Any surgery is a stressful experience. Dr Novikova works with a highly skilled and very pleasant team so you can be assured you will be looked after very well and will receive excellent care.  Dr Novikova and her team will give you as much information as possible so you know what to expect. Make sure to ask all the questions you have about surgery. Dr Novikova will take you through the details of procedure, risks, complications, outcomes, alternative treatment options. She will explain what you can expect depending on your situation and your wishes. 

You will have to fill in the hospital admission form, consent form, consent Covid-19 form (surgery during pandemic implications and risks), Covid-19 check-list.  

You will have Covid-19 test 4 days before your surgery.

You will get information about the anaesthetist and the hospital where the procedure will be performed.

Dr Novikova performs surgeries at Mediclinic Cape Town, Cosmetic Surgery Institute, Sandton Day Hospital.

She works with anaesthetists from Anaesthesia Cape Town – https://www.a-ct.co.za/.

Usually Dr Anthony Aubin or Dr Owen Porrill are anaesthetists on the day.

Dr Novikova performs major gynaecological surgery with an assistant specialist gynaecologist Dr Gary Groenewald – https://www.capegynaecologist.co.za/

She will do her best to accommodate you in terms of the surgery date. You are expected to obtain an authorisation from your medical aid for the procedure and hospital admission. You will be given all the necessary documentation to facilitate the authorisation process. Depending on your medical aid cover you may have to pay a co-payment for doctor’s fee. Our fees are payable on a day of the service provision.

Investigations before surgery

Please inform the doctor about all regular medications and supplements you take.  Some medications have to be stopped before the procedure.

You may be asked to have blood tests, X-ray, ECG or other tests to assess your fitness for surgery.

You should not eat and drink anything six hours before the operation. You can shave the area of surgery a few days before, however, it is not essential. 

You may have to have bowel preparations or enema on admission for certain procedures that may involve bowel.

Hospital Admission

You will be admitted to the hospital on the day of the procedure (unless advised otherwise) and very likely to be discharged on the same day. You will be advised on the time you need to come to the hospital (usually 6 am if surgery is planned in the morning and 10 am if it is planned in the afternoon), or usually an hour before the procedure is performed under local anaesthesia.
Depending on the procedure you may be able to go home on the same day or you may have to stay in the hospital for one or more days.

After Surgery

You are not allowed to drive for 24 hours after general anaesthetic and resumption of driving will depend on type of surgery, level of pain, medications you take for pain and your motor-vehicle insurance rules.

Do not take any valuables with you to the hospital. Although it is a good idea to have a support person with you (friend or family member) this is not allowed during Covid-19 pandemic.  You can advise the doctor who you wish to be called following the procedure.

After the surgery you will stay in the hospital until you are awake enough to go home. You should have someone to pick you up from the hospital. Dr Novikova will prescribe pain medication, antibiotics, laxatives and antibacterial ointment to apply the wound area if necessary. 

You can eat and drink immediately after the operation.  Dr Novikova will advise when you can resume exercise and sex. Generally, you should not insert anything vaginally and not have sex for 6 weeks after the operation. 

The stitches on the wounds are dissolvable. The dressing covering the wound can be pulled off in a shower a week after the operation. You can keep the wound clean and dry after taking the dressing off by washing normally and drying with a towel. If you have concerns Dr Novikova will guide through.

Regarding your surgery payment – the practice is not contracted to medical aid. 

Please contact Dr Novikova if you have any issues or questions.

Diet Before Surgery

General Anaesthesia: You should not eat or drink anything for 6 hours prior to your allocated surgery time if you are having general anaesthesia.
Local Anaesthesia: Please continue with your regular meals and medications if you are having a procedure under local anaesthesia.

There is no need for a special diet or bowel preparation unless instructed otherwise.

PLEASE NOTE:

if you do not adhere to the diet prior to your surgery, your surgery will not proceed.

Your Regular Medications Before Surgery

It is very important to report all medications (including food supplements and herbal medicine) you take to Dr Novikova during your visit as some of them may thin or thick your blood and cause potential complications. Because of that, some medications have to be stopped before the operation.
Hormones are to be continued unless advised otherwise. Tamoxifen should be stopped 14 days before the procedure. Non-steroidal anti-inflammatory pain medications such as Nurofen, Ponstan, Voltaren, Aspirin, Clopidogrel need to be stopped 7 days before your surgery. If you are taking Clexane or Warfarine or any other blood-thinning medication, please discuss with Dr Novikova regarding when to stop these prior to the surgery. Continue other medications (e.g. heart, diabetes, antihypertensives) – take with a small amount of water on the morning of your surgery. Herbal medicine and nutritional supplements such as omega-3, fish oil, echinacea, creatine, ginger should be stopped 7 days before surgery.

Anaesthesia

Dr Novikova works with the anaesthetist Dr Anthony Aubin and Dr Tim Kambarami, from the ACT Group. Please refer to their website at  www.a-ct.co.za for more information on anaesthesia for surgery.

After Surgery

    • Diet – You can eat and drink immediately following the operation. Start with small portions and light meals and gradually increase it to your regular diet. Keep well-hydrated with water, which will help to prevent clots.
    • Medications – you can re-start your regular medications following surgery. You will be given pain-killers (maybe as an injection initially, and as tablets, once your pain is improved). Please note that strong pain medications generally cause constipation, therefore, we try to wean them off as quickly as possible.
    • Pains after Surgery – it is common to have pain around the incision area as well as around the area of surgery inside of tummy, painful cramps, nausea, swelling in the tummy due to gas used in laparoscopy, pain in shoulders and upper abdomen, especially with breathing. It is important to remember that pain should be gradually getting better and not worse.
    • Vaginal Bleeding – you may have vaginal bleeding for about a week following surgery. The bleeding should be getting lighter day by day. Your period after surgery may come at a different time to usual time.
    • Bowel function / Constipation – it is common to develop constipation because of anaesthesia, the surgery itself as well as opioid pain medications (codeine, panadeine, morphine, oxycodone) used following surgery. It is important to stay well-hydrated with water, eat a healthy high-fibre diet with vegetables and yoghurt, and start a physical activity (walking) as soon as possible following surgery. Sometimes we use laxatives (movicol) to help with bowel function.
    • Exercise -walking can be started as soon as possible and for as long as you are comfortable. Avoid high impact exercise for 4 weeks following surgery. If you would like to re-start a particular type of exercise before 4 weeks please discuss the details with Dr Novikova to make sure it is safe.
    • Going Home – you are usually discharged from the hospital on the same day or following day after the laparoscopic or hysteroscopic procedure, and in 2 days after open/abdominal surgery. Your discharge will depend on your general condition, support at home, pain control (you should not need injections for pain when you are at home), bowel and bladder function. On some occasions, if you are unable to pass urine following surgery, you may have to go home with the catheter (tube in your bladder), which will be removed once your bladder function recovers usually in about a week.
    • Driving – please contact your insurance company to find out when you are allowed to drive following surgery in terms of your insurance cover. General medical advice (not related to your individual insurance) is that you can drive when you have no pain, are not using any pain killers and able to press your foot hard on the floor without any pain in your body. If you had minor surgery (for example, hysteroscopy) you can re-commence driving 24 hours following anaesthesia.
    • Sex – you can resume sexual activity as soon as you stopped bleeding and have no discomfort. If you are trying to fall pregnant you can resume trying to conceive following your menstrual period. You are not allowed to have sex for 6 weeks after any major gynaecological surgery (labiaplasty, pelvic floor repar, hysterectomy) and at least 3-4 weeks after LLETZ procedure.
    • Work – you will be able to return to work in 2 weeks following laparoscopic or vaginal surgery and in6 weeks following abdominal surgery. You can return to work following day after hysteroscopy, treatment of abnormal Pap smear. You should avoid heavy lifting, intense household duties for 4 weeks following surgery.
    • Post-operative Care – Dr Novikova will see you in the hospital following surgery and will advise you on follow-up visit after surgery. You are welcome to contact her with any questions.

**WARNING SIGNS**

Please contact Dr Novikova if you develop any of the following symptoms after surgery

– vomiting
– pain in your tummy that is increasing in intensity and is not controlled by the prescribed pain killers
– persistent vaginal bleeding, which is becoming heavier
– smelly vaginal discharge
– pus, swelling, increasing redness around incisions
– fever
– pain or burning when you are passing urine or need to pass urine frequently
– inability to pass urine
– collapse, dizziness
– any concerns you may have about your surgery

If you are unable to get in touch with Dr Novikova please present to the hospital Emergency Department of Mediclinic Cape Town or any other hospital