The Post Operative Protocol

When I first took over at Charing Cross, patients followed the protocol used by my predecessors James Dalrymple and Mike Royle. This essentially involved lying flat in bed for 5 days on clear fluids only, with the theatre dressing remaining in position. Both the nursing staff and I had significant concerns about this. Firstly, there seemed to be a high risk of DVT and other thrombotic complications. Secondly, any problems with the wound only became apparent after 5 days. Thirdly, being starved for 7 days (including the 2 days before the operation) seemed to us to be unnecessary; some of the patients were almost too weak to stand at the end of it. The protocol was therefore gradually changed to that shown below. This was carefully audited at all stages, and we were pleased to find that early mobilisation resulted in a halving of the prolapse rate. Changing the type of pack has reduced prolapse rates yet further. There has not been any rise in infection rates or of haematoma formation. Reducing the dressing early, allowing early mobilisation, and allowing normal diet has made the whole process much more pleasant for the patients, and has significantly reduced the risk of thromboembolic complications.

The current post operative protocol is;