Whether emergency or elective, open or laparoscopic, surgical recovery can take a long time. We explore natural remedies to help you heal after surgery.
Understanding surgical interventions
Surgery has been defined as, “any intervention involving the incision, excision, manipulation, or suturing of tissue, usually requiring regional or general anaesthesia” (1). The term ‘surgery’ is said to have its origins in both the Greek and Latin language translating as either “hand work” or “hand action”(2).
Human remains have been discovered that suggest mankind has attempted surgical measures dating back to the Neolithic era; including trepanation during which a hole was drilled into the skull. In many of these cases it appears to have been undertaken as an intervention following physical head injury, however, may also have been intended to relieve symptoms of other physiological and potentially psychological conditions (3).
The oldest known medical text to mention surgery is considered to be an Egyptian papyrus which has been dated from close to 5000 years ago (4). More recent historical texts have been discovered that describe surgeries such as rhinoplasties and caesarean sections being performed throughout Ancient India over 2600 years ago (5,6).
Despite there being evidence to suggest that many of the individuals who underwent surgical procedures during these ancient times were seen to have survived, by the early 19th century throughout Britain and Europe surgery had become fraught with risks through filthy conditions in hospital theatres invariably leading to the high rate of post-operative infections and likely death. Furthermore, although the use of anaesthesia would soon become an accepted practice, prior to this, strength and speed were considered the most desirable attributes for a surgeon (7).
Since these times we have seen extraordinary breakthroughs in the medical field including infection control, anaesthesia and advanced surgical techniques that would have been unimaginable even a hundred years ago. It is estimated that 60% of the population will have some sort of surgical procedure during their lifetimes, with 230 million people worldwide undergoing surgery each year (8,9).
What surgery entails
Surgery is seen to have a role across a wide spectrum of conditions that impact and may decrease the quality or longevity of a person’s life if left untreated, or cause unnecessary pain and suffering to that individual. Surgery encompasses seemingly minor procedures such as dental work or relief from an in-growing toenail to major operations, such as heart transplants or neurosurgery. Surgical care can be required at any age from treating newborns with life-threatening defects or abnormalities to a hip replacement in an elderly person.
Surgery is often a vital intervention in acute emergency care of patients with life threatening injuries or conditions. In these cases it is frequently performed immediately, or within 24 hours of admission to hospital (10,11).
However, the majority of surgical procedures are considered elective and subsequently can be planned for in advance. These surgeries are scheduled for conditions that are not immediately life threatening and may be considered to be curative, to improve quality of life or for cosmetic reasons (10,12). Some types of surgery may be carried out as either an elective or emergency procedure depending on the circumstances; for example, a caesarean section or removal of the gallbladder (13,14).
Having surgery may involve a length of stay in hospital afterwards. Following emergency surgery the length of stay is an average of five days; however, factors influencing this will include the seriousness of the condition resulting in emergency surgery being required or the type of surgery performed. The overall health of the patient prior to emergency surgery will also potentially affect recovery time and consequently the length of time spent receiving in-patient care. Other factors affecting surgical recovery time include pre-existing health conditions and age. Postoperative complications may also increase the length of time necessary to remain in hospital post-operatively. Socioeconomic or safeguarding issues are also seen to impact delayed discharge from hospital based care (15,16).
In contrast to surgery following an emergency admission, elective surgery provides an opportunity for forward planning of the peri- and post-operative period resulting in reduced anxiety for the patient and their family and improved surgical outcomes. Length of stay is dependent on a manner of factors, some of which are unmodifiable such as the age of the patient, underlying diagnosis, other concurrent health conditions and the type of procedure being performed.
Although a significant amount of patients undergoing surgery electively, particularly orthopaedic procedures or those that are an aspect of cancer treatment, will require hospital care as an inpatient, there has been a transition from automatic overnight hospital admission to day case surgery for more minor procedures. Furthermore, length of stay is seen to be influenced by considerations such as surgical start time, requirements for peri- and post-operative medication and early mobilisation — which has been seen to be crucial for optimal surgical recovery and the reduction of the length of hospital stay required (17,18).
Types of surgery
The majority of surgical procedures by their very nature are invasive to the body (19).
Historically, surgery has been done as an open procedure requiring a relatively wide incision and the use of stitches or staples to close the resulting wound. Open surgery is in many cases still a necessity providing increased exposure to the surgical field however is frequently associated with greater postoperative pain levels, and consequently greater requirement for analgesic medications, alongside a longer recovery time (12,20). Since it was first pioneered in the 1980s, keyhole surgery, including laparoscopic procedures, has been used for increasingly, having the advantage of being considered less invasive, causing less trauma and pain to the patient and often resulting in a shorter length of stay in hospital and enhanced overall recovery time (21,22).
Excision and resection
Excision and resection surgery involve the removal of part, or in the case of resection surgery, all of an organ, tissue or growth using a sharp instrument such as a scalpel, laser or other cutting tool. The names of this type of surgery tend to end with the suffix ‘-ectomy’, from the Greek word εκ-τομια which translates as ‘the act of cutting out’. In the cases involving an organ, this is often prefixed with the name of the organ, such as removal of the appendix being referred to as an appendectomy (19,23,24). Excision surgery includes procedures such as polypectomy (removal of polyps), whilst examples of resection surgery would include cholecystectomy (removal of the gallbladder) and sigmoidectomy (removal of the entire sigmoid colon) and are often performed as a result of chronic disease, acute inflammatory states or cancer (23). On occasion, some of these surgeries may be accompanied by a procedure to create a permanent or temporary opening known as a stoma, such as a colostomy following a sigmoidectomy (25).
Ablation
Ablation surgery involves the use of heat, cold or radiofrequency to destroy tissue or a body part (24). This may be used to correct a range of conditions such as cardiac ablation to treat an irregular heartbeat or endometrial ablation in the treatment of excessive menstrual bleeding as an alternative to hysterectomy (26,27,28). Cardiac ablation is considered to be a minimally invasive procedure during which keyhole incisions are made in the groin through which catheters can be passed into the veins and guided towards the area of the heart targeted for treatment (26). During endometrial ablation the majority of the lining of the womb is destroyed or removed. This is a relatively short procedure taking on average about 30 minutes and is often performed as day surgery. A hysteroscope, a tiny camera, is passed through the cervix into the womb and the uterine lining destroyed or removed using either radiofrequency, heat or an electric wire-loop (27).
Amputation
Amputation involves the removal by surgery of a limb, or part thereof, or extremities such as fingers or toes. In the 1800s, this would have been the main domain of the surgeons of that time as surgery to other parts of the body such as chest and abdomen had proven to be inevitably fatal (7). Reasons for amputation still include extreme injury to a limb seen to be beyond repair or reconstruction, frostbite when the tissue damage is irreversible, malignant tumours unresponsive to other treatment or severe infection resistant to antibiotics that is considered life-threatening. However, in developed nations today diabetes and peripheral arterial disease (PAD) are the leading causes of lower limb amputations. Patients who are diabetic are twenty times more likely to undergo amputation surgery in their lifetimes than non-diabetic patients with 90% of the lower limb amputations performed in the UK each year being attributed to peripheral arterial disease. (29,30).
Reconstructive
Although reconstructive, or cosmetic, surgery is often perceived as being a personal choice by individuals for aesthetic reasons, it is frequently performed for reasons such as the repair of tissues due to extensive burns or complex wounds to restore both function and appearance of the affected area (31,32). Reconstructive surgery may also be an option following the removal of cancerous tumours that result in significant loss of tissue or disfigurement. For example, breast reconstruction after mastectomy — an increasingly prevalent surgery owing to the number of patients opting for reconstruction after breast cancer surgery rising to 43.3% in 2014 compared to only 26.9% in 2005 (33)
Surgery to reconstruct tissues that are damaged or deformed due to circumstances including severe injury or congenital conditions may be necessary to increase an individual’s ability to eat, speak or breathe, improving psychological wellbeing as well as physiological function (34).
Transplantation
The first successful human organ transplant surgery was performed in 1954 and involved the transplanting of a kidney. By the end of the 1960s heart, liver and pancreas transplants had been successfully performed whilst lung transplants were not achieved until the 1980s (35). In 2023 there were over 170,000 organ transplants globally for end stage organ failure with kidney transplants being most commonly performed. Organs are donated from either living or deceased donors depending on the type of procedure being performed (36). As with any surgical procedure, potential complications may arise. However the risk of rejection of the transplanted organ along with an increased infection risk due to anti-rejection medications are specific to transplant surgery (37).
Surgery may be done for preventative reasons, also referred to as prophylactic surgery. This may be considered by patients with increased risk factors for developing a disease in the future, such as women with a family history of breast or reproductive organ cancers or having been identified as carrying the BRAC 1 or 2 gene (10). However, other types of surgery are performed as preventative care aimed to reduce the risk of developing health issues or complications in the future, such as bariatric surgery to assist weight loss, aimed to prevent future cardiovascular and metabolic disease; voluntary male circumcision, seen to reduce the transmission of HIV by 60% (38) or removal of a healthy appendix prior to military expeditions or those involving travel to polar regions or space to prevent the possibility of acute appendicitis whilst in the field (39).
Endoscopy
Minimally invasive investigative procedures may also be done within a surgical setting and are commonly used for the diagnosis and treatment of many conditions. Endoscopy involves passing a long thin tube which carries a small camera inside of the body to visualise the organs and tissues. The specific name of the procedure depends on which body system is being investigated.
Gastroscopy, also referred to as an upper endoscopy or oesophagogastroduodenoscopy, allows for the upper digestive tract to be visualised and is used for diagnosis of conditions such as unexplained acid reflux, gastritis, gastric ulcers, cancers of the upper digestive tract as well as narrowing of or swollen veins in the oesophagus. It may also be used in procedures to remove growths in the upper gastrointestinal tract such as polyps or to treat bleeding from ulcers (40).
Colonoscopy, which involves the imaging of the entire colon, or sigmoidoscopy, imaging solely the lower part of the colon, are included in established guidelines for the diagnosis of inflammatory bowel diseases such as ulcerative colitis and crohn’s, diverticulitis, polyps as well as cancer of the bowel and colon. Biopsies may be taken during these procedures for further histological investigation (41).
Hysteroscopy allows for minimally invasive visualisation of the intrauterine cavity entering into the uterus through the cervix. It is most commonly indicated in the investigation of abnormal uterine bleeding or thickening of the endometrium and fertility issues and may also be used for the surgical management of cervical or uterine pathologies (42).
How does surgery affect the body?
The effect that surgery has on the body will depend on a number of factors including method and duration of anaesthesia, type of procedure performed, whether the surgery is performed electively or after emergency admission, age, state of health of the patient at the time of the surgery (43). Comorbidities such as diabetes, cardiovascular and respiratory conditions, kidney or liver disease and obesity have a higher theoretical risk of increased complications after surgery including for infection of the surgical site (44).
Post-operative complications
Complications as a consequence of any kind of surgery may be relatively minor, resolving without undue harm or distress to the patient, or have more serious implications that result in a potential threat to life, extended length of stay in hospital, admission to intensive care facilities and additional surgical interventions. Furthermore complications following surgery may cause long-term disability, decreased quality of life and psychological stress to the patient (45). In addition, there is seen to be a reduction in long-term survival rates of patients who have experienced complications within 30 days of surgery (8).
The most common postoperative complications include (19):
- Blood loss
- Blood clots
- Adverse drug reactions to postoperative medications
- Infection
- Pain
- Scarring and adhesions
- Dysbiosis of the gut microbiota due to antibiotics and the stress of surgery
All surgical procedures, even those considered to be minor procedures or minimally invasive, are inevitably traumatic to the body triggering multiple local and systemic changes intended to restore homeostasis, which is disturbed by surgery. Localised acute inflammation is a vital response by the innate immune system to initiate the process of repair to damaged tissues; however, pain, redness, heat and swelling of the area are invariably a necessary result of this, subsequently causing postoperative discomfort for which analgesic medication is often required (46,47).
Stress to the body during surgery is characterised by the increased demand for oxygen and changes to metabolism required to provide energy sources, maintain fluid levels and restore homeostasis. These demands trigger the activation of the sympathetic nervous system (often described as the fight or flight response) as well as an increase in pituitary gland activity, which results in a rise of hormones such as cortisol (8,48).
It has been estimated that up to around 40% of individuals will experience some level of post-operative cognitive dysfunction with the likelihood of this increasing in older patients over 65 years. It is defined as a significant reduction in cognitive function which may negatively affect memory, attention span, verbal ability and executive function and is seen to persist for several weeks after the surgery was performed (49,50). Causes include surgical trauma induced inflammation, infection, opioid pain medications, sleep disturbance, stress and the effect of general anaesthesia (17,19).
Herbal solutions for surgical recovery
The main concerns around the taking of herbal medicines or supplements during the perioperative period include their potential effects on blood clotting and interactions with anaesthetic or post-surgical medications. For this reason it is generally advised that patients should stop taking any herbs a week before surgery is due to be performed. When herbs can be recommenced following surgery will depend on the herbs themselves along with any post-surgical medications that have been prescribed. It is recommended that advice around this is sought from a qualified medical herbalist with experience in this field and that the medical team involved in post-surgical care have full awareness of any herbs or supplements being taken (19,51,52,53),
Before surgery
Milk thistle (Silybum marianum)
An exception to the rule regarding stopping all herbs a week before surgery is milk thistle. Milk thistle has been shown to reduce the impact on the body of having a general anaesthetic, particularly on the liver. Its hepatoprotective, hepatotonic and anti-inflammatory actions protect the liver whilst being very safe, with no evidence to suggest that it has any interactions with anaesthesia. It is recommended that it is started three weeks before the date of surgery and continued for between three weeks and three months afterwards depending on the length of the procedure and subsequent time spent under anaesthesia. It can be taken until the day before surgery and may be restarted as soon as possible afterwards (19,51,54,55).
Passionflower (Passiflora incarnata)
Passionflower has been found to be of benefit to patients feeling understandably apprehensive in anticipation of imminent surgery. It has been shown to be effective at reducing anxiety without resulting in interactions with general anaesthetics or level of sedation (56).
After surgery for enhanced recovery
Ginger (Zingiber officinale) and chamomile (Matricaria chamomilla)
Both ginger and chamomile have been found to reduce the symptoms of post-surgical nausea. These herbs can be taken as a tea; to be drunk either hot or cold, or a few drops of the tincture can be added to a little water and sipped (57).
Echinacea (Echinacea purpurea/ E. augustifolia)
The immunomodulating, anti-inflammatory, antimicrobial, lymphatic, antiseptic and wound healing properties of echinacea make it an ideal herb for post-surgical use to promote improved healing and enhanced surgical recovery. Even minor surgery unavoidably causes some level of tissue damage and consequently requires the activation of the innate immune system to initiate the inflammatory processes necessary for healing. Major surgery has been shown to suppress activity of natural killer cells, a type of white blood cell vital to the immune system for their role in destroying infected or damaged cells. The ability of echinacea to support the innate immune response and increase natural killer cell production and activity further indicate its use after surgery (51,53,54)
Gotu kola (Centella asiatica)
Gotu kola has a range of properties seen to be beneficial to promote enhanced post-surgical recovery. Its nootropic, cerebral circulatory stimulant and anxiolytic actions may be indicated to improve post-surgical cognitive dysfunction. In some studies it has been shown to promote nerve regeneration and reduce levels of cortisol and adrenaline (19,58).
The benefits of gotu kola are also evident for the promotion of healthy wound healing. Its actions as an antifibrotic and connective tissue regenerator make it particularly valuable in the prevention of adhesions and post-surgical scarring (54,57).
In addition to it being taken as an internal remedy, gotu kola may be used externally as a topical preparation to enhance the healing of post-surgical wounds and is specifically indicated for the prevention of keloid or hypertrophic scars (54).
Holistic solutions
Preparing for surgery, also referred to as prehabilitation, is increasingly being recognised as a key factor in supporting positive surgical outcomes including a reduction in post-surgical complications and length of hospital stay required (8). Optimal nutrition is recommended during the months leading up to a surgical procedure and any deficiencies, such as iron or B12 which may indicate anaemia, corrected during this time (8,19). Optimal bowel function should be established prior to surgery and may help in preventing or reducing the post-surgical constipation experienced by some patients as a combined effect of insufficient hydration, reduced mobilisation and opioid pain medications following a procedure (19,59,60). Ensuring a healthy gut microbiome is maintained is a priority both before and after surgery for optimal immune function, particularly if antibiotics are prescribed (19).
Exercise in preparation for surgery has been seen to be associated with lower rates of post-surgical complications and earlier restoration of normal function in post-surgical patients, subsequently reducing the time taken before they are able to return to their previous daily lifestyle and routines (8,61).
Consistently good restful sleep needs to be a priority in the time leading up to surgery and during surgical recovery. It has been shown that insufficient sleep has a negative impact on systems including immune responses and cognitive function. It has also been associated with increased sensation of pain (61,62). Alongside good sleep, stress management around the time of surgery is essential particularly given that anxiety regarding a forthcoming procedure or the unconducive to relaxation hospital environment may be added to existing day to day stresses and concerns. Herbs such as nervines and adaptogens may help as can practices such as yoga, meditation or mindfulness (19,58,61).
A balanced, nutrition-rich diet is the optimal option whilst recovering from surgery; however, this may be affected by the choice of hospital food whilst receiving in-patient care and issues such as reduced appetite, decreased mobility, and pain levels once discharged to home. Supplements that are often suggested to be of benefit during this time include B and C vitamins, zinc, selenium, omega 3 oils, probiotics, green tea and turmeric (19,63).
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