AFTER PROCTOLOGICAL LASER SURGERY
Usually after the operation you will be able to accept some fluids (tea, chamomile, soup) and get up and walk. If you are still dizzy from the anesthesia it is best to remain lying down. A few hours later (or the next morning), after the doctor has examined you again, and if you are able to leave you will be discharged with simple instructions which usually include treatment with lactulose or another mild laxative and simple painkillers (consult the doctor before take any preparation if you suffer from chronic diseases such as diabetes mellitus). On the first bowel movement, feel free to remove all surgical dressings and go to the toilet as normal. Also do not be alarmed by the blood or hemostatic sponge that is placed inside the rectum at the end of the operation, and comes out with the first bowel movement. It is recommended to apply a sponge (gauze) daily between the buttocks for the next 10 days, as there may be a few drops of blood post-operatively during this time. If a laser has been used, it is a good idea to apply a cold compress to the area twice a day (eg a glove with ice cubes for 5-10' until they melt), for the next 5 days. Caution: if you do not tolerate the cold pad, put a towel in between, and avoid prolonged exposure and frostbite (do not use ice packs). At this point you can get rid of the elastic stockings (provided you are moving and drinking enough fluids).
Diet for the next 6-7 days should be without residue (avoid vegetables, fruits with a lot of fiber and skin), so that there are no constant bowel movements from the operated area. Many patients should avoid foods that cause bloating (legumes, raw vegetables, certain fruits, dairy, fatty foods), as severe flatulence is sometimes observed in the first days after proctological surgery. Attention: since constipation should be avoided at all costs, be sure to add foods that will help the bowel movement (boiled zucchini, a kiwi in the evening, yogurt with kiwi, etc.). Regular refeeding and return to normal diet within the next 6-7 days is recommended. In contrast to what happens with other operations, in proctology operations you can usually wet the area immediately after the first bowel movement. It is a good idea to use a mild antiseptic soap for the next 6-7 days immediately after a bowel movement (or while bathing). Exercising and driving are not prohibited as long as you don't feel any pain from the operated areas. Return to your normal activities at home. Although rest for 2-3 days is recommended, most patients are able to return to work immediately after surgery with absolutely no discomfort. If there is pain, reasonable use of anesthetic cream (xylocaine) is recommended before and after each bowel movement for the first week. Before you go back to work, make sure there is no pain at all, that the blood has subsided and that you have good bowel control (due to taking the lactulose). If you are taking other medicines, these can usually be restarted the morning after the operation. Consult the doctor to know what medications are allowed after the operation (especially if you are taking anticoagulants). Contact your surgeon Dr. Savvas Chirides and his colleagues for anything you need in relation to the operation. In the unusual event that you experience severe pain, inability to pass stools, flatulence or fever, or if any other symptom concerns you, contact your surgeon immediately.
AFTER HEMORRHOIDS OPERATION
In addition to the simple instructions above, after laser/Doppler hemorrhoid surgery, you may feel the nodules for several weeks until the results of the surgery begin to show. There is no need to worry as this is completely normal if the pain and bleeding have subsided. After 6 weeks, you may still feel the skin tags, which are excess skin at the site of the old hemorrhoids. These usually get smaller over time. But if they are still bothersome, they can be easily removed with local anesthesia on an outpatient basis. Do not hesitate to contact Dr. Cheiridis for any similar discomfort.
AFTER ANAL FISSURE EXCISION
Unlike laser hemorrhoid surgery, after anal fissure surgery, the use of xylocaine cream before and after voiding is required for the first few days to prevent spasm and facilitate smooth healing of the stretch mark. As mentioned above and here, the bowel movements should be very soft, (almost watery) to avoid further injury to the operated area. In cases of persistent fissures, or the appearance of new fissures, the doctor may recommend restarting treatment with sodium hyaluronate cream or suppository. If a sphincterectomy has not been done, it may need to be done in persistent, difficult cases for the most definitive result.
AFTER PERIANAL ABSCESS - FISTULA OPERATION
In addition to the above simple instructions, after fistula surgery, frequent changes of the surgical wound will be needed until it is completely healed. Where the external opening of the fistula was, there will now be a small open wound, left open to heal by secondary intention. Using the FILAC laser to destroy the walls of the fistula can speed healing. If a combination of laser with the seton technique (bandage with elastic material) was used, then fistula healing is prolonged until the seton passes through the sphincters without damaging them (to avoid gas and/or fecal incontinence). The time that the cutting seton will pass and the recovery will be completed varies from patient to patient and from fistula to fistula. Whenever it takes a lot of patience and regular visits for monitoring by Dr.Cheiridis and his colleagues.