Surgical Process
In the medical clinic, the surgeon meets with the patient. He/she gathers the patient's medical history (anamnesis) and collect as much information as possible about their health status (previous surgeries, current and past illnesses, ongoing drug therapies). The surgeon then analyzes the issue that led the patient to seek their help, evaluates any instrumental exams the patient has undergone (reports), and reviews images from CDs (which the patient should have available, particularly CT and MRI scans).
Next, a physical examination is performed with the patient on the examination table. The affected anatomical area (often the abdomen) is assessed. In the case of anorectal conditions, a digital rectal exam (with the patient in the left lateral decubitus position) may be necessary, allowing the surgeon to evaluate the rectal mucosa, the characteristics of the prostate, and the fecal content.
The physician will then document their findings in a written report, which the patient can keep and share with their general practitioner.
The surgeon may recommend medical therapy and/or dietary advice for conditions that do not raise significant concerns. Conversely, further diagnostic tests (ultrasound, CT, MRI, endoscopies) may be requested and reassessed in a subsequent follow-up visit.
If surgery is indicated, the patient will be informed about the type of surgery, the expected hospital stay, and possible complications. The surgeon will schedule the operation, considering the symptoms, the potential neoplastic nature of the issue, and the urgency of the case. Additionally, the patient will be informed about the potential need for blood transfusions or other derivatives in the pre-, intra-, or post-operative phases. A printed information sheet will be provided, summarizing the type of surgery for the condition and possible complications.
BEFORE THE SURGERY
Depending on the condition being treated, targeted dietary behavior, medical therapy, and physical and respiratory exercises may be beneficial, especially if a major surgery is planned for elderly patients with comorbidities.
Pre-hospitalization tests will be performed: blood tests, ECG, chest X-rays (typically avoided in young patients with benign conditions). An anesthesiology consultation will also be conducted to assess the patient's health status, the condition requiring surgery, and the operative risks based on the type of surgery. The patient will be assigned an anesthesiological risk class (ASA Score according to the American Society of Anesthesiologists), which helps determine their fitness for surgery and the associated risks. The anesthesiologist will also assess specific parameters for the type of anesthesia (e.g., spine health in the case of spinal anesthesia, mouth opening, and tracheal deviations for general anesthesia with orotracheal intubation).
If deemed necessary, the anesthesiologist may request additional diagnostic tests or specialist consultations to ensure the patient's safety during surgery (e.g., a cardiology consultation). They may also coordinate with the surgeon on the need for post-operative intensive care or sub-intensive care to monitor the patient and provide resuscitation support for more delicate cases undergoing major surgery.
POST-OPERATIVE CARE
Depending on the type of surgery, the patient may be discharged the same day (as in Day Surgery for hernia or proctological procedures) or require a more extended hospital stay for major surgeries. The patient will be monitored by nursing staff, who play a critical role in administering therapies and providing care, as well as healthcare workers (HCWs) and, if needed, other professionals such as physiotherapists or nutritionists.
Medical staff (surgeons from the operating team) will rotate to check on the patient's progress multiple times a day. This care includes a gradual reintroduction of food, adjustments to ongoing therapies, and dressing the surgical wounds until discharge.
AFTER DISCHARGE
At discharge, the patient will receive instructions on how to contact the facility and the doctors responsible for their care in case of needs or emergencies. A post-surgical follow-up will be scheduled for dressing changes and suture removal. An appointment will also be arranged to deliver the histological exam results and to plan any further treatment, especially if the condition is cancerous.
