Nephrectomy: instructions before and after surgery

General and important instructions before surgery

Before surgery:

- When you are admitted to the hospital, bring all the tests performed for the surgery.

- Fasting before surgery must last at least 8 hours, including water.

- There is no need to shave the abdomen or pubic area (trichotomy) at home. If indicated, this will be done at the hospital shortly before surgery.

- Allergies to medications, latex, foods or anything else must be reported to the medical and nursing team at admission.

- Antihypertensive medications (blood pressure medicines) should be taken even on the day of surgery, with the smallest amount of water needed to swallow them.

- Some medications must be stopped before surgery:

- Oral hypoglycemic agents (diabetes medicines) must be stopped the day before surgery.

- Antiplatelet agents such as acetylsalicylic acid (AAS®, Somalgin®, etc.) and clopidogrel (Plavix®, etc.) should be stopped at least 7 days before surgery if the patient takes only one of these medications. If both are used, they should be stopped 10 days before the surgical procedure.

- Patients taking anticoagulants such as warfarin (Marevan®) or rivaroxaban (Xarelto®) must stop the medication 5 and 3 days before, respectively. During this period, some patients will need to use enoxaparin sodium or unfractionated heparin until the day before surgery.

After surgery:

- After returning from surgery to the room, once the patient is fully awake, they may eat the diet prescribed by the medical team. Food should be introduced according to the patient's tolerance.

- On the morning after surgery, after breakfast, it is already possible to get out of bed to shower and take short walks in the room and along the ward corridors. It is recommended to ask a family member or a member of the nursing team for help.

- After surgery, all patients have a urinary catheter (Foley) in the bladder and an abdominal drain. During the hospital stay, the medical and nursing team will care for these devices and teach patients and family members how to handle them at home.

- The urinary catheter is usually removed on the morning after surgery, and the abdominal drain before hospital discharge, depending on its daily output. In specific situations, the patient may be discharged home with these devices.

- The hospital stay usually ranges from 1 to 3 days, depending on the type of approach (open vs. laparoscopic or robotic) and on each specific case.

- After surgery, increased intestinal gas is normal, and the bowel may take up to 3 days to return to normal function. Laxatives, antispasmodics and anti-gas medications will be given as needed.

After hospital discharge:

Diet:

- There are no specific dietary restrictions; the patient should eat a healthy diet. During the first week, it is advisable to avoid foods that are harder to digest, such as fried foods, very fatty or highly seasoned foods and sweets, as they cause intestinal gas to build up.

- Fluids (water, tea and natural juices) may be consumed freely.

- Alcoholic beverages such as beer, wine and spirits may be consumed in modest amounts about 15 days after the operation, if the patient has no contraindication.

Incision care:

- Dressings protecting the incision should be changed daily, preferably after showering. If discharge from the wound heavily soils the dressing, it may be changed more than once a day. The dressing may get wet; after showering, it should be carefully removed and the wound cleaned with saline solution, dried and covered with gauze or directly with surgical tape (Micropore).

- Usually there is no need to remove stitches, as we use absorbable sutures.

- If the skin around the incision becomes very irritated by the adhesive tape, hypoallergenic tape may be used, or the incision may even be left uncovered.

Abdominal drain care:

- In some situations, the patient may be discharged with the abdominal drain in place. The abdominal drain (Blake drain) is a closed vacuum system that drains secretions from the surgical site. Its collector should be emptied 3 times a day or whenever it is full and has lost its vacuum. The amount discarded, the date and the time should be recorded for later review by the medical team. In general, the drain is removed when its output is less than 100 ml over 24 hours.

Physical activity:

- During the first 2 weeks after surgery, the patient should maintain relative rest, avoiding strenuous work activities, lifting weights (including small children and pets) and any kind of intense physical exercise. However, during this period it is important for the patient to move around carefully, and gentle daily walks are allowed.
- After 2 weeks, the patient may do light activities such as somewhat longer walks. Work activities that do not require physical effort can be resumed if the patient wishes. More strenuous activities, such as driving, running, sit-ups, tennis and soccer, horseback riding, cycling or workouts involving greater muscular effort, will be cleared case by case after assessment by the medical team, but in general they are not allowed before 6 weeks after the procedure.
- The patient is generally cleared to drive after the third postoperative week.
- After discharge, the patient may go up and down stairs, as long as this is done carefully.

Medications:

- At discharge, you will be instructed about the medications you will take at home. Usually, painkillers for mild pain are prescribed and, when necessary, anti-gas medications and laxatives. Antibiotics are used only as prophylaxis before surgery and are not prescribed for home use, except in selected cases where the medical team considers it necessary.
- Prevention of venous thromboembolism (VTE) will include encouraging early walking, intermittent pneumatic compression devices, elastic compression stockings and, when indicated, medications such as enoxaparin sodium or unfractionated heparin, given as subcutaneous injections, according to your risk of developing VTE.
- Warning: in case of severe pain that does not improve with the prescribed painkillers, significant bleeding through the catheter or drain, fever, thick yellowish discharge (pus), shortness of breath with pain when breathing, feeling unwell with a drop in blood pressure, or any other complication or concern, go directly to the emergency department of the hospital where you had surgery.
- Note: this information serves as general guidance for the patient. It does not replace the guidance given in person by the attending physician, which must be individualized according to the characteristics of the patient, their disease and the planned operation.