. Another patient may benefit from the cancellation of your appointment. If you feel worried or nervous and want to talk to someone, the nurses on the unit will be pleased to help in any way they can. Please ring the number of the unit at the hospital you are going to for your operation; Monday to Friday 10.00am 4.30pm. The numbers are given below: Leicester Royal Infirmary (0116) 258 5164 Glenfield Hospital (0116) 256 3661 Leicester General Hospital (0116) 258 4192 (day case 1) (0116) 258 8130 (day case 2) What are haemorrhoids (piles)? Haemorrhoids or piles are folds of skin in your back passage (anus), which can bleed or hang down so you can feel them. 2
What is a haemorrhoidectomy? The piles are cut to remove them, and the area is often stitched. You will be told if you have stitches before you go home. What are the benefits? Removing your piles should stop any bleeding and discomfort you have had. Are there any risks or complications? Passing wind without being able to control it for a short time (this is rare). Long-term problems can include lack of control of your bowels (this is very rare). Piles may return. Excessive bleeding. Infection. 1 in 100 patients have a big bleed, you will be given a contact number on discharge if you have a problem. If you have any specific questions about the risks of the operation please ask the doctor. 3
Are there any alternatives to this operation? Most haemorrhoids can be treated without an open operation, some cannot. Your operation will have been tailored to your particular needs. What happens before my operation? You will be seen in a pre-assessment clinic before you come in for your operation. This is to make sure you are fit for day surgery. At this appointment you will fill out your paperwork with the nurse, and you will be given information about your operation. You will be told about the consent form, that you will be asked to sign to give the surgeon permission to carry out your operation. This appointment is a good time to ask any questions you may have. Please write these down if that will help. Depending on your general health and your age, you may have some tests carried out. These will be discussed with you, and may include an electrocardiograph (heart tracing/ecg) and blood tests. Please also bring in all the medication you are currently taking. 4
MRSA screening before surgery You may have heard of the infection MRSA (methicillin resistant staphylococcus aureus) that lives on skin and inside noses. We take MRSA very seriously, so during your visit to the Pre- Assessment Clinic you will be tested for MRSA. This is done by using cotton bud to swab your nostrils, sometimes we may need to take other swabs. This swab will be sent to the laboratory where they will be examined for MRSA. If we find that you have MRSA, we may need to delay your operation so that you can be treated. This is a five day course of treatment with special antiseptic soap and nasal ointment. You will then be asked to have the swabs repeated on three consecutive days to check that the treatment has worked. If your operation is delayed because of this you will not be put to the end of the waiting list but will be slotted in as soon as possible. If your surgeon thinks that your surgery is urgent this will go ahead as planned and all precautions will be taken to aid your safe recovery. If your results do show that you do have MRSA, you will be contacted by telephone and asked to return back to the Pre- Assessment Clinic to collect your treatment where it will be explained how to carry out the treatment and answer any questions you may have regarding this. If you are shown to have MRSA, do not worry, you can get advice from the Day Ward Staff. Please do not hesitate to call the number at the front of the leaflet if you are at all concerned. We will be please to help put your mind at ease. It is important that you bath or shower before coming in for surgery as this also helps to reduce the amount of skin bacteria (germs). 5
What do I need to do before my operation? You may be advised to take a medicine called Lactulose for three days before your operation. This softens your stool/motions, making it easier to open your bowels, and less painful. What arrangements must I make before my operation? Before you can have your operation as a day surgery patient, you need to plan the following things: You must be collected by a responsible adult, who must take you home in a car or taxi following your operation. You must have a responsible adult at home with you for at least 24 hours after your operation. You must have a telephone at home. You must not drive, cycle, operate machinery, drink alcohol, or be alone for a minimum of 24 hours after your operation. Important: Driving soon after an anaesthetic may constitute a criminal offence, and will affect your insurance cover. 6
What do I need to do before my operation? Read your admission letter carefully. Do not eat or drink anything from the time stated in your letter. Do not wear any nail polish, false nails or make up. Do not wear contact lenses. Do not wear any jewellery, except for a wedding ring. Do not bring any valuables with you into hospital. University Hospitals of Leicester cannot accept responsibility for loss or damage to personal belongings. Do have a bath or shower before you come into hospital. Do wear comfortable clothing and footwear to go home in. Do expect to wait on the unit before your surgery. What do I need to bring with me? Your appointment letter. The time you are given to arrive is not the time of your operation. The surgeon needs to see you before the start of the list, so you may be waiting for your operation for two to four hours. Any drugs, medicines or inhalers you are using. Please take your necessary medication before attending. The pre-assessment nurse will tell you when you should take your medication. Please ask your GP or the doctor you see in clinic about stopping warfarin, clopidogrel, and aspirin before surgery. A contact number for your lift home. A dressing gown and slippers, if you have them. Something to do while you are waiting such as a book, magazine etc. 7
What will happen on the day of my operation? You should come to the day surgery ward and report to reception. Your details will be checked and you will be directed on to the ward, or to the waiting room where a nurse will collect you. The nurse will talk to you about your operation and ask you a few questions. You will meet one of the surgical team who will ask you to sign a consent form, if you have not signed one in clinic. Please ask your surgeon if there is anything you do not understand before you sign the form. You will be visited by the anaesthetist. This is the doctor who will look after you while you are asleep. You may have an enema before your operation. This involves having some fluid inserted into your back passage which will make you open your bowels. You will need to change into a theatre gown, the nurse will tell you when to do this, and then take you to theatre. What happens after the operation? After you have come round in the recovery area you will return to the day ward and staff will make sure you are comfortable, and provide you with refreshments. If you have any discomfort or sickness please, let the staff know so that they can help you. You will recover on the ward until your nurse is happy that you are well enough to go home. You will need to eat and drink before you can go home. You will get a phone call at home in the next day or two to check how your recovery is going. Very occasionally patients need to stay overnight if the nurse or doctor feels this is necessary. 8
Wound care You may have some bleeding after surgery. This is normal, you may need to wear a pad for a few days. You may also bleed when you have your bowels open. This should stop quickly. If you have continuous bleeding you should contact your GP. You may have a dressing in your back passage, this will fall out when you first have your bowels open. If you have stitches, they will be dissolvable. You will be given more advice about this before you go home. You should have a bath or shower daily after you have had your bowels open. Contact the nurse at your doctor s surgery if you are concerned about your wound in any way. Tablets for pain You may have some pain following your operation. The amount will depend on your operation and how well you take painkillers. Pain killing tablets will be given to you when you go home. Take them regularly as prescribed for the first few days. If you run out of tablets you can take the empty box to your chemist who will let you know which tablets to buy; or you can arrange to see your own GP to get some more tablets. Please read the following points. Take painkillers when the pain starts. Don t wait for it to get really bad. Take painkillers before you go to sleep so you are able to rest. 9
Tablets for pain (continued) If your pain is very bad take the painkillers regularly, i.e. four times a day, so they keep your pain away. Take painkillers when you wake up, so they are working before you get out of bed. Painkillers can cause constipation, so you should drink plenty of water, and eat some high fibre foods like as fruit, vegetables and cereals. Everyone is different; do not be surprised if you are still having some pain for a week or two, this is quite normal. Driving You must not drive for 24 hours after a general anaesthetic. You will not be covered by your car insurance. You may not be able to drive comfortably for a few weeks; this depends on how quickly your wound heals. Work The length of time you need to be off work depends on what your job is. Please discuss this with the doctor doing your operation or the nurse. If you need a sick note, please ask the nurse before your operation. 10
Sex You may return to your usual activities once you are comfortable, if you have any questions, please ask the pre-assessment nurse or the ward nurses. Physical activity Do not do too much too soon. It is usual to feel some aches and pains for a few days, perhaps up to two weeks. Avoid strenuous activity for about two weeks after your operation. Holidays Flying too soon after an operation can increase the chance of problems, and you may not be covered by your insurance, please discuss this with your insurance company. 11
Important There are 5 things you must do before you come in: 1. Follow your starving instructions. 2. Organise a responsible adult (over 18) to take you home in a car or taxi. 3. Organise a responsible adult to stay with you for 24 hours after your operation. 4. Read all the information leaflets you have been given. 5. If you smoke you need to stop smoking 48 hours before your operation. There are 4 things you must not do for 24 hours after your anaesthetic : 1. Do not drive a car or operate machinery, including kettles, irons, etc. 2. Do not carry children in case you feel dizzy. 3. Do not sign legal documents, as your judgement may be impaired. 4. Do not drink alcohol. 12
Please read the following, and sign at the end Patient agreement I understand that if I do not follow the instructions about my operation it may be cancelled. I have been given information leaflets and I have read and understood them. I wish to have my operation done as a day case. Patient s signature:... Pre-assessment nurse:... Signature/grade:... 13
Your questions Please make a note of any questions you would like to ask: 14
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If you would like this information in another language or format, please contact the Service Equality Manager on 0116 258 8295 Haddaad rabto warqadan oo turjuman oo ku duuban cajalad ama qoraal ah fadlan la xiriir, Maamulaha Adeegga Sinaanta 0116 258 8295. Eĝer bu broşürün (kitapçıĝın) yazılı veya kasetli açıklamasını isterseniz lütfen servis müdürüne 0116 258 8295 telefonundan ulaşabilirsiniz. Produced: January 2008 Reviewed: December 2009 Next Review: December 2011 (Heald)12091523KR SUR024-1209