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Post-Op Information

Post-Operative Information: ETS Surgery

Immediately After Surgery:

Wound care
The chest wounds usually have no sutures in them. They are closed by a steri-strip and a waterproof dressing. The patient can shower and pat this dry. On the fifth day these dressings should be removed and the wounds can then be left open. If the wound becomes red or swollen, this may mean infection has set in and the patient should notify the rooms. We recommend you do not swim or bathe for one week after surgery.

Post-operative pain
There is usually little pain from the chest wound port insertion sites, There is referred pain from the lungs and airways and this is usually felt behind the chest bone or in the middle of the back or in various moving places around the chest wall. Patients over the age of 40 years seem to find that this pain persists for 4 to 6 weeks.

We recommend taking two Panadol or Panadeine the night after discharge from hospital and thereafter as needed. Taking a morning and afternoon dose and a third dose in the evening for tow or three days is quite a good way to break the pain cycle if it is causing you a problem.

Post –operative activity
We recommend the patient have one week off work. Patients aged in their 20’s find this to be more than enough. Patients over the age of 40 usually ask us why we didn’t suggest 2 weeks off work. The internal operation is larger than the external incisions would lead you to believe so please be sensible and plan accordingly.

What you can do
Normal work, drive the car (after 2 days at home), walking, swimming (after 1 week when the wounds are healed), non-contact sports.

What you can’t do
Fly in an aeroplane, Scuba-diving, contact sports (including soccer and basketball), general anaesthesia within 6 weeks. Please remember that the internal operation wounds have to heal and your lungs have to recover, and although you may feel well this recovery takes about a month.

Other possible problems
Some patients have had a cold or sore throat, and even one patient had an infected throat requiring a course of antibiotics. Please respect these problems and attend early for treatment. You have had interference with your airway and both lungs, and it does take time for the lungs to recover.

There are occasional aches and pains from lying in hospital or on the operating table. Some people get sore shoulders or sore areas on their chest. These mostly resolve. Please notify us of any significant problems, especially if they persist to the time of your review consultation.

Smokers
PLEASE NOTE: We don’t recommend starting smoking again. If you must start, please wait a month.

Further medical care
You will usually be asked to have an x-ray at about 3 weeks, and attend a review consultation about 4 weeks. Patients who delay attending for their review consultation will be contacted by our Rooms. It is an important part of your total treatment to attend to describe the post-operative changes and for further information. If you have any hospital accounts that don’t seem to make sense, this is an ideal time to bring all the paperwork and we will see if we can help.

Long term follow-up
Formal long-term appointments are not usually made but we are keen to see how patients are well down the track. If there are any problems, please call the rooms and we will arrange an appointment. Compensatory hyperhidrosis can take 6-12 months to settle.

You may notice a few changes after sympathectomy, whether it was for blushing or sweating. We will have discussed these, and this is a bit of a reminder.

Dry hands
Dry hands should occur after thoracic sympathectomy. Hands can become so dry that the skin will crack. The treatment is moisturiser and after a few months the skin will become used to being warm and dry and you won’t need so much moisturiser. Some patients stop using it entirely, or use it twice a day. Complaints about dry, cracked skin mostly come from men who haven’t used much moisturiser. Use whatever is your favourite moisturiser. I recommend Vaseline Intensive Care “Dry Skin Formula” (in the yellow bottle). Buy several (bathroom, bedside, office drawer, car, and handbag).

Dry face or dry hair
Virtually no one complains of this. Women should use their normal moisturising solutions. Men might like to try plain Sorbolene Cream e.g. Hydraderm, if needed.

Compensatory sweating
This is often mild and self-limiting, but can be severe especially for the first month or so. Patients having sympathectomy either before or over summer are particularly inconvenienced by this.

Adjust your clothing appropriately i.e. use layering with an inner layer that can wick the perspiration to an absorbent outer layer. Singlets, t-shirts and loose clothing help.

“Mitchum” is a standard roll-on anti-perspirant which is helpful to apply to particularly bad areas. This is available from supermarkets and chemists. “Driclor” is a much stronger aluminium-based anti-perspirant which is available from chemists only (possibly about $30). Widespread and excessive use of this can cause eczema. It is particularly useful only for severe areas. Don’t use it on your hands or face. A combination of the above two may be useful to add to changes in clothing for the first couple of months after surgery. Many patients have complained of severe compensatory sweating, but very few have a significant problem after a few months. There are no particularly effective drug therapies.

Chest pain
There may be some pain from the port sites, but this is usually minimal. The chest pain is often referred to behind the sternum (breast bone). It may feel burning. Various aches and pains around the chest wall when you move, especially if you are playing sport, are likely in the first month. Avoid any contact or high impact sports. Take Panadol or Panadeine at a dose of 2 tablets once or twice a day for the first couple of weeks. Few if any patients require this level of post-operative medication, so if you find you need this much beyond the first week or so less physical activity and an earlier review may be appropriate.

How will you feel over the next 12 months
In 4 weeks you will have some early indication of the success of surgery. You will be assessed and your recovery from the immediate effects of anaesthesia and surgery will be confirmed.

At about 3 months you will have a much better ideas because you will have been in situation which cause sweating or blushing and usually have found an improvement. This will result in less emotional stress and hence less positive feedback promoting sweating or blushing. By this stage you should have been in the most stressful activities, e.g. public speaking, visiting the boss, and experience an improvement, and hence the next time you do that activity there will be less nervous system activation and a better appreciation of the results. By this time compensatory sweating will usually be starting to noticeably diminish.

By 12 months we hope you have come home from a particularly busy and stressful day at work and are sitting down having a drink, and you say to your partner “gosh, that was a terrible day”. At that stage you realise you have been so busy and stressed that you forgot to sweat or blush. That is when the final benefit of the operation is felt.

Any questions or problems
Please call the rooms.