The battles ahead on Rob Ford’s road to recovery

WATCH ABOVE: Dr. Samir Gupta discusses what lies ahead on Rob Ford’s road to recovery after surgery.

There has been a lot of discussion about Rob Ford’s recent abdominal surgery to remove his malignant liposarcoma, and many people are curious about what the next few days will hold for Ford, and how his recovery is likely to proceed.

After any major surgery like this, there are several things that surgeons will be paying attention to. The first is ensuring that there is no major internal or wound bleeding. Also, they have to manage the wound, ensure that it stays closed, and keep it dressed properly so that it does not get infected.

Along with that is managing the pain from the wound. The patient should be kept as comfortable as possible, and we try to control the pain in such a way as to enable patients to be able to take deep breaths in order to prevent pneumonia. But at the same time, pain management can be tricky because the same drugs that relieve the pain can cause confusion and drowsiness, nausea and vomiting (which put strain on the wound), and constipation (which slows down the recovery process of the gut).

The other issue is that the gut becomes inflamed after it is manipulated during a surgery like this, and it takes a few days for its function to return. So surgeons will be watching for signs that his bowels have recovered, and very carefully advancing his diet from liquids to solids accordingly.

The other issue that a number of people have asked me about it the report that part of his abdominal wall was removed, and a biological mesh was placed. Actually, this is not at all unusual. We have a number of organs and about 30 feet of bowel inside the abdominal cavity, and all of that is held in place by the muscles of the abdominal wall and a number of strong sheets of tissue under the muscles, called the fascia.

In abdominal surgeries like this one, in order to access the tumor, the surgeons have to cut through these layers. The challenge is that when the surgery is over and it’s time to sew everything back together on the way out, it’s sometimes hard to put everything back in place in such a way as to be able to neatly align those edges and sew those layers back together. And even if the layers do align, the repair represents a point of weakness. When the patient coughs or strains after surgery, this is an area that is at risk of popping open, allowing abdominal contents to “herniate” out. This is what’s called an “incisional” hernia.

According to a study by Toru Yamada and colleagues published in the Annals of Surgical Oncology in 2015, this is a complication that obese patients are at higher risk for. In order to prevent this, surgeons reinforce the area by placing a mesh over the repair, which provides an extra layer of security in preventing post-operative hernias.

Top five Postoperative Complications To Look Out For

• Wound infections — According to data from the US Centers for Disease Control, would infections can be seen in anywhere from 2 to 7 percent of patients after this kind of surgery. Research by Debra Malone and colleagues published in the Journal of Surgical Research in 2002 suggests that certain risk factors like diabetes put patients at a higher risk.
• Wound dehiscence — Dehiscence is the term used to describe a wound that partly or completely opens up on its own shortly after surgery. It only occurs in about 0.5 percent of cases, but presents a major risk to the patient. A study by Theodoros E. Pavlidis and colleagues published in the European Journal of Surgery in 2001 suggests that obesity is a risk factor for this.
• Post-operative Pneumonia — This is a risk seen particularly after abdominal surgeries, because patients don’t take deep breaths and can’t cough properly after surgery, due to pain. This can result in some lung collapse, which predisposes to pneumonia.
• Peri-Operative Heart Attack — A surgery can put a lot of strain on the heart, and up to 3 to 5 percent of patients can have a heart attack, (called a “myocardial infarction”) during or after surgery.
• Blood Clots — Deep venous thrombosis is the term we use for blood clots in the large veins, usually occurring in the legs when a patient is bedbound after surgery. These clots can travel to the lungs, called a “pulmonary embolism,” which is life-threatening. We often give patients blood thinners and get them on their feet as soon as possible to prevent this.