What can I expect after abdominal surgery?

May 20, 2009 5:49 PM

I just found out I need major surgery, and I've got some questions...

So I just found out I need to have abdominal surgery. Basically, I need to have a few inches (they think about 3, but won't know for sure till they're in there) of my terminal ileum resected. The issue is that I'd previously been told they could do it laparoscopically, which would mean two days in the hospital, teeny scar, and a week's recuperation time. But now, based on some new tests, they're saying that it'll have to be full-on surgery, using something called a "hand helper", I think. It'll mean about 3-4 hours under anesthesia, a 4+ inch incision, and up to three weeks of recovery time. So I'm freaking out.

My concern is this: my surgeon is painting a pretty rosy picture of what I can expect in terms of postop pain, both immediately after and over the next couple of weeks. He keeps saying "it won't be that bad"- I think he is attempting to be reassuring and he doesn't seem to believe that I'd prefer honesty, and also his English isn't spectacular. When I search online for firsthand accounts of what to expect, all I'm seeing is horror stories, and long lists of complications and things that have caused people horrible discomfort.

I don't want this to be chatfilter, but can anyone with experience of a similar operation let me know how it was for them? To all of a sudden find out that they're going to be slicing my guts open rather than making a tiny incision is really creeping me out, and I don't feel mentally prepared for this. Any information would be hugely appreciated.

Thank you!

posted by anonymous to health & fitness (21 comments total)

It's not a similar surgery, but I had an aortic aneurysm repair in 2007, for which they cut into the side of my chest. I was under for 8 hours and in the hospital for six days. And the thing of it was, I had no pain. I was wiped out, had now energy, etc, but the pain... none. They can indeed totally manage pain almost out of the equation now. You really don't need to worry that much. Good luck to you.
posted by xmutex at 5:54 PM on May 20

I had full-anaesthetic, 8-inch incision surgery on a joint injury a few years ago and I was really scared of taking drugs. I would wait until the pain was so intense I was in tears before I took a partial dose. I had one of those intravenous morphine pumps and I was allowed a pump every 15 minutes. I took 4 pumps in 2 days. It was horrible- doing what I did was a VERY BAD IDEA.

My advice to you is to take the recommended dose of any pain medication they give you, always as soon as they give it to you. Don't try to be tough and take less medication than they say you need. Once the pain gets started, it's much harder to make it go away. You want to pre-empt the pain by taking medication before the pain gets bad. It's much easier to head it off before it starts intensifying, and when you medicate at a consistent dosage, the pain will be bearable or even almost unnoticeable. But I promise that if you try to be tough like I did, the pain will suck! Remember that modern medicine is really good at pain control! Trust your doctors' recommendations and use their wisdom when dosing your pain medication... There is no need to let yourself suffer!
Good luck!
posted by pseudostrabismus at 6:08 PM on May 20 [2 favorites]

Discuss this with your surgeon, but my advice is to take huge doses of anti-inflammatory meds such as naproxen or ibuprofen after the surgery to reduce adhesions which are a major problem in abdominal surgeries. Don't take them before as they increase the risk of bleeding during the surgery. They are also pain killers. Enough said.

Also, it won't be that bad, but it will be bad.
posted by caddis at 6:12 PM on May 20

Mine experiences over several surgeries these past few years aren't exactly similar either, but I can tell you this about my experience with abdominal surgery in general:

Even when the post-op pain is managed very well, it's hard not to feel helpless with abdominal surgery. This is because, in my experience, you use the muscles in your torso so much more than you'd probably guess, and this becomes glaringly obvious when there's a surgery incision there disturbing the equilibrium.

The thing about surgery in general is that you're forced to consciously make decisions to do things like activating the muscles necessary to get out of bed, to lower yourself onto a toilet, to run a washcloth over your body, and to pull a shirt over your head. I predict that if all goes as the surgeon is predicting, within a few days you will adjust to the new normal of dealing with all these conscious decisions, in addition to the exhaustive medical self-care that will probably be necessary, and that it will mostly soon recede into gigantic nuisance territory and out of "how the hell do I even DO this?" territory.

I wish you good luck. And if you have any doubts at all about your surgeon, don't hesitate to get a second opinion or at least be frank in asking another person in his office for more info. Nurses usually are really good for giving supplemental info like this.
posted by ImproviseOrDie at 6:13 PM on May 20 [1 favorite]

I agree with what pseudostrabismus said in that you should not try to tough out any pain. But I would also like to add that if you don't need pain medication, don't let anyone pressure you into using it. My doctors also gave me a morphine drip after my jaw surgery, and to be honest, for me, it hurt more to use it than to not. Keep in mind that I have a high pain threshhold. But morphine did nasty things to me.
posted by litterateur at 6:25 PM on May 20

I am not directly answering your question, but I will give you a bit of medical advice regarding surgery: you should be seeking more opinions, and stat. I don't know what your problem is, but if you feel you need top-of-the-line specialists, do not hesitate to research them, write a cover letter, and contact them directly. You will be amazed at the responses you receive. There may still be minimally invasive options out there for you and you can't let your fear/trepidation of the impending surgery cloud your mind from seeking these options out.

To wit: in less than 3 weeks I'm having brain surgery. Most neurosurgeons would perform what I'm having done by utilizing an open craniotomy, which involves removing a good chunk of skull, spending half a day under anesthesia, moving around parts of the brain, and obviously comes with a high risk of morbidity and WEEKS of recovery time. I thoroughly researched my options. Turns out I can have the surgery endoscopically through a tiny burr-hole, it will take 1-2 hours, I will spend a night in the hospital, and then I'm free to go on living my life.

Every ounce of effort you put into researching your condition and potential surgeons is worth it. This is your existence we're talking about here. If you want to memail me with questions, please feel free.
posted by sickinthehead at 6:56 PM on May 20 [11 favorites]

I had abdominal surgery in January - although mine WAS laprascopic. I had five incisions, each about an inch long. I have an incredibly low pain threshold and it was nowhere near as bad as I was expecting. I used the morphine pump pretty often in the hospital, but I think it was more out of novelty value rather than actual pain. I had liquid hydrocodone for when I was out of the hospital and I think I had three doses in two days and then never used it again.

Again, the pain wasn't anywhere near I imagined (and thus has made me feel a lot better about my upcoming breast reduction surgery this fall), but it's definitely difficult moving around in bed and getting up and down. You get used to it after a day or two and it's less of a "ow!" surprise when you move. And if you're a stomach sleeper like me you're going to be pretty unhappy for a few weeks.

Good luck!
posted by elsietheeel at 6:57 PM on May 20

Very different operation here (reproductive system rather than digestive), but it sounds like I've had a similar incision. And the post-op pain really, really wasn't that bad. ImproviseOrDie has it right that some things are different, although I really only seemed to notice it for the first couple weeks. And it isn't necessarily pain that you notice -- something that freaked me out a little was that for about a week, I was simply not able to bend over and tie my shoes. Not because it hurt -- because my body simply didn't respond. I'd be sitting on the edge of a bed and have the regular impulse to do it -- "okay, time to tie my shoes" -- but it was as if my "bend-over" ability was just not there. My body simply wasn't doing it. I couldn't lift my foot up to tie my shoes either. My doctor told me that that wasn't uncommon, and it was temporary; it was indeed.

I agree with litterateur that you should listen to your own body when it comes to how much pain mediation you need. I turned out to not need that much -- I had a self-directed morphine drip in the hospital, but ended up not needing all that much, and after I got discharged I could handle any soreness pretty well with the prescription meds I had (I think I even had some left over). The most "ouchy" moments came when I had to cough, sneeze, or laugh -- get a pillow to brace against your stomach for when you have to do any of those things, because, ow.

I was pretty ambulatory after a week or so, but still took it easy -- I didn't lift anything heavy for about a month, and for a couple weeks I was walking around a little hunched over because it felt like the skin around the incision wasn't able to stretch yet. That gradually faded, and by the time the doctor took the stiches out I was feeling more flexible again. I do still have a scar, but the doctor hid it under the bikini line so it's not visible.

These days, aside from the scar, the only lingering aftereffect is that it's more difficult to do ab work at the gym (the muscles will never be as toned as they could have been if I hadn't had the surgery, and every once in a blue moon I'll go to do an ab crunch and it will feel like I'm pulling a stitch -- even though it's been twelve years since I HAD stitches there; when that happens, I just stop for the day, and usually the next time I try an ab crunch I'm fine).
posted by EmpressCallipygos at 7:02 PM on May 20 [2 favorites]

I agree with ImrpoviseOrDie, the real pain and difficulty comes after you leave the hospital and have to assume the responsibility of caring for yourself. Here's my experience recovering from a 6-inch incision (open laparotomy) in my lower abdomen, no bowel involvement.

Date of surgery through 4 days post-op was spent in the hospital with excellent pain management. I experienced a great deal of discomfort after my IV pain meds were discontinued on day 3, but adapted well to oral pain meds.

Day 4-6 were spent at home with 24/7 support from my partner. Every activity required assistance and the pain was significant enough that I didn't attempt very much. I spent this time in bed, reading, watching films and sleeping.

Day 6-10 were also spent at home, with morning and evening support from my partner. I spent the days alone as he returned to work, but had help taking showers and my meals were prepared for me. By day 10 post-op I was puttering around the house, felt up to going out to see a movie and went to get a facial at a spa.

Day 10 onwards were a gradual return to my previous activities. I began going out socially for low-impact activities, went out for meals at restaurants and returned to work as my energy level and pain would permit.

According to my Google Calendar, I felt well enough on Day 20 to follow through with a previously planned vacation to Whistler, Canada. I did well on the flight, but did not carry my own luggage. I spent a large portion of the vacation resting, but did get out for meals each night, cooked at our vacation apartment, went on a dogsled ride as a passenger and had a decent time.

On the downside, it took months to regain even a minimal amount of strength in my abdominal muscles and I lost a lot of sensation from my navel to my upper thighs due to the placement and depth of the incision. I didn't return to my beloved activity (sailing) until a solid 3 months after surgery and it took about 6 months for me to confidently feel like I had recovered.

Overall, I can say that the pain involved was something I could live with and given my particular health circumstances I wouldn't hesitate to have the operation again if I needed to. It was not a trauma, and the most fear I felt was BEFORE the surgery. Everything that came afterwards was manageable and I felt well supported by my MDs and my family. Having that trust and support in place is key, so I would encourage you to speak further with your primary care physician and your surgeon. Surgeons aren't the most delightful people in the world, and you might get more out of a conversation with your primary care team.

Best wishes with your upcoming surgery.
posted by cior at 7:18 PM on May 20 [1 favorite]

I want to 2nd sickinthehead: If you think there's any chance that there's a reasonably accessible surgeon who can reliably perform the surgery laprascopically, you owe it to yourself to check it out.

Besides the pain and hassle issue, here's another reason: It's a pretty good rule of thumb that, for every hour you spend under general anesthesia, you should expect about one month of recovery time. You won't be bedridden all that time, nor will you be off work, but you'll find yourself being absolutely exhausted after even a relatively easy day.
posted by DrGail at 7:20 PM on May 20

About pain meds, I had a discektomy (spelling?) in my lower back, developed an infection, and was in the hospital for a week (and with a jugular shunt for antibiotics for a month after that). During that time, they put me on a morphine pump. Instead of doing anything for the pain, it made me incredibly nauseated, to the point of vomiting. If you do have a long stay in the hospital, do take the pain meds they give you (because pain sucks), but if you start to feel bad in any way, ring the button. The puking thing? Not so good for stiches.
posted by Ghidorah at 7:52 PM on May 20

I had a very similar surgery about 4 years ago. Five inch incision, not quite sure how long the surgery took (maybe 5 or 6 hours?) The anesthesiologist gave me a choice between having an epidural or morphine for the post-op pain, and I opted for the morphine pump. After a day or so of that I had a reaction and was switched to something different in the pump, and then to percocets, and then tylenol 3 by the time I went home. They make you get up and walk as soon as possible, and trying to sit up was by far the hardest part.

I was released from the hospital seven days after the surgery. I had a homecare nurse come every other day for about a week, and she removed the staples maybe three weeks after the surgery. That part was easy, and I appreciated that my stomach no longer resembled a Chucky doll.

It's hard for me to remember how long it took to recover fully. I was very ill before the surgery and had been for a very long time, but I was for the most part "cured" and I was really enjoying life again by 3 weeks post-surgery. I had an appetite! I could eat real food! I could walk for more than 5 minutes without having to sit down for a rest, etc., etc.

Opting to have the surgery was really really scary, and a very hard decision to make. I successfully talked myself and my doctors out of it for too long, but it ended up being a breeze compared to being sick for so long. I was lucky to have a good surgical team, and they were in general very good with answering questions and reassuring me.
posted by raxast at 8:55 PM on May 20 [1 favorite]

Keep in mind, too, that there are always more stories about things that went wrong, but millions of surgeries go totally smoothly and no one has any big stories to tell about them simply because there is no interesting story.
posted by so_gracefully at 9:20 PM on May 20 [2 favorites]

Don't forget that you always have the right to talk to another surgeon. Even if you conclude that this surgeon is the best doctor for the job, talking to someone else about your options and what the recovery will be like might be more reassuring, since it sounds like you're not really connecting with your surgeon.
posted by zachlipton at 10:16 PM on May 20

So_gracefully is so right (ha). I do not bother reading online accounts of procedures I have to have because they are uniformly negative and read as if angry crazy people wrote them. Not one has ever reflected my own experience. So don't let what you read online freak you out. Good luck, I hope all goes well.
posted by vincele at 11:01 PM on May 20 [1 favorite]

I was expecting to have laparoscopic surgery last year, and it turned into full-on laparotomy *while I was anaesthetised on the operating table* so my experience might be useful to you. This was upper abdomen (gallbladder) rather than lower, so different muscles are involved. For me, the surgery was successful (had they continued with laparoscopy, it might very well not have been) and I was sent home after six days. Before I could go home I had to demonstrate to the physiotherapist that I could clear my own lungs, walk around and climb stairs, all of which I could do with difficulty. I think this is pretty standard procedure.

It was a surprise to come round and find I had been under for five hours instead of the planned one, and that I had a seven-inch incision as well as three keyhole incisions. Recovery wasn't exactly pleasant but really, it's amazing what the human body can do. I was off work for about ten weeks and then took things very slowly after that. It probably took about six months to feel normal again, and now a year later it feels like it happened to someone else.

I second the advice to take the painkillers. My surgeon told me that pain has actual physiological effects and can slow down your recovery, so you want to be as comfortable as you can be. I had morphine (liquid and via pump) for a few days, then diclofenac + paracetamol for a week, then ibuprofen + paracetamol after that.

While I was in hospital it suddenly became very clear to me why inpatients get pneumonia - it's because you build up secretions when you're lying still, probably sleeping on your back post-surgery, and then if coughing hurts like hell (seconding advice to find a pillow to brace against when coughing/sneezing) it's very difficult to clear them out in the way that you do normally when mobile. I learnt to fear the physiotherapist, as everything she did made me hurt, but I grudgingly admit she was very useful.

Best of luck, and as the others say, do seek a second opinion if you can but be prepared for the fact that it might be the same as the first opinion.
posted by altolinguistic at 3:01 AM on May 21 [1 favorite]

An anesthesiologist I know (who is not your doctor!) suggests that the incision in the area you are discussing would be very painful *without proper management*. With proper management it should be fine. He suggests that if you are offered an epidural for post-op pain, you should accept it.
posted by nprigoda at 3:46 AM on May 21

I had six inches of my lower intestine remove, with an incision of similar length from just above my belly button straight down. Here were the most miserable parts of the experience:

1) The prep. Cleaning out the bowels and having to drink that awful fucking shit that is designed to roto-root your innards to a newborn's sheen. I pooped, I puked, I cried... something I'm hoping to never have to repeat.

2) Coming out of anesthesia. Apparently, I'm mildly allergic. I woke up and immediately started to get the spins like the worst motion sickness I've ever had. Two nurses had to press down on my fresh wound while I dry heaved my way back up to my room and my morphine drip.

3) The first bowel evacuation, five days post surgery. Let's just call the "sensation" of moving my bowels at that point "surprising" and leave it at that.

4) The dull drone of pain after a week spent with access to a morphine drip. It wasn't that bad, but I missed the morphine like I missed a summer fling with a beautiful girl.

All in all, it wasn't that bad for me. I bounced back pretty quick after step three, above.
posted by GamblingBlues at 4:40 AM on May 21

There is the usual mix of good and not so good info in this thread. I have not had surgery myself but do have twenty years experience seeing people during and after all kinds of surgery so I will offer a few thoughts based on the limited info you have given. They may or may not apply to you, but will hopefully give you enough info to ask your surgeon and anesthesiologist good questions.

First of all, your description sounds like you may be having hand-assisted laparoscopic surgery; I say that because a 4-inch incision is a good bit smaller than a standard laparotomy incision and you use the term "hand-helper". There is a little bit about this technique here; a more technical article is here. Basically this is a technique that combines laparoscopic and open techniques and allows the use of a much smaller incision than a purely open technique.

Your concerns about postoperative pain are very common and the OR staff should be comfortable addressing them. Postoperative pain varies extremely widely. One factor is the type of incision. The worst in terms of pain are usually considered to be subcostal (just below the ribs) and thoracotomy (between the ribs); the former is used for open gallbladder surgery and the latter is used for lung surgery. Other abdominal incisions are painful, but much less so. The surgeon's skill enters into it some; a better/more experienced surgeon causes less trauma to the tissue. This is a more minor factor, though. Perhaps the biggest variable is the patient. I have seen many appendectomies in my time (to choose something somewhat comparable to your surgery) and given a series of patients who got the same operation and comparable doses of pain medicine in the OR, most will be reasonably comfortable in the recovery room, a few will be writhing in pain, and a few will be sitting up asking if they have had the surgery yet. It is hard to predict where any given patient will fall on that spectrum, but one factor that seems to play a role is anxiety (abstract of some research in this area here). You should have a chance to talk to your anesthesiologist before the surgery and this will be a good opportunity to bring up your concerns. Typically he will be responsible for making you comfortable until you leave the recovery room and so together you can formulate a plan for pain management ahead of time. If having a post-op epidural is an option, seriously consider it. They are very effective and allow you to minimize the use of intravenous narcotics which are good at relieving pain but can make you feel kind of crappy in other ways. The other advantage to having a post-op epidural that most people don't realize is that it will be managed by the anesthesia pain service (or some variant thereof) which means you will have a physician or team of physicians and nurses whose job it is to look after the epidural and keep you comfortable. We have some thoracic surgeons who won't do certain cases without an epidural (to the point of canceling the case if we can't get it in) because the patients do so much better with them. As I mentioned above, your incision will be less painful than a thoracotomy, so an epidural might be overkill, but it is worth asking about. The most important thing is talking with the people involved in your care enough that you have confidence they will take good care of you.

I hope you find some of this helpful. There are millions of procedures similar what you describe done worldwide each year, and the vast majority of patients do very well. Both the World Health Organization and various accrediting agencies in the US have made insuring adequate pain control a priority. Good luck and I hope all goes well. Feel free to contact me if you have more questions.
posted by TedW at 6:35 AM on May 21 [2 favorites]

Get a second opinion. Not just because another surgeon may recommend the less invasive surgery, but also because you don't seem to trust your current doctor. If you don't feel as though he's communicating clearly with you (he's not being forthright with you and the language barrier makes it hard for the two of you to communicate with one another), you need to find a doctor who will.
posted by decathecting at 7:50 AM on May 21

but my advice is to take huge doses of anti-inflammatory meds such as naproxen or ibuprofen after the surgery to reduce adhesions which are a major problem in abdominal surgeries. Don't take them before as they increase the risk of bleeding during the surgery. They are also pain killers.

And that can also cause post-op bleeding and renal failure, so speak with the anesthesiologist and surgeon, not people online. Find a surgeon you can trust; he's cutting you open.
posted by gramcracker at 8:32 AM on May 21 [2 favorites]