The day of the surgery

• Aim to arrive at the time allocated to you by the hospital, which is called the admission time. Arriving early doesn’t mean you’ll be admitted or have surgery early.
• When you’re admitted, you might not know the exact time of the surgery, but you’ll probably know if it will be in the morning or the afternoon. Sometimes there are unexpected delays, depending on other patients or emergencies – the receptionists and nurses will keep you informed.
• You will change into a surgical gown and put your personal possessions in a bag for storage or to give to your support person. 
• If the surgery is to a part of your body with hair, it will be shaved unless you have already done it yourself.
• Some people are given a sedative (pre-medicine or pre-med) as an injection or tablet to help them feel relaxed.
• While your medical team can give you information about the surgery, there may be some unknown factors. For instance, they may not know until the surgery how many stitches you will need or if you will need a blood transfusion. See Unknown factors for information about side effects.

You will be given drugs (anaesthetic or anaesthesia) to temporarily block any pain or discomfort during the surgery. An anaesthetist will administer these drugs and monitor you throughout the operation.

Before you receive anaesthetic, the medical team will talk to you about your medical history. You should also tell them when and what you last ate and drank, or if you think you have a cold or the flu.

There are different types of anaesthetic depending on the type
of surgery:

• General anaesthetic – This is usually an injection of drugs into a vein that puts you into an unconscious state. A general anaesthetic can also be given as gas through a mask that the anaesthetist places over your face.

  You may experience some side effects, such as nausea, when you wake up from general anaesthetic. Most of these effects are temporary and are easily managed by your medical team.

• Regional anaesthetic (nerve block) – A local anaesthetic is injected through a needle placed close to a nerve or nerves near the surgical site. This numbs the part of the body being operated on. A local anaesthetic cream is usually applied to the skin first to minimise the pain from the needle. You may be given a light sedative to help you relax, or stronger medicine to put you to sleep. You won’t feel any pain or discomfort during the surgery.
• Local anaesthetic – This involves numbing the skin or surface of the part of the body being operated on. It is usually done via an injection, but drops, sprays or ointments may be used instead. You may also be given a sedative to help you relax. You are still awake during surgery, but you won’t feel any pain or discomfort. The numbness typically lasts for several hours to a day.

Risks of anaesthetic

It’s uncommon to have an allergic reaction to anaesthetic. Your medical team will review your medical records and general health to determine whether you are at risk of a reaction.

Anaesthetists are trained to recognise the adverse effects of anaesthetic, and they will give you medicine to manage any complications.

You will lie on a bed that is wheeled into the operating theatre, which is a sterile (clean) room where the surgery occurs. The surgical team will wear caps, masks and gowns to help prevent infection.

If you are having a general anaesthetic, the anaesthetist will put a small tube (cannula) into a vein in the back of your hand or arm. The anaesthetic will be injected into the cannula. You might feel a slight stinging sensation, but once the drugs take effect, you won’t be aware of what’s happening. Some people say that having a general anaesthetic feels like a deep, dreamless sleep.

During surgery under general anaesthetic, a machine called a ventilator breathes for you. The anaesthetist constantly monitors your vital signs (heart rate, temperature, blood pressure and blood oxygen levels) to ensure they remain at normal levels. They also give you pain medicine so you are comfortable when you wake up.

When the surgery is finished, the anaesthetic will begin to wear off slowly, or you will be given more medicine to reverse the effects. You’ll be taken to the recovery room and your vital signs will be monitored until you are fully awake.

There are some things the medical team may not know until the surgery is in progress. The surgeon will discuss these with you during your preoperative assessment appointment.

• Taking a different approach – The surgeon may plan for keyhole surgery but revert to open surgery for better access to the tumour or due to complications.
• Involving another surgeon – Another surgeon may be called into the theatre to assist your surgeon. This is standard practice, as the extra support can help achieve the best outcome for you. For example, a gynaecological surgeon may ask for assistance from a colorectal surgeon if they discover cancer in the bowel.
• Removing extra tissue – It may be difficult for your doctor to tell you exactly what will be removed during the surgery, as scans don’t always detect all of the cancer. If the cancer is found in places that weren’t indicated on scans, your surgeon may remove extra tissue to cut out as much cancer as possible.
• Creating a stoma – The medical team will talk to you before surgery about the possibility of creating an artificial opening in the body (stoma). An example of a stoma is a colostomy, when part of the large bowel is brought out through an opening in the abdomen, and a pouch is attached to collect waste from the body. A stoma may be temporary or permanent.
• Needing a blood transfusion – If you lose a lot of blood, some blood or blood products can be transferred into your body (transfusion). Blood from a donor is usually used. There are strict screening and safety measures in place, so this is generally very safe.

  If you’re concerned about receiving someone else’s blood products, you might be able to bank some of your own blood before the surgery so it can be transfused back to you. However, this procedure is rarely used. Talk to your doctor if you are worried about needing a blood transfusion.

Your surgeon can choose how to close up the wound (incision) created during the surgery. Their approach will depend on the part of your body affected and what kind of surgery you have (e.g. open or keyhole surgery). Common methods of closing a surgical wound include:

• sutures or stitches – sewing the wound closed using a strong,
  threadlike material that can dissolve or will be removed at a later
  date
• staples – small metal clips
• glue – transparent liquid or paste used to seal minor wounds
  (up to 5 cm) or applied on top of sutures
• adhesive strips – pieces of tape placed across the wound
  to hold the ends together, which may be used with sutures.

The wound will usually be covered with surgical dressings to keep it dry and clean. These will be in place for a few days, then changed regularly. If you have surgery as an inpatient, the nurses can look at the wound to see if it’s healing and check for bleeding or signs of infection. If you have a shower, the dressing will be taken off and reapplied afterwards.

If you have day surgery, you may need to see your general practitioner (GP) to have the wound checked before seeing your surgeon a few weeks later.

The wound may feel itchy or irritating after surgery. Tell the nurses if this happens – it could be a sign it’s healing, but it may also be a problem, such as an allergic reaction to adhesive tape.

Sometimes complications occur during surgery. It’s very unlikely that all of the complications described here would be relevant to your situation. Your surgeon can give you a better idea of your actual risks.

Generally, the more complex the surgery is, the higher the chance of complications.

• Bleeding – You may lose blood during surgery. Your surgeon will usually manage and control bleeding, and you may receive a blood transfusion to replace lost blood. However, needing a blood transfusion during surgery is rare.
• Damage to nearby tissue and organs – Most internal organs are packed tightly together, so operating on one part of the body can impact on nearby tissue and organs. This may affect the function of other organs after surgery – for example, the surgeon’s handling of the bowel during pelvic surgery may cause temporary constipation (difficulty passing a bowel motion) or a build-up of gas in the abdomen.
• Drug reactions – In rare cases, some people have an adverse reaction to anaesthetic or other drugs used during surgery. This can cause a drop in blood pressure, heart rate and breathing, which is why an anaesthetist monitors you during surgery. Tell your doctor if you’ve had any previous reactions to over-the-counter, prescribed or herbal medicine, even if the reaction was small.