What should I do before surgery ?
What can I expect after the operation ?
What complications can occur ?
What signs indicate potential complications ?
What will I need to know to go home ?
How long does it take for my incision to heal ?
How should I alter my diet after adrenal surgery ?
When can I go back to work ?
What should I do before surgery ?
Preoperative Clinic Visit will include:
- A History and Physical Examination:
It is important to know your full health history and any and all of the medicines you take. Depending on your other medical problems, you may need to be seen by another specialist before your operation.
- Blood work and Tests: According to your age, medical condition, and the type of surgery planned, you may be asked to have an EKG (heart tracing), chest x-ray, or blood work before your surgery.
- Instructions for You and Your Family: We will explain what to expect on the expect on the day of surgery and answer any questions that you may have. We will also give you written information with maps and phone numbers. A doctor will explain the surgery and you will be asked to sign a Consent to Surgery form.
- Anesthesia Evaluation: The anesthesiologist will see you on the morning of surgery if you are generally in good health. If you have any serious medical conditions, we will send you to our Preoperative Anesthesia Clinic. Your record is then reviewed and the type of anesthesia is planned in advance.
Most patients are admitted to the hospital on the day of the operation. You may be required to abstain from food or drink at least 6 –12 hours prior to surgery. This reduces the chances of you vomiting when you are being put to sleep, an event which could lead to life-threatening lung infections. You may also be asked to temporarily stop taking certain medications or take new medications prior to surgery.
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What can I expect after the operation ?
How long does surgery last ?
The duration of the actual surgical procedure varies between 45 minutes and 4 hours, depending on the extent of the operation (number of the glands), and the operative approach.
How long is hospital stay ?
One primary determinant of the length of hospital stay is the operative approach, and extent of the operation. Directed parathyroidectomy can be performed as an out-patient procedure requiring a few hours stay in the hospital, however a more extensive parathyroidectomy may require hospital admission for several days.
After the Operation
- You will have a call light handy - let the nurse know if you need something!
- It is normal to feel tired, groggy and weak from the effects of anesthesia. Do not get out of bed by yourself! Ask for help.
- You will be asked to remain in a sitting position (in bed). You will be able to move your head as you wish.
- You may also feel nauseated (sick to your stomach) and have some soreness and stiffness in your neck from the operation. Medications will be available if you need them to relieve discomfort. You must let the nurse know when you throat feel better.
- You'll be checked frequently for signs of bleeding and swelling along the incision (some swelling is normal). Your breathing and blood pressure will be checked as well.
- Depending on the type and extent of your surgery, we will look for signs of decreased blood calcium by obtaining blood samples to check the calcium level.
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What are the possible complications of parathyroid surgery ?
Parathyroidectomy is a safe and effective procedure. In addition to the complications associated with a general anesthetic such as stroke, blood clots (deep vein thromboses) and heart attacks, there are few specific complications of parathyroid surgery. These include damage to nerves supplying the vocal cords (recurrent laryngeal nerve and superior laryngeal nerve), and inadequate function of the remaining parathyroid glands after surgery. The former complication may cause voice hoarseness or breathing difficulty, whereas the latter can usually be managed by life-long calcium replacement. When identified during surgery, nerve injuries can be repaired and damaged parathyroid glands can be transplanted into the neck or fore-arm. Another potential complication of parathyroid surgery is bleeding into the neck after surgery. This may occur suddenly and may require re-admission the hospital and/or another operation. Scar complications such as keloids are rare and may occur during the weeks to months following surgery.
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What are the signs of surgical complications ?
Warning signs may not occur prior to any complications, however some signs may indicate that you have developed complications. The most troubling complication after parathyroid surgery is bleeding into the neck. One sign of this complication is the gradual or sudden onset of difficulty breathing or noisy breathing. This constitutes an emergency and should be treated immediately. Symptoms of low blood calcium include numbness or tingling in the fingers, toes or around the lips. Spasms in the muscles may also occur in the presence of low blood calcium. You should seek urgent medical attention if these latter symptoms or signs occur.
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What will I need to know to go home ?
- A nurse will review discharge instruction with you and give you written take home.
- You will be scheduled to see your surgeon in 1-3 weeks after your operation. This will be in the same clinic in which you were seen before your admission.
- When you leave, your wound will be covered by paper "Steri-Strips," which will remain in place until your post-operative clinic visit. If they become unsightly or bothersome to you, you may remove them 10 days after your operation.
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How long does it take for my incision to heal ?
- Neck incisions heal rapidly. They are watertight in about 24-36 hours allowing you to shower carefully. The incision normally heals fully within a few weeks. There is also swelling and a feeling of firmness under the incision that may last for a couple of months.
- Most scars are most noticeable 1-2 months after operation and gradually become less so after several months. Until that time, you may notice the color is more red than surrounding skin. This is normal and will improve. However, this skin is sensitive to ultraviolet radiation so you should cover the incision with sunscreen when outdoors for extended periods of time to prevent darkening (hyperpigmentation) of the area.
- If you wish, you may use vitamin E cream or other moisturizers on the incision.
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How should I alter my diet after parathyroid surgery ?
There are no uniform general dietary restrictions for patients who have had parathyroid surgery, however your surgeon may ask you to temporarily increase dietary calcium intake or take calcium pills until your blood calcium levels stabilize.
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When can I go back to work ?
Convalescence after parathyroidectomy is usually short but depends on the extent of your operation. Many patients return to an active work schedule within days after directed parathyroidectomy, however it may require up to 1 week to return to work after extensive neck exploration for parathyroidectomy. Consultation with your surgeon will determine when you can return to work after parathyroidectomy.
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