Consultation and physical examination by Dr. Papoulas take place in his office – outpatient clinic. Once a surgical treatment is determined, our surgical coordinator will solidify your surgery date. We routinely obtain a preoperative cardiac clearance from a cardiologist for all patients above age 50. One of our team members will go over with you our standard preoperative preparation (nothing to eat/drink before midnight and whether you need to stop taking medications such as blood thinners for a certain number of days before your procedure). For bowel surgery, you may need to have a bowel preparation prior to the operation.

We use the ERAS (Enhanced Recovery After Surgery) protocol for all our major surgeries. In summary, this modern protocol entails taking high protein diet starting 5 days before the operation, injection of intrathecal Duramorph in the morning of surgery by an anesthesiologist to reduce pain, and minimizing use of narcotic/opiods after the operation.

Next, you will be scheduled to have an anaesthetic appointment in the hospital, a few days prior to your operation or on the day of surgery, to make sure everything is completed and ready to go for surgery.

If you take Coumadin blood thinner, you will have to stop it 5 days prior to the operation. You may need a Clexane/Low Molecular Weight Heparin brigde depending on the indication of your anticoagulation. If you take Xarelto, Elliquis, or other similar class of blood thinners, you will have to stop them 3 days prior to the operation. You may continue taking your baby aspirin.

If you are a smoker, this is a great opportunity to stop smoking. If you are a drinker, this is a great opportunity to stop drinking.

Do not eat anything for 6 hours before surgery. Your stomach must be empty. You are allowed to drink clear fluids (water, tea) up to 2 hours before surgery.

Laparoscopic cholecystectomy and laparoscopic inguinal hernia repair is done as outpatient. Laparoscopic liver cyst surgery, laparoscopic liver biopsy, laparoscopic liver ablation and port-a-cath insertion are also day surgery procedures.

Minimally invasive (laparoscopic or robotic) liver, pancreas and biliary duct surgery require an admission to the hospital. Similarly, laparoscopic splenectomy, adrenalectomy, bariatric surgery, diaphragmatic hernia repair or incisional hernia repair require a short hospital stay. Benefits of minimally invasive surgery include faster recovery, less pain and scarring and faster return to your daily activities. The average length of hospital stay following those procedures is 1 to 3 days.

Open major liver resections, pancreatic surgery, bowel surgery, sarcoma and complex surgeries for advanced tumours require longer hospitalisation and prolonged recovery. The average length of stay for those surgeries is 5-7 days.

An abdominal drain is placed routinely in patients who undergo major liver surgery, pancreatic surgery, biliary tract surgery and bariatric surgery. The output from the abdominal drain is monitored daily and is removed within the first 2-4 days after surgery, if there is no evidence of leakage or bleeding.

Between 7 and 14 days after surgery, you will typically return for a follow-up visit where Dr. Papoulas and his team will:

• Examine the incisions.
• Evaluate your progress, taking into account your activity level, diet, and pain management.
• Discuss histopathology results, long-term follow-up plans and any additional therapy.