Pre and Post-Operative Care for SRS Surgery: Everything You Need to Know
Hair Removal
The hair removal process should be initiated on the perineal skin above the anus seven to five months before Sigmoid Graft Vaginoplasty. Hair removal can take up to 5-7 months to be effective. Please note, for the PPV surgery, hair removal is required on the perineal skin as well as the scrotal skin because more scrotal skin is used for the vaginal entrance and lining.
The patients should visit a local hair removal specialist technician to ask for recommendations on how often and how hair removal should be performed. Generally, patients will be required to repeat the process once a month for three to five times depending on each patient’s skin condition. The hair removal process should be completed at least 2 months before the surgery to allow the skin to recover and regain its strength and elasticity.
Please note: Patients should not perform laser hair removal on any parts of the penile skin, as it may cause scar tissue, thus making the skin too thick for constructing aesthetic neovagina.
Care for SRS Surgery
Sigmoid Graft Vaginoplasty
Recovery from Sigmoid Graft Vaginoplasty is a delicate process and requires special care. To avoid the risk of intra-abdominal and wound infection, patients are required to follow instructions below:
4-6 Weeks before surgery
Hormones
All anti androgen and hormone injections must be completely discontinued four weeks before the surgery. Oral tablets and other forms of treatment such as skin gel and patches must be discontinued two weeks before the surgery to prevent the risk of Deep Vein Thrombosis (DVT).
Smoking
Patients must discontinue smoking four to six weeks prior to surgery for optimal recovery. Smoking should be halted until at least one month after the surgery and patients should be aware of serious adverse effects caused by smoking during recovery period.
Two Weeks before surgery
Aspirin (e.g. Advil), Ibuprofen, and Vitamin E must be held for two weeks prior to the surgery as they can increase the risk of intra operative bleeding and other complications. Certain foods which can cause excessive bleeding such as garlic and ginkgo leaves should also be avoided.
Three days before surgery
Patients can only ingest a clear liquid diet during the day prior before the surgery. Laxative pills must be taken on the last day prior to the surgery.
The Day Before Surgery
One day before surgery, patients are required to:
• be admitted to the hospital
• go under bowel preparation procedure, to avoid wound risk from wound and intra abdominal infection
• continue clear liquid diet
• take liquid laxative (Sodium Phosphate Oral Suspension – Swiff or other medicines depending on the colorectal surgeon’s decision)
• take a shower since they will not be able to take a shower for at least 5 days after the surgery
The Day of Surgery
On the day of surgery, patients will be allowed to take clear fluids only up to 6 hours before surgery or up until arriving at the clinic. Patients who have cold, flu symptoms, or are physically unwell will be asked to postpone the surgery. Therefore, it is very important to maintain your optimal health prior to surgery.
Immediately After Surgery
Generally, the postoperative period at the hospital for SRS patients is 6 days. After the SRS, it is common to experience incisional pain, swelling, and irritation from the urinary catheter.
Care for SRS Surgery
Non-Sigmoid Graft Vaginoplasty Patients
For all non-signmore graft surgeries, patients are asked to remain in bed until the doctor examines them and the vaginal stent is removed.
Sigmoid Graft Vaginoplasty Patients
Sigmoid Graft Vaginoplasty Patients will be asked to begin ambulation as soon as possible to initiate bowel movement. On the second day after the surgery, it is recommended that patients walk around their bed and room. On the third day, patients can walk around within the hospital ward.
Urethral Catheter
After the surgery, patients will require a urinal catheter which will remain in for at least 5 days. When regaining consciousness, they will feel tube drain and catheter and might feel the need to urinate due to irritation caused by the catheter. This feeling will gradually subside within 2-3 days. Some blood may be found in the drainage tube and around the outside of the catheter. These are common and should be considered normal as long as the catheter is draining.
Four days after surgery, bladder training will be conducted by clamping the urinary catheter tube every 4 hours. This will initiate the bladder’s movement and urinary system. On the sixth day, the catheter will be removed and nursing staff will assist the patient with showering and begin urinating in a sitting posture. The patients might have difficulties urinating due to swelling around urethral opening so they will need to try urinating with full muscle strength.
After the patients are able to urinate by themselves twice, they will be discharged and relocated to a nearby hotel. Patients have the option to extend their stay at the hospital should they require extended catheterization. Patients who have already relocated to the hotel but have difficulty urinating can return to the hospital. In such cases, the urinary catheter may need to be utilized until the patient is able to urinate independently.
Pain Management
During and immediately after surgery, IV pain medication (morphine) is used to control the pain. This medication will be stopped within 24 hours after the surgery. After that, the patients usually take oral pain medication. However, if the patient feels pain is not properly managed with oral pain medication, IV morphine can be continued upon the patient’s request.
Non-Sigmoid Graft Vaginoplasty Patients
During the first few days after surgery, patients will be served soft meals which contain low fiber and residue to avoid defecation, which may cause infections. Vegetables, fruit and other high fiber products must not be taken at this time. Regular meals can be resumed three to four days post-surgery (after the patients are able to have bowel movement). The medical team will monitor and instruct next steps.
Sigmoid Graft Vaginoplasty Patients
During the first few days after surgery, no food and water can be consumed. On the third day, the patient can start sipping water. On the 4th day, the patients will be served a clear liquid diet which contains no fiber and residue to avoid defecation, which may cause infections. On the fifth day, the patient will be transitioned to a soft diet. Vegetables, fruits and other high fiber food must not be taken at this time. Five days post surgery, soft meals may be served depending on the doctor’s recommendations. Regular meals can be resumed after the patient is able to have bowel movement.
Vaginal Stent
When the surgery is completed, vaginal packing will be inserted into the vagina and will remain for five days to ensure that the skin graft is in contact with the vaginal structure. Since this packing is very tight and close to the rectum, it can create an urge to defecate even when the bowel is empty. This sensation will gradually subside within 2 days. On the sixth day, vaginal packing, tube drain, and catheter will be removed altogether.
After the vaginal packing and other tubes are removed, patients can be discharged from the hospital and continue their recovery at the hotel. After packing removal, there might be some bleeding from the vagina and urethral opening. In such cases, patients are advised to stretch their legs while keeping both of their knees together and stay still in this position for 30 minutes. The bleeding will eventually stop. If the bleeding does not stop, patients can apply firm pressure with gauze directly to the wound until the bleeding stops.
Bowel Movement
During the first 2-3 days after surgery, bowel movement should be avoided. However, if defecation is necessary during this period, it can be done in the bed by a bedpan but with the utmost care and cleanliness.
On day three, patients will usually be able to start bowel movement on their bed or in the toilet. After bowel movement, the anal area needs to be cleaned carefully and thoroughly, as the area is very close to the surgical wound. When cleaning the anal, they should wipe from the front towards the back so that the stool will not contaminate the wound and cause infection.
Home Care Instructions
After being discharged from the hospital, patients are required to follow very specific instructions while recovering at the hotel and after returning to their country.
Wound Care
After vaginal packing is removed, patients are able to take a shower. The vagina should be cleaned with saline solution only.. Then, with cotton buds, Betadine should be generously applied on the wound including labia majora and labia minora. If there is bleeding, press the wound with a dry cotton ball for around 15 minutes.
Medication
Patients must continue medication as prescribed by Dr. Theerapong and ensure they understand medication regimen. Contact the doctor right away if there are any problems related to medicine.
Sanitary napkin
After the surgery, patients will need to change their sanitary napkin 2 – 3 times a day to absorb blood from the wound and maintain good hygiene. During the first 3 – 4 weeks, sanitary loop napkins should be used. After that, patients can use normal sanitary napkins.
Hormone therapy
Hormone therapy can be resumed 3 to 4 weeks after surgery after the wound is completely healed. However, it is recommended that patients resume their hormone replacement therapy after returning to their home country to avoid deep vein thrombosis during the return flight. Patients should consult their doctor or specialist before resuming the hormone therapy.
Smoking
Smoking is strictly prohibited until one month after the surgery. Nicotine and other toxins have a significant impact on oxygen and nutritional flow, which can seriously compromise wound healing. Patients must discontinue smoking four to six weeks prior to surgery for optimal recovery. Patients should be aware of serious adverse effects caused by smoking during the recovery period.
After-care Supplies
Necessary after-care supplies will be provided to you after surgery. This includes, lubrication, dilator, condoms, wound dressing, saline, betadine, gauze, gloves, and bed pads.
Care for SRS Surgery