Your Surgery Guide

Instructions for the day before surgery

It’s normal to feel a little anxious before surgery, especially if this is your first one. It may help to keep in mind that we are here to assist you every step of the way. Please do not hesitate to call or email us with any questions you may have. We are always happy to help.

 Medication schedule

• 8:00AM-10:00AM: Consume a light breakfast. Do not eat any other solid foods after 10:00AM.
• 10:00AM: Drink 10 ounces of magnesium citrate* either alone or diluted with water or juice. You will develop diarrhea within 30 minutes to several hours of consumption.
• 12:00PM: Take one Cytotec pill*, inserted vaginally. Normal side effects include slight cramping or vaginal bleeding.

      *Magnesium citrate and Cytotec are included in your pre-op tote.

 Additional instructions 

• Drink plenty of water or other clear liquids throughout the day, and up to three hours before your surgery the next day.
• Limit dinner to clear liquids such as broth, juice, Jell-o, or electrolyte-rich drinks.
• Remove nail polish from at least one finger or toe.

 Shopping list 

• Extra-strength Tylenol
• We also advise that you make a “post-surgery shopping list” for the day following surgery. Below is a list of items frequently recommended by patients:
  • heating pad
  • water and other fluids
  • light foods (soups, broths, juices)
  • comfortable clothing
  • books, movies, and other forms of easy entertainment to help you relax 

One patient’s pre-surgery routine 

Many patients find comfort in the words of other women who have undergone endometriosis surgery. Allie, a patient of Dr. Seckin’s, provided us with her personal pre-op routine, which we have included below. While Allie’s routine worked well for her, every patient’s condition is unique. Please devise a regimen that adheres to your comfort level and lifestyle. 

Allie’s tips for developing a pre-surgery routine  

Surgery is something that every endometriosis patient has to endure in order to find lasting relief from constantly recurring symptoms. The phrase many doctors use to introduce surgery is, “well, let’s go in and take a look.” Sounds simple enough, but there are deeper implications of what that means to the patient.

I just recently had my 6th endometriosis surgery, an excision surgery with the Seckin Endometriosis Center. The idea of having surgery means something very different to me now than when I first learned I had to have my appendix removed almost a decade ago. I don’t know if I have gotten better at having surgery or if it is just that I now have a better surgeon, but these past couple of recoveries have been a lot smoother overall. I also attribute my post-op success to knowing what to expect during surgery and being able to physically and mentally prepare for it. So without further ado, here are five suggestions for you before any surgery:

Get your body ready

My past surgery was an extensive one, so I wanted to make sure I was in the best possible shape going in. I tried to go for walks when I felt up for it just to get my body moving and feeling strong. I made sure to drink at least 64 ounces of water every day starting two weeks before the surgery to stay hydrated. Drinking so much water also made my bowel prep go smoother.

leading up to the surgery, I consistently went to my chiropractor knowing that surgery and recovery are often rough on my back. I made sure I had enough sleep and tried to eat as best as I could. I made sure I remembered to take my daily multivitamin and tried to eat foods rich in iron. Also, I took the time to get a bikini wax. After my first emergency laparoscopy in the dead of winter, I was shocked to learn that a nurse had to “prep my pelvic area” with a razor. I now go in prepared.

Get your house ready

Before all of my surgeries, I have certain chores I like to do, which will make my life easier when coming home from the hospital. I wash all the bedsheets in the house the day before surgery. I love coming home from the hospital to clean sheets. Also, I make sure I have fresh towels available. I also do all of my laundries and make sure I have a top dresser drawer dedicated to post-op clothes. In it, I have loose pants, cotton shirts, clean underwear, and comfortable bras. I also like to give the house a good clean pre-op, knowing it will be a while before I have the energy to do it again. If you can, have a friend or relative gift you a pre-op and post-op cleaning service.

Prepare a shopping list

About two weeks before surgery, I like to create a master shopping list of things I will need post-op. I make sure I have all the food I need in the house in order to prepare for my bowel prep and other light foods I will eat immediately post-op.

I take an inventory of my clothing and note if I need an extra pair of sweatpants or a new pair of slippers. Also, I make sure I have my favorite shampoo, deodorant, and moisturizer on hand. These little things make such a difference. I also make sure the house has plenty of things like toilet paper! Few things are worse than running out of toilet paper in the middle of bowel prep! I also make sure I have things to entertain myself. I will often go to the library beforehand and get a few good books to read or DVDs to watch.

Prepare your workplace

Hopefully, your job is understanding and respectful of your surgery and leave period. It is so unfortunate that endometriosis is such a misunderstood disease and is not recognized by many. I think the following questions are good to ask yourself when thinking about post-op work: are you able to work from home post-op? Can you start back with half days? Is there work you can do ahead of time to make things run smoother when you are gone? Are you able to be honest with your boss about what kind of surgery you are having? Can a co-worker cover for you? I always find having a work plan before the surgery leads to much less anxiety post-op.

Prepare yourself emotionally

A patient often feels a lot of anxiety and sometimes even sheer panic when faced with an impending surgery. For weeks leading up to my past surgery, whenever I would become anxious I would take a deep breath say in my mind, “breath in peace,” and as I exhaled I would say, “breathe out stress.” I would repeat that until I felt calmer.

I also made it a point to schedule a meeting with my therapist to talk about the stress and anxiety about the surgery a few weeks before. Reaching out to family and friends is also a big part of getting emotional support.

About a week before surgery, I make sure I sent an email out to close friends and family explaining what I was going through and how they could help. Like many other endometriosis patients, I value my independence and have a hard time accepting a lot of help. Obviously, when you have surgery, accepting help is inevitable. I am not sure what I would have done without people cooking for me and my family, going shopping, sending me cards, and taking me to post-op appointments in those first weeks. It was nice to feel their emotional support. 

Excision surgery is currently the best way to help improve the quality of life of an endometriosis patient. Although it can seem daunting, I have often found that the anticipation of endometriosis surgery is sometimes worse than the actual surgery and recovery itself. Mindfully preparing for endometriosis surgery, both physically and emotionally, can often help with those pre-op jitters and lead to a less stressful recovery period. So try not to stress, you are truly in good hands.

The surgery day

Below is a list of instructions to keep in mind on the day of your surgery.

• Do not eat or drink anything after midnight (12:00 am) or your surgery will be forfeited and postponed. 
• Make sure your schedule is completely free on the day of your surgery.
• Wear comfortable clothing. You will also be provided with a hospital gown.
• Avoid bringing any jewelry or valuables. Although we provide every patient with secure storage space, it’s best to keep personal possessions to a minimum. 
• Please arrive at the hospital 60-90 minutes prior to your scheduled surgery. You may go directly to the main entrance of the hospital and then make a right. The OR waiting room will be on your left. For assistance, front desk personnel can direct you to the appropriate area. 
• All patients must be accompanied by a significant other, family member, or close friend to escort them home. We are not permitted to discharge a patient home unaccompanied, even by taxi, due to anesthesia. We also recommend that women bring their partners or loved ones for comfort and support. 
• Surgery can take anywhere from one to more than five hours depending on your case. 
• Recovery rates vary. However, most of our patients are well enough to leave the day of surgery and return to the comfort of their own homes.

After surgery

If you need to visit the Emergency Room, please make sure to go to Lenox Hill Hospital 100 East 77th Street. This is very important as our team can only work out of this hospital, without exception.

Activities to avoid

• Do not drive for at least three days after surgery.
• Start walking around as soon as you get home. You may use stairs but move slowly.
• Wear loose, non-binding clothes.
• You may shower the day after surgery. It is okay to use soap and water on your abdomen, but do not wash or scrub your incisions. After showering, gently blot incisions dry with a towel.
• No douching, tampon application, tub baths, swimming, or sexual intercourse for six weeks after surgery.
• Do not lift more than 10 pounds or engage in an abdominal exercise of any sort for six weeks after surgery.

 Diet

• Stay on a clear liquid diet until you are able to pass gas. Hot liquids are especially beneficial.
• Avoid spicy foods the first three days after surgery.
• Avoid leafy vegetables and fiber-heavy foods such as kale and beans.
• Eat simple, light meals.
• Hot tea is helpful for mobilizing the bowels and reducing gas pain.

 Incision care

• Remove the clear bandage and gauze from your belly button 48 hours after your surgery. The other incisions will be covered by small strips of tape (“steri-strips”). The steri-strips will fall off on their own within seven days, or they will be removed during your post-op visit to the office. If they have not fallen off after seven days, you can remove them yourself.
• Keep your incisions clean and dry. If you prefer, you may clean your belly button with hydrogen peroxide twice per day, but this is not necessary.
• Do not apply any ointments or creams to your incisions.
• There is no need to cover your incisions with band-aids.

 Pain medication

• Toradol: 50 mg (instructions on the bottle)

OR

• Advil (ibuprofen, Motrin): 600 mg every six hours around-the-clock for five days
• DO NOT take Toradol and Advil. Use one or the other

PLUS

• Tylenol 1,000 mg every six hours around the clock for five days
• Alternate Advil with Tylenol, so you will be taking some kind of pain medication every three hours

PLUS

• Pyridium 200 mg (for bladder and UTI prevention)

Bowel regime

• The bowels can become “sleepy” after surgery, but it is very important that you do not become constipated.
• Walking and moving around is the best way to get rid of gas pain and “wake up” the bowels.
• Take Gas-X (simethicone) every eight hours to help with gas pain.
• Use a stool softener such as Colace 100mg (docusate sodium) twice per day.
• Take a mild stimulant such as Senna 17.2 mg once or twice a day until you have regular bowel movements.
• If you still have not had a bowel movement after two or three days of taking Colace and Senna, take one generous tablespoon of Miralax (polyethylene glycol 3350) daily.
• If you still have not had a bowel movement after trying all three medications, you may need to give yourself a Fleet Enema. You can buy this over-the-counter at any drugstore. Follow the instructions on the bottle.

 Pregnancy

• The best time to achieve pregnancy is immediately after endometriosis excision surgery
• If you do not wish to become pregnant, you may be put on a low-dose oral contraceptive pill or a Mirena IUD, depending on your surgical findings

 Normal post-surgery symptoms

The following are post-surgical symptoms that are normal and can arise within the first few days of surgery. If any of these complaints last longer than specified below, please contact us.

• Light vaginal bleeding
  • It is normal to have some spotting or light vaginal bleeding (generally nothing heavier than a period) for up to two or three weeks after surgery.
  • Heavy bleeding (soaking through a pad every 30-60 minutes) is not normal and you should call the office to speak with Dr. Seckin if this happens.
• Abdominal tenderness, usually lasting one to three days after surgery
• Lack of bowel movement should last no more than 72 hours after surgery. If it lasts longer than 72 hours please contact us.
• Shoulder pain, usually lasting 24-48 hours after surgery
• For post supracervical hysterectomy (uterus removed, cervix retained) procedures it is not uncommon to experience some spotting/light bleeding around the time of your period.

When to contact us?

Please contact us if:

• You experience severe pain or abnormal symptoms.
• You develop vaginal bleeding heavier than a menstrual period, persistent nausea, fever, vomiting, or increasing pain not relieved by your medication.
• Your temperature is greater than 100.4F.
• You have any additional questions or concerns.
• In case of a medical emergency, please call 911.

 If you are experiencing severe pain of any kind, please call the office at (212) 988-1444 and we will put you into contact with Dr. Seckin.