Pre-Operative Instructions

Prior to your surgery

You will receive a phone call from the hospital one week prior to your scheduled surgery date.  The hospital will make contact to schedule you for any required pre-operative testing that needs to take place before your surgery and to register you with the hospital.

If you have any questions or have not received a phone call from the hospital, please call 559-321-2857 to speak with Dr. Leung’s receptionist, Crystal.  You may also email Crystal at This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Pre-operative evaluation

  • Your primary doctor will need to state that you are well enough to have surgery and anesthesia. This should be done at least 2 to 4 weeks before your surgery.   Also, in patients at risk for heart problems we will need your cardiologist to clear you for surgery.
  • A history and physical will need to be completed before your surgery in our main Fresno office with Dr. Leung’s nurse practitioner or physician assistant.
  • The following testing will be needed prior to your surgery: 
Complete blood count with platelets.
  1. Basic metabolic panel (BMP) (sodium, potassium, chloride, carbon dioxide, blood urea nitrogen, creatinine, glucose, calcium).
  2. Prothrombin time / INR – This lab test will tell Dr. Leung how long it takes your blood to clot.
  3. Blood type and screen to determine your blood type.
  4. An EKG (electrical picture of your heart) with rhythm strip or a treadmill stress echo with EKG rhythm strip.
  5. A chest x-ray is also needed (PA & lateral) .

    As indicated in the section above, the hospital will be calling you one week prior to your scheduled surgery to do the pre-operative testing described in this section

    The Day Before your Surgery

    1. Do not drink any alcohol for 48 hours before, and 48 hours after surgery.
    2. The day before your surgery, do not eat any solid foods. Just drink clear liquids. Clear liquids are fluids that you can see through including: water, bouillon or clear broth, lemonade, Snapple, apple juice, Gatorade, white grape juice, cranberry juice, black coffee or tea, Jell-O, and popsicles.
    3.  Drink plenty of fluids and avoid dairy products the day before surgery.
    4. You will also need to clean out your bowels completely.  This step in your pre-operative process is very important.  First, Dr. Leung needs as much space as possible to work in inside the abdomen. Second, in the rare setting (<1%) whereby an inadvertent injury to the intestine occurs, we want to limit the amount of abdominal contamination as much as possible. Please be sure to stay close to a restroom when completing this step.  You are required to do the following:
      A.    The day before your surgery, drink a bottle of Citrate Magnesia. Start drinking this at 10:00 a.m. Drink this slowly over one hour.
      B.    Perform a Fleets enema before bedtime at around 8:00 p.m. the night before your surgery
      C.    You will need to have another Fleets enema about one hour before arriving at the
    5. We have called in your Neomycin prescription to your pharmacy to prevent infection.  Please take 2 pills orally (500mg) the day before your surgery at 10am, 2pm, and 6pm.
    6. Do not eat or drink anything after midnight the night before surgery.


    Morning of surgery:

    • The morning of surgery you may take your heart and blood pressure medications with a sip of water.  If you are on insulin, take half of your normal dose.

    14 Days before your surgery stop using these medications:

    • Do not take aspirin or aspirin products 14 days before your surgery.
    • Do not take Motrin (ibuprofen) or other non-steroidal anti-inflammatory drugs (NSAID) for 14 days before surgery. 
    • Stop using herbal remedies such as Saw Palmetto, Ginseng, and St. John's Wort 14 days before surgery.  You should also stop using vitamin E and garlic supplements.  Please discuss all herbs and remedies you use with the surgeon.

    Other medicine precautions:

    • Please make certain that we know if you take medicine that affects bleeding or is a "blood thinner." Examples of these are coumadin, warfarin or plavix.  A safe plan will need to be made about how and when you take this medicine near the time of your surgery.  Usually this type of medicine will be stopped for around 2 weeks before this operation.

    Medications that may be taken on the day of surgery

    Medications that may NOT be taken on the day of surgery

    • Take half of your insulin dose
    • Heart pills
    • Blood pressure pills
    • Seizure pills
    • Water pills
    • Diabetic pills
    • Aspirin-Must be stopped at least 10 days before surgery
    • Coumadin-Must be stopped 7 days before surgery and must be cleared by the prescribing doctor