Dr Tushar K. Halder
MBBS FCPS FRACS
Specialist Surgeon: General, Endoscopy, Breast & Endocrine
VMO Canterbury Hospital VMO Auburn Hospital
Patient Information Sheet
Thyroidectomy
The three main problems related to the thyroid operation are as follows:
1. Reactionary haemorrhage possibility is 1-2%.
2. Recurrent laryngeal nerve injury possibility <1%.
3. Temporary low calcium possibility around 10%.
1. If reactionary haemorrhage happens within the first 24 hours, there will be the possibility of returning to the Operating Theatre to control the bleeding.
2. Recurrent laryngeal nerve injury is the least common complication but it has a significant material risk. It may give you permanent hoarseness of the voice. I will do a postoperative nasopharyngoscopy immediately after the operation in the Recovery Room to assess the vocal cord function. If there is a problem in the vocal cord function, you may need to consult an ENT Specialist for the management of the nerve injury.
3. Temporary low calcium occurs in around 10% of patients and is due to temporary low blood supply to the parathyroid gland during operation. If that occurs, you will need temporary calcium replacement and the Hospital stay can be prolonged for 1-2 days to stabilise the calcium. If the calcium level does not reduce substantially, you will be able to go home on the third day following surgery.
Following a total thyroidectomy you will need replacement Thyroxin for the rest of your life.
Patient Information Sheet
Laparoscopic Inguinal Hernia Surgery
Details and main risks for the Laparoscopic Inguinal Hernia surgery:
1. Haematoma Formation (Blood clots). If this occurs, further surgical intervention may be required to drain the haematoma. The chance of a haematoma occurring is less than 1% during my operations. Some patients may get bruising in the lower abdomen which usually clears up within 3 weeks.
2. Urinary Retention. This is not a very common complication but if it happens a urinary catheter may be required and this may involve a longer stay in hospital.
3. Chronic Pain. This occurs in about 5% of cases and usually will settle within two to three months. In an exceptional case, the patient may require long term analgesia to control the pain.
4. Recurrence of Hernia. This is not a common occurrence and occurs in only 1-2% of cases. If this occurs, the repair would be an open operation. Laparoscopic (Keyhole) cannot be performed twice.
5. Future Procedure involving the Prostate. If in the future the patient should develop prostate cancer and require surgery, as the mesh is placed directly in front of the prostate gland, this can make prostatic surgery extremely difficult. In some cases, surgery may not be possible at all due to the presence of adhesions which may develop around the prostate gland.
For more information and post-operative instructions, please go to my website
www.drtusharhalder.com.au
Open Inguinal Hernia Surgery
This operation involves an incision being made over the hernia swelling site and the mesh is placed under the muscle. There are some risks involved with this procedure. The main risks are:
1. Haematoma Formation (Blood Clots). The incidence of this occurring is in the range of 1-2%. They can sometimes be quite large and may require further operative intervention. The smaller haematoma can be managed non-surgically.
2. Urinary Retention. This is not a common occurrence and happens mostly in patients who have an enlarged prostate or sudden distension of the bladder. If this should occur, the majority of cases require a urinary catheter to relieve the distension. It may also involve a prolonged hospital stay and possibly the involvement of another Specialist such as a Urologist. The patient should always empty their bladder before sleep at night to avoid overdistension of the bladder.
3. Chronic Pain. This usually develops in 5-6% of cases and often subsides spontaneously within two to three months. In an exceptional case, the patient may continue to experience chronic pain which will require analgesia for control.
4. Recurrence of Hernia. This occurs in about 1-2% of cases and should it occur, the next procedure may be either a laparoscopic (keyhole) repair or open operation.
5. Loss or Reduction of Sensation over the repair area. Due to the division of the ilioinguinal nerve, loss of sensation may occur but this often improves in the course of time.
For more information and post-operative instructions, please go to my website www.drtusharhalder.com.au
Patient Information Sheet
Laparoscopic Cholecystectomy Surgery
The following are risks involved with a laparoscopic cholecystectomy (keyhole) gallbladder operation.
It has been my experience that in 99% of cases the procedure can be done laparoscopically. However, in 1% of cases there may be a requirement for an open operation. If an open operation is necessary, it will be done immediately while the patient is under anaesthetic. An open operation is not considered a complication.
In about 1-2% of cases there is a chance the patient can have bleeding or bile leak. If there is a significant amount of blood loss, this may result in a further laparoscopic procedure or open operation to control the bleeding.
Bile leak from a bile duct injury is extremely uncommon and occurs in 1/1000 patients. However, if this occurs the patient will require further operative intervention which may involve other Specialists as well.
During the operation, I will be doing an operative cholangiogram or an X-ray to assess whether there is any stone in the common bile duct. The incidence of stone in the common bile duct is around 6-10%. If a stone is detected in the X-ray, the patient will require another endoscopic procedure called an ERCP to remove that stone within a week of the first operation in a major hospital.
The possibility of any of the above complications is very rare. The majority of patients are discharged within the next two days without any significant complication.
For more information and post-operative instructions, please go to my website www.drtusharhalder.com.au
Patient Information Sheet
Haemorrhoidectomy Surgery
Details and main riskes for the Haemorrhoidectomy surgery
1. This operation is a very painful one and the patient will be required to stay in hospital overnight for the administration of strong medication for pain control. They will also be observed for any postoperative bleeding. The incidents of post operative bleeding is less than 1% under my care
2. The patient will need 2 different types of tablets to control the pain for 1-2 weeks.
3. If the haemorrhoids are all around the anus, they cannot all be removed in one operation. I usually remove the larger one and I band the smaller ones from the inside. I always ensure enough skin is left behind to close the wound without the narrowing of the anal canal
4. The success rate of this surgery is around 90%. There is small chance the haemorrhoids can grow back. The patient can prevent the recurrence if they can reduce straining when going to the toilet. I recommend a high fibre diet and laxative medication when required to avoid the risk of constipation and the recurrence of haemorrhoids.
For more information and post-operative instructions, please go to my website www.drtusharhalder.com.au
Patient Information Sheet
Pilonidal Sinus Surgery
Details and main risks for the Pilonidal Sinus operation:
1. I always prefer to close the wound and it usually heals primarily in more than half of my patients.
2. Most of my patients stay in hospital for 1-2 days with a drain
3. This operation has a high rate of wound infection and wound breakdown, due to high tension on the sutures in a sitting position.
4. If the wound develops an infection or has discharge, the sutures will need to come out early. As a result, some wounds may require dressing and packing. This does not mean immediate failure as some surgeons always leave the wound open. In this case, the wound will heal secondarily in 4-6 weeks without any significant difference to the outcome in the long term.
5. The healing of a Pilonidal Sinus wound is not very strong in 2 weeks. it can open up by sudden pressure or minor injury to the operation area after removal of sutures. I usually advise patients to have the sutures removed by a general practitioner 10 days after surgery. After suture removal, the patient needs to be very careful for another 2-3 weeks
6. Long term recurrence rate remains at 1-5 % even after a successful primary healing.
For more information and post-operative instructions, please go to my website
www.drtusharhalder.com.au
Patient Information Sheet
Carpal Tunnel Surgery
A carpal tunnel operation is performed to release the median nerve. The nerve gets compressed within the carpal tunnel causing the symptoms. During the surgical operation I don't repair the nerve I just make the nerve free and it will then regenerate itself. Sometimes this regeneration may be incomplete or there may be a secondary cause of the symptoms in the hand, for example rheumatoid arthritis. In those cases, the success rate of the carpal tunnel is reduced from 100% to 90%.
If the neurophysiological study shows severe carpal tunnel syndrome, it is better for the patient to have the operation to prevent further nerve damage.
I perform this operation with a very small incision in the palmer part of the hand to prevent scarring after the healing of the wound. In some cases the incision site becomes invisible. I do not place any plaster on the hand, only a small dressing, but recommend 24 hours rest as being necessary. After this time the hand can be used within the tolerance of pain.
Early removal of the sutures in a carpel tunnel operation can cause wound breakdown, so the stitches have to remain for more than 2 weeks to prevent this. I usually advise removal of sutures after two weeks by the general practitioner. After removal of the sutures, the operation area still needs to be carefully monitored. If there is sudden pressure or stress on the operation area the clean wound can still open up.
The hand exercise I recommend is to firstly dip the hand in warm water for 10 minutes then squeeze a stress ball for a further 10 minutes. This does help to ensure a good recovery. Full recovery takes about two to three months. In some cases the tingling numbness goes away within a week, however the weakness in the hand takes a longer time to recover.
I do not perform this operation on two hands at the same time. Firstly due to the inability of the patient being able to manage daily living activities with both hands being operated on together. The other reason is the carpal tunnel operation has a 10% failure rate. The Patient should have surgery on the one hand first and if they get benefit from this I will then do the operation on the other hand usually after two to three months.
For more information and post-operative instructions, please go to my website www.drtusharhalder.com.au
Preparation Instructions for Colonoscopy
Name ……………………………………DOB …………….
Please read all your instructions carefully.
prevent diarrhoea e.g. Imodium/Lomotil.
1. PicoPrep- 3 sachets or PICOSALAX - 3 Sachets
A. Day before Colonoscopy:
Drink CLEAR FLUIDS ONLY for breakfast, lunch and dinner.
Solid foods, milk and milk products are NOT allowed.
Clear fluids include:
. Strained fruit juices without pulp – apple / grape / orange
. Water
. Coffee / Tea – without milk or non-dairy creamer
. Clear soup / Bonox
. All the following except those coloured red or purple - Fruit flavoured cordials / Staminade
- Plain jelly (without added fruits or toppings)
- Carbonated or non-carbonated soft drinks
- Clear ice-blocks
Doses and timing of PicoPrep (Or Picosalax):
1st dose: 2 pm – Add 120 mls of water to one sachet of PicoPrep. Follow with a glass of approved clear fluids immediately and then continue to drink clear fluids (at least one litre) until 5.00 pm.
2nd dose: 5 pm – Add 120 mls of water to the second sachet of PicoPrep. Follow with a glass of approved clear fluids immediately and then continue to drink clear fluids (at least one litre) until 8.00 pm.
3rd dose: 8 pm –Add 120 mls of water to the THIRD sachet of PicoPrep. Follow with a glass of approved clear fluids.
Clear fluids may continue to be taken until it is necessary to fast for the procedure.
At the completion of the diarrhoea, the faecal fluid may be coloured but should be free of particulate matter.
Nil by mouth from MIDNIGHT or approximately 6 hours prior to time of admission to hospital.
B. Day of Colonoscopy:
Arrive at booked hospital for your procedure as per instructions of admission office.
Dr Tushar K Halder
MBBS, FCPS, FRACS
VMO/ Specialist Surgeon
Auburn & Canterbury Hospital
DISCHARGE INSTRUCTIONS FOR
BANDING AND INJECTION OF HAEMORRHOID
Dr Tushar Halder
HOW THE RUBBER BAND AND INJECTION WORKS
You may have been treated with rubber band and/or injection for your internal haemorrhoid. The rubber band works by cutting off the blood flow to the haemorrhoid for four to six hours. Sometimes the rubber band may fall off after a few hours but it’s ischemic effect continues for a long time.
The injection works by slowly reducing the blood flow to the haemorrhoid. The combined effect of the rubber band and injection shrinks the haemorrhoid in up to 70-80% of cases.
You may experience a small amount of bleeding and pain in the perianal area for two to three days. This is quite common after the banding and injection. Please do not be alarmed if you see the band has fallen off.
POSTOPERATIVE INSTRUCTIONS
1. Diet
You should have a high fibre diet to avoid constipation.
2. Pain control
For mild pain you can have Panadol x 2 tablets every four hours.
For moderate to severe pain you may need Nurofen or Panadeine Forte tablets together with Metamucil.
3. Warm salt baths
Warm Salt baths may be helpful to reduce mild discomfort in the perianal area.
4. Follow up appointment
You should also make an appointment to see your general practitioner within a week and see me in two weeks’ time.
Please notify your local doctor or my consulting rooms immediately if you experience the following:
- A large amount of blood loss rectally
- A high temperature
- Difficulty in passing urine
MBBS FCPS FRACS
Specialist Surgeon: General, Endoscopy, Breast & Endocrine
VMO Canterbury Hospital VMO Auburn Hospital
Patient Information Sheet
Thyroidectomy
The three main problems related to the thyroid operation are as follows:
1. Reactionary haemorrhage possibility is 1-2%.
2. Recurrent laryngeal nerve injury possibility <1%.
3. Temporary low calcium possibility around 10%.
1. If reactionary haemorrhage happens within the first 24 hours, there will be the possibility of returning to the Operating Theatre to control the bleeding.
2. Recurrent laryngeal nerve injury is the least common complication but it has a significant material risk. It may give you permanent hoarseness of the voice. I will do a postoperative nasopharyngoscopy immediately after the operation in the Recovery Room to assess the vocal cord function. If there is a problem in the vocal cord function, you may need to consult an ENT Specialist for the management of the nerve injury.
3. Temporary low calcium occurs in around 10% of patients and is due to temporary low blood supply to the parathyroid gland during operation. If that occurs, you will need temporary calcium replacement and the Hospital stay can be prolonged for 1-2 days to stabilise the calcium. If the calcium level does not reduce substantially, you will be able to go home on the third day following surgery.
Following a total thyroidectomy you will need replacement Thyroxin for the rest of your life.
Patient Information Sheet
Laparoscopic Inguinal Hernia Surgery
Details and main risks for the Laparoscopic Inguinal Hernia surgery:
1. Haematoma Formation (Blood clots). If this occurs, further surgical intervention may be required to drain the haematoma. The chance of a haematoma occurring is less than 1% during my operations. Some patients may get bruising in the lower abdomen which usually clears up within 3 weeks.
2. Urinary Retention. This is not a very common complication but if it happens a urinary catheter may be required and this may involve a longer stay in hospital.
3. Chronic Pain. This occurs in about 5% of cases and usually will settle within two to three months. In an exceptional case, the patient may require long term analgesia to control the pain.
4. Recurrence of Hernia. This is not a common occurrence and occurs in only 1-2% of cases. If this occurs, the repair would be an open operation. Laparoscopic (Keyhole) cannot be performed twice.
5. Future Procedure involving the Prostate. If in the future the patient should develop prostate cancer and require surgery, as the mesh is placed directly in front of the prostate gland, this can make prostatic surgery extremely difficult. In some cases, surgery may not be possible at all due to the presence of adhesions which may develop around the prostate gland.
For more information and post-operative instructions, please go to my website
www.drtusharhalder.com.au
Open Inguinal Hernia Surgery
This operation involves an incision being made over the hernia swelling site and the mesh is placed under the muscle. There are some risks involved with this procedure. The main risks are:
1. Haematoma Formation (Blood Clots). The incidence of this occurring is in the range of 1-2%. They can sometimes be quite large and may require further operative intervention. The smaller haematoma can be managed non-surgically.
2. Urinary Retention. This is not a common occurrence and happens mostly in patients who have an enlarged prostate or sudden distension of the bladder. If this should occur, the majority of cases require a urinary catheter to relieve the distension. It may also involve a prolonged hospital stay and possibly the involvement of another Specialist such as a Urologist. The patient should always empty their bladder before sleep at night to avoid overdistension of the bladder.
3. Chronic Pain. This usually develops in 5-6% of cases and often subsides spontaneously within two to three months. In an exceptional case, the patient may continue to experience chronic pain which will require analgesia for control.
4. Recurrence of Hernia. This occurs in about 1-2% of cases and should it occur, the next procedure may be either a laparoscopic (keyhole) repair or open operation.
5. Loss or Reduction of Sensation over the repair area. Due to the division of the ilioinguinal nerve, loss of sensation may occur but this often improves in the course of time.
For more information and post-operative instructions, please go to my website www.drtusharhalder.com.au
Patient Information Sheet
Laparoscopic Cholecystectomy Surgery
The following are risks involved with a laparoscopic cholecystectomy (keyhole) gallbladder operation.
It has been my experience that in 99% of cases the procedure can be done laparoscopically. However, in 1% of cases there may be a requirement for an open operation. If an open operation is necessary, it will be done immediately while the patient is under anaesthetic. An open operation is not considered a complication.
In about 1-2% of cases there is a chance the patient can have bleeding or bile leak. If there is a significant amount of blood loss, this may result in a further laparoscopic procedure or open operation to control the bleeding.
Bile leak from a bile duct injury is extremely uncommon and occurs in 1/1000 patients. However, if this occurs the patient will require further operative intervention which may involve other Specialists as well.
During the operation, I will be doing an operative cholangiogram or an X-ray to assess whether there is any stone in the common bile duct. The incidence of stone in the common bile duct is around 6-10%. If a stone is detected in the X-ray, the patient will require another endoscopic procedure called an ERCP to remove that stone within a week of the first operation in a major hospital.
The possibility of any of the above complications is very rare. The majority of patients are discharged within the next two days without any significant complication.
For more information and post-operative instructions, please go to my website www.drtusharhalder.com.au
Patient Information Sheet
Haemorrhoidectomy Surgery
Details and main riskes for the Haemorrhoidectomy surgery
1. This operation is a very painful one and the patient will be required to stay in hospital overnight for the administration of strong medication for pain control. They will also be observed for any postoperative bleeding. The incidents of post operative bleeding is less than 1% under my care
2. The patient will need 2 different types of tablets to control the pain for 1-2 weeks.
3. If the haemorrhoids are all around the anus, they cannot all be removed in one operation. I usually remove the larger one and I band the smaller ones from the inside. I always ensure enough skin is left behind to close the wound without the narrowing of the anal canal
4. The success rate of this surgery is around 90%. There is small chance the haemorrhoids can grow back. The patient can prevent the recurrence if they can reduce straining when going to the toilet. I recommend a high fibre diet and laxative medication when required to avoid the risk of constipation and the recurrence of haemorrhoids.
For more information and post-operative instructions, please go to my website www.drtusharhalder.com.au
Patient Information Sheet
Pilonidal Sinus Surgery
Details and main risks for the Pilonidal Sinus operation:
1. I always prefer to close the wound and it usually heals primarily in more than half of my patients.
2. Most of my patients stay in hospital for 1-2 days with a drain
3. This operation has a high rate of wound infection and wound breakdown, due to high tension on the sutures in a sitting position.
4. If the wound develops an infection or has discharge, the sutures will need to come out early. As a result, some wounds may require dressing and packing. This does not mean immediate failure as some surgeons always leave the wound open. In this case, the wound will heal secondarily in 4-6 weeks without any significant difference to the outcome in the long term.
5. The healing of a Pilonidal Sinus wound is not very strong in 2 weeks. it can open up by sudden pressure or minor injury to the operation area after removal of sutures. I usually advise patients to have the sutures removed by a general practitioner 10 days after surgery. After suture removal, the patient needs to be very careful for another 2-3 weeks
6. Long term recurrence rate remains at 1-5 % even after a successful primary healing.
For more information and post-operative instructions, please go to my website
www.drtusharhalder.com.au
Patient Information Sheet
Carpal Tunnel Surgery
A carpal tunnel operation is performed to release the median nerve. The nerve gets compressed within the carpal tunnel causing the symptoms. During the surgical operation I don't repair the nerve I just make the nerve free and it will then regenerate itself. Sometimes this regeneration may be incomplete or there may be a secondary cause of the symptoms in the hand, for example rheumatoid arthritis. In those cases, the success rate of the carpal tunnel is reduced from 100% to 90%.
If the neurophysiological study shows severe carpal tunnel syndrome, it is better for the patient to have the operation to prevent further nerve damage.
I perform this operation with a very small incision in the palmer part of the hand to prevent scarring after the healing of the wound. In some cases the incision site becomes invisible. I do not place any plaster on the hand, only a small dressing, but recommend 24 hours rest as being necessary. After this time the hand can be used within the tolerance of pain.
Early removal of the sutures in a carpel tunnel operation can cause wound breakdown, so the stitches have to remain for more than 2 weeks to prevent this. I usually advise removal of sutures after two weeks by the general practitioner. After removal of the sutures, the operation area still needs to be carefully monitored. If there is sudden pressure or stress on the operation area the clean wound can still open up.
The hand exercise I recommend is to firstly dip the hand in warm water for 10 minutes then squeeze a stress ball for a further 10 minutes. This does help to ensure a good recovery. Full recovery takes about two to three months. In some cases the tingling numbness goes away within a week, however the weakness in the hand takes a longer time to recover.
I do not perform this operation on two hands at the same time. Firstly due to the inability of the patient being able to manage daily living activities with both hands being operated on together. The other reason is the carpal tunnel operation has a 10% failure rate. The Patient should have surgery on the one hand first and if they get benefit from this I will then do the operation on the other hand usually after two to three months.
For more information and post-operative instructions, please go to my website www.drtusharhalder.com.au
Preparation Instructions for Colonoscopy
Name ……………………………………DOB …………….
Please read all your instructions carefully.
- Please stop Aspirin or other blood thinning tablets 7 days prior to the procedure.
- Stop all iron containing medications, e.g. Ferrogradumet/Fefol, and any tablets that
prevent diarrhoea e.g. Imodium/Lomotil.
- If you are diabetic, then you should have received special instructions regarding your diabetic medication.
- You should continue to take your regular blood pressure medication with sips of water
1. PicoPrep- 3 sachets or PICOSALAX - 3 Sachets
A. Day before Colonoscopy:
Drink CLEAR FLUIDS ONLY for breakfast, lunch and dinner.
Solid foods, milk and milk products are NOT allowed.
Clear fluids include:
. Strained fruit juices without pulp – apple / grape / orange
. Water
. Coffee / Tea – without milk or non-dairy creamer
. Clear soup / Bonox
. All the following except those coloured red or purple - Fruit flavoured cordials / Staminade
- Plain jelly (without added fruits or toppings)
- Carbonated or non-carbonated soft drinks
- Clear ice-blocks
Doses and timing of PicoPrep (Or Picosalax):
1st dose: 2 pm – Add 120 mls of water to one sachet of PicoPrep. Follow with a glass of approved clear fluids immediately and then continue to drink clear fluids (at least one litre) until 5.00 pm.
2nd dose: 5 pm – Add 120 mls of water to the second sachet of PicoPrep. Follow with a glass of approved clear fluids immediately and then continue to drink clear fluids (at least one litre) until 8.00 pm.
3rd dose: 8 pm –Add 120 mls of water to the THIRD sachet of PicoPrep. Follow with a glass of approved clear fluids.
Clear fluids may continue to be taken until it is necessary to fast for the procedure.
At the completion of the diarrhoea, the faecal fluid may be coloured but should be free of particulate matter.
Nil by mouth from MIDNIGHT or approximately 6 hours prior to time of admission to hospital.
B. Day of Colonoscopy:
Arrive at booked hospital for your procedure as per instructions of admission office.
Dr Tushar K Halder
MBBS, FCPS, FRACS
VMO/ Specialist Surgeon
Auburn & Canterbury Hospital
- If you have any queries, please contact my rooms (02 8197 1900) or the Hospital where you are booked in for your Colonoscopy
DISCHARGE INSTRUCTIONS FOR
BANDING AND INJECTION OF HAEMORRHOID
Dr Tushar Halder
HOW THE RUBBER BAND AND INJECTION WORKS
You may have been treated with rubber band and/or injection for your internal haemorrhoid. The rubber band works by cutting off the blood flow to the haemorrhoid for four to six hours. Sometimes the rubber band may fall off after a few hours but it’s ischemic effect continues for a long time.
The injection works by slowly reducing the blood flow to the haemorrhoid. The combined effect of the rubber band and injection shrinks the haemorrhoid in up to 70-80% of cases.
You may experience a small amount of bleeding and pain in the perianal area for two to three days. This is quite common after the banding and injection. Please do not be alarmed if you see the band has fallen off.
POSTOPERATIVE INSTRUCTIONS
1. Diet
You should have a high fibre diet to avoid constipation.
2. Pain control
For mild pain you can have Panadol x 2 tablets every four hours.
For moderate to severe pain you may need Nurofen or Panadeine Forte tablets together with Metamucil.
3. Warm salt baths
Warm Salt baths may be helpful to reduce mild discomfort in the perianal area.
4. Follow up appointment
You should also make an appointment to see your general practitioner within a week and see me in two weeks’ time.
Please notify your local doctor or my consulting rooms immediately if you experience the following:
- A large amount of blood loss rectally
- A high temperature
- Difficulty in passing urine
