Aug 27, 2013 EveryDay Health
Anyone who has ever had major abdominal surgery knows the drill. The bowel prep starts days before with a liquid diet, enemas and fasting. During surgery so much fluid is administered intravenously that it’s not unusual to gain weight and look like a puffball for days after. We’re not even talking about the multiple post op trips to the bathroom to pee off all that fluid. Then there is the mandatory “no food” until you pass gas rule. Even rubbery green Jell-O starts to look appealing. The prep and aftercare is sometimes far worse than the pain from the surgery.
If what we do now seems miserable, consider the experience your great grandmother would have had in the 1940’s.
Women were generally admitted to the hospital days prior to surgery. An enema the night before and the morning of surgery were mandatory. Following the enema, the patient’s abdomen, pubic region, and perineum were shaved and a douche was administered.
On the second postoperative day, the woman would be given another enema to “secure a bowel movement.” By the fourth day after surgery, it was permissible to prop the woman up in bed and offer solid food. Only on day five, was the woman allowed to sit straight up! The tenth day was when it was time to get out of bed. Women who were “worn out” by ill health or heroic work for their children were encouraged to remain “in bed for two or more weeks before attempting ambulation.” Total hospital time for an uncomplicated hysterectomy averaged three to four weeks.
Quite the contrast to most of my patients, who check in for a laparoscopic hysterectomy at 6:00 a.m., are home with a few stitches by dinner time, and back at work within two weeks.
Things have clearly come a long way since the 1940’s or even since I wrote the first edition ofThe Essential Guide to Hysterectomy. Today, even my patients who require major abdominal surgery are encouraged to get out of bed quickly and eat as soon as they have an appetite. I no longer recommend pre-operative bowel preps unless cancer or a lot of scar tissue is anticipated.
But the Mayo Clinic has taken it one step further and just released a study that proves that even with complex abdominal surgery, as in the case of advanced ovarian cancer, there is a better and faster recovery if patients forgo the bowel prep, excessive IV fluids, and drains that are standard surgical treatment.
This is a win for everyone. Yes, the insurance companies will benefit. But more important, patients will benefit. Getting out of bed and getting home sooner means fewer blood clots, lower infection rates, and quicker overall recovery. Far from being cruel, most women are far more comfortable in their own beds, eating their own food, and peeing in the privacy of their own bathrooms.
So if you are scheduled for major surgery know that you may be able to forgo the nasty prep and you might get to enjoy that delicious hospital food faster! On the other hand, be careful what you wish for. Hospital food is generally terrible and once you are given the green light you might want to order in. The nurses are a great source of menus, of course; they know better than to eat hospital food.