Laparoscopy
Information for patients from Women's Health
This leaflet will explain the following.
What a laparoscopy is.
The alternatives to having a laparoscopy.
What the benefits and risks are.
What happens before, during, and after surgery.
Advice on how to get back to normal activities after surgery.
We hope this leaflet answers some of the questions you may have. If you have any further questions or concerns, please speak to a member of your healthcare team.
What is a laparoscopy?
During a laparoscopy a doctor passes a small telescope (a laparoscope) through a small incision (cut) under the navel (belly button). The telescope allows the doctor to see the organs in the pelvis (uterus, ovaries, and fallopian tubes). So they can see these organs clearly, they pass a small amount of carbon dioxide through a fine needle into the abdominal cavity (tummy).
How will a laparoscopy help?
A laparoscopy is often performed to find out what is wrong. Particularly in the investigation of subfertility or pelvic pain. A laparoscopy can also check an abnormality, if one is found on an ultrasound scan.
We perform some therapeutic operations (treatments) with the help of a laparoscope. These will include:
freeing scar tissue from around the fallopian tubes;
treatment of some cases of endometriosis; and
uncomplicated ovarian cysts and hysterectomies.
Sterilisation is also commonly performed with the help of a laparoscope.
Are there alternatives?
To help diagnose pelvic problems, you may have an ultrasound scan before a laparoscopy.
You may have an x-ray (hysterosalpingogram (HSG)) to check whether your fallopian tubes are open or not. However, a HSG only gives limited information about the other pelvic organs. It also exposes the ovaries to a small dose of radiation. As a general rule, we reserve a HSG for a small group of patients after a laparoscopy.
What are the benefits of having a laparoscopy?
We use a diagnostic laparoscopy and a laparoscopy and dye test to look for the cause of bleeding problems or subfertility. These are diagnostic procedures and are not meant to help with symptoms. However, if you have other procedures (for example diathermy) your symptoms may improve.
Is the treatment safe?
All surgical procedures carry risks.
There may be complications causing bleeding or damage to other organs (bladder or bowel). This may mean making a larger incision into the abdomen to repair damage (a laparotomy).
Other possible risks include urinary tract infection and abdominal bruising.
The gas inserted at the time of laparoscopy can cause irritation to the diaphragm (rib cage). If this happens, your brain interprets it as pain in your shoulder. This is called ‘referred pain’ and is a common side effect of the operation. This pain usually stops after 48 hours.
Like all operations, laparoscopy carries a risk of mortality (loss of life). In the case of laparoscopy this is very small.
What are the risks?
Serious risks
Approximately 1 in 500 women will have a serious complication from a diagnostic laparoscopy. This includes damage to the bowel, bladder, ureters, uterus, or major blood vessels. If this happens you would need immediate repair by laparoscopy or laparotomy (open surgery is uncommon). However, in up to 15 in every 100 cases bowel injuries might not be diagnosed during the laparoscopy.
Your doctor may not be able to enter your abdominal cavity and complete the procedure.
A hernia can develop at the site where the laparoscope enters your abdomen. This happens to less than 1 in 100 women.
You may have thromboembolic (blood clot) complications; this is rare or very rare.
Although very rare, 3 to 8 in every 100,000 women undergoing a laparoscopy may die as a result of complications.
Frequent risks are usually mild and get better on their own. They may include bruising, shoulder-tip pain, wound gaping, and infection.
What should I do before I come into hospital?
Before the day of your surgery, you will have an appointment at the Pre-assessment Clinic. We will take a detailed medical history during this appointment. You will have blood tests before your procedure.
Please refer to your appointment letter for instructions on what to do before you come to hospital. Make sure you understand the advice about fasting (not eating and drinking) before your procedure.
What will happen when I arrive at the hospital?
A member of the ward team will greet you when you arrive at the hospital. They will explain the care you will receive whilst you are in hospital. You will also meet your consultant and / or one of their team. Please remove any make-up, nail varnish, and jewellery.
How can I prepare for my surgery?
While you wait for your surgery date, you can start preparing for your operation. Research shows that fitter patients, who are able to improve their health and activity levels before surgery, recover more quickly. Taking an active role in planning and preparing for your operation will help you:
feel in control;
leave hospital sooner, and
get back to normal more quickly.
To help with this, you may be contacted by a member of the One You Kent (OYK) team. OYK work in the community, and help patients improve their general health. This includes help and advice on:
Stopping smoking
Losing weight
Getting more exercise
More information can be found on the following web sites.
One You Kent (Kent Community Health)
Fitter Better Sooner Toolkit (Royal College of Anaesthetists)
Will I have an anaesthetic?
Yes. You will have a general anaesthetic (you will be asleep) for this procedure.
How will I feel after my procedure?
You may feel some pain in your shoulders and abdomen. We will give you pain relief after your procedure. Pain relief can be given in many different ways, as:
tablets that you swallow;
an injection; or
suppositories which can be given via the rectum (back passage).
You can expect to have 2 or 3 small cuts in your abdomen; one in your navel area and the other just above your pubic hair.
You may feel some nausea (sickness) after your anaesthetic, but this is rare.
How long will I be in hospital?
We perform most laparoscopies as day cases, however some patients do need to stay in hospital overnight. This will depend on the reasons for your operation, or your social circumstances.
What can I expect after my laparoscopy?
Stitches
We will close your cuts with stitches. Most stitches dissolve by themselves in 2 to 3 weeks.
If your stitches need to be removed, this is usually done by your GP practice nurse about 5 to 7 days after your operation. We will explain which stitches you had before you leave hospital.
Wound dressing
After surgery we will cover your cuts and stitches with a dressing. Most patients can remove the dressing 24 hours after their operation. At this time you can have a wash or shower (see the section on Washing and showering below).
Vaginal bleeding
You may get a small amount of vaginal bleeding for 24 to 48 hours after your operation. This is normal.
Pain and discomfort
You can expect some pain and discomfort in your lower abdomen for a few days after your operation. You may also have some pain in your shoulder. This is a common side effect of the operation.
At your pre-assessment appointment the nurse will tell you to buy some painkillers (such as paracetamol). Painkillers that contain codeine or dihydrocodeine can make you sleepy, slightly sick, and constipated. If you need to take these, try to eat extra fruit and fibre to reduce your chances of becoming constipated.
Starting to eat and drink
If you had a short general anaesthetic, once you are awake we will offer you a drink of water or cup of tea and something light to eat before you go home.
Washing and showering
Twenty-four hours after surgery, most patients can shower / bath and remove any dressings. When you first take a shower or bath have someone at home with you, to help you if you feel faint or dizzy. Do not worry about getting your scars wet. Make sure you pat them dry with clean disposable tissues or let them dry in the air. Keeping scars clean and dry helps healing.
How can I reduce the risk of blood clots forming?
There is a small risk of blood clots forming in the veins of your legs and pelvis (deep vein thrombosis) after any operation. These clots can travel to your lungs (pulmonary embolism), which could be serious. You can reduce the risk of clots by following the advice below.
Move around (be mobile) as much and as early as you can after your operation.
Exercise when resting.
Pump each foot up and down briskly for 30 seconds.
Move your ankle and each foot in a circular motion.
Bend and straighten your legs for 30 seconds. One leg at a time, 3 times for each leg.
We may also give you other measures to reduce your risk of developing a clot. This is more likely if you are overweight or have other health issues. These may include the following.
Daily heparin injections (a blood-thinning agent). You may need to continue having these injections daily when you go home. Your doctor will tell you the how long to take these for.
Wear compression stockings day and night, until your movement has improved and you can move around again.
What can help me recover?
A daily routine
Establish a daily routine and keep it up. For example, try to get up at your usual time, have a wash and get dressed, move about and so on. Sleeping in and staying in bed can make you feel depressed. Try to complete your routine and rest later if you need to.
Eat a healthy and balanced diet
Make sure that your body has all the nutrients it needs by eating a healthy balanced diet. A healthy diet is a high fibre diet (fruit, vegetables, wholegrain bread, and cereal) with up to two litres per day of fluid, mainly water.
Remember to eat at least five portions of fruit and vegetables each day. For more information on the importance of eating your 5-A-Day, please go to the NHS Live Well web site.Stop smoking
Stopping smoking will benefit your health in all sorts of ways. For example, it reduces the risk of getting a wound infection or chest problems after the anaesthetic. Even if you only stop smoking while you recover, you will bring immediate benefits to your health. If you are unable to stop smoking before your operation, you may need to bring nicotine replacements for use during your hospital stay. You will not be able to smoke in hospital.
For free friendly support and medication to help you stop smoking, contact One You Kent.
One You Kent
Telephone: 0300 123 1220
Email
A positive outlook
Your attitude towards recovery is an important part of how your body heals and how you feel in yourself. You may want to use your recovery time as a chance to make some long-term positive lifestyle choices.
If you are not doing so already, start exercising regularly. Gradually build up the levels of exercise that you do.
Eat a healthy diet. If you are overweight, eat healthily without trying to lose weight for the first couple of weeks after your operation. After that, you may want to lose weight by combining a healthy diet with exercise.
What can slow down my recovery?
The following can affect your recovery.
If you had health problems before your operation. For example, women with diabetes may heal more slowly and be more likely to get an infection.
Smokers are at increased risk of getting a chest or wound infection during their recovery. Smoking can also delay healing.
You were overweight at the time of your operation. If so, it can take longer to recover from the effects of the anaesthetic. There is also a higher risk of complications, such as infection and thrombosis.
There were complications during your operation.
Recovering after an operation is a very personal experience. If you are following all the advice that we gave you but do not think that you are at the stage you should be, talk with your GP.
When can I return to work?
Most patients return to work 3 to 5 days after their operation.
Will I have to come back to hospital?
This will depend upon the particular problem troubling you, but usually no.
Getting back to normal
Around the house
While it is important to rest after your operation, start some of your normal daily activities as soon as you feel able. You will find you are able to do more as the days pass. If you feel pain, try doing a little less for another few days.
Remember to lift correctly.
Have your feet slightly apart.
Bend your knees and keep your back straight.
Brace (tighten or strengthen) your pelvic floor and stomach muscles as you lift.
Hold the object close to your body and lift by straightening your knees.
Exercise
The day after surgery, most patients can go for a short 10 to 15 minute walk in the morning and the afternoon. Rest afterwards if you need to. They are able to increase their activity levels quite quickly over the first week. There is no evidence that normal physical activity levels are in any way harmful. A regular and gradual build-up of activity will help your recovery. Most women are able to walk slowly and steadily for 30 to 60 minutes by the middle of the first week. They will be back to their previous activity levels by the second week.
Swimming is an ideal exercise. If you had no additional procedures while in hospital, you can start as soon as you feel comfortable. If you had other procedures with your laparoscopy, you may need to avoid contact sports and power sports for a few more weeks. This will depend on your levels of fitness before surgery. Please discuss this with your doctor.
Having sex
It is safe to have sex when you feel ready. If your vagina feels dry, especially if you have had both ovaries removed, try using a lubricant. You can buy this from your local pharmacy.
Travel plans
If you are considering travelling during your recovery, it is helpful to think about whether:
your travel insurance covers any medical treatment, in case you have a problem after your operation; and
your travel plans are in line with the levels of activity recommended in this leaflet.
If you have concerns about your travel plans, please talk to your consultant or GP before you travel.
Driving
Do not drive for 24 hours after a general anaesthetic. Each insurance company will have their own conditions for when you are insured to start driving again. Check your policy.
Before you drive you must be:
free from the sedative effects of any painkillers;
able to sit in the car comfortably and work the controls;
able to wear the seatbelt comfortably;
able to make an emergency stop; and
able to comfortably look over your shoulder to manoeuvre.
It is a good idea to practise driving without the keys in the ignition. See whether you can do the movements you would need for an emergency stop and a three-point turn, without causing yourself any discomfort or pain. When you are ready to start driving again, build up gradually, starting with a short journey.
When should I ask for medical advice after a laparoscopy?
Contact Day Surgery or the Women’s Health Suite (see numbers below), your GP, or 111 if you have any of the following symptoms.
Burning and stinging when you pass urine or you pass urine frequently. This may be due to a urine infection, which we will treat with a course of antibiotics.
Red and painful skin around your scars. This may be due to a wound infection, which we will treat with a course of antibiotics.
Increasing abdominal pain. If you have the following symptoms your may have a damaged bowel or bladder. If so, we may need to admit you to hospital again.
A temperature (fever).
Have lost your appetite (do not want to eat).
Vomiting (being sick).
A painful, red, swollen, hot leg or difficulty putting weight on your legs; this may be due to a deep vein thrombosis (DVT). If you have shortness of breath, chest pain, or cough-up blood, it could be a sign that a blood clot has travelled to the lungs (pulmonary embolism). If you have these symptoms, ask for medical help immediately.
Expect a gradual improvement in your symptoms over time. If this is not the case, ask for medical advice.
Contact details
Gynaecology Assessment Unit
Queen Elizabeth the Queen Mother (QEQM) Hospital, Margate
Telephone: 01843 235009 (open 24 hours a day)Women’s Health Suite
William Harvey Hospital, Ashford
Telephone: 01233 651987 (open 24 hours a day)
We have used the term ‘women’ throughout this leaflet. When we use this term we also mean people with female reproductive organs who do not identify as a woman. East Kent Hospitals is committed to supporting people of all gender identities. Please tell your doctor or nurse how you would like them to address you, so we can be sure to get this right.
Ask 3 Questions
There may be choices to make about your healthcare. Before making any decisions, make sure you get the answers to these three questions:
What are my choices?
What is good and bad about each choice?
How do I get support to help me make a decision that is right for me?
Your healthcare team needs you to tell them what is important to you. It’s all about shared decision making.
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