www. VirginiaWomensCenter.com Gynecologic Surgery Frequently- Asked Questions and What to Expect Before and After Your Abdominal Surgery
Two methods of abdominal surgery are laparotomy and laparoscopy. This booklet addresses both kinds of surgery. Laparotomy INTRODUCTION You will be undergoing a surgical procedure that involves the abdomen. We have prepared this booklet to put your mind at ease by addressing how you will feel physically and what you can expect as your body heals. For additional resources, we recommend you visit www.virginiawomenscenter.com. Laparotomy refers to the opening of the abdominal cavity for direct examination of its contents, for example, to locate a source of bleeding. It may or may not be followed by repair or removal of the primary problem. Laparoscopy Laparoscopy is a minimally-invasive approach to abdominal surgery where rigid tubes are inserted through small incisions into the abdominal cavity. The tubes allow introduction of a small camera, surgical instrument, and gases into the cavity for direct or indirect visualization and treatment of the problem. The abdomen is inflated with carbon dioxide gas to make the area easier to see, and a video camera is used to show the procedure on a monitor in the operating room. The surgeon moves the instruments within the abdominal cavity to perform procedures such as a hysterectomy. The laparoscopic method speeds recovery time and reduces blood loss and infection as compared to the traditional open hysterectomy. However, it is not appropriate for every patient. 1
Hysterectomy TABLE OF CONTENTS Hysterectomy is a common abdominal surgery that may be performed using laparotomy or laparoscopy to treat conditions that affect the uterus. Some reasons a hysterectomy may be needed include: Uterine fibroids Endometriosis Pelvic support problems (such as uterine prolapse) Abnormal uterine bleeding Cancer Chronic pelvic pain PREPARING FOR SURGERY... 4 JUST AFTER SURGERY...... 6 ABDOMINAL DISCOMFORT... 7 AFTER DISCHARGE........ 9 RECOVERY TIME.......... 11 PROBLEMS.............. 12 The type of hysterectomy chosen depends on the reason for the surgery and the findings of a pelvic exam. Your doctor will discuss the following options with you: Total Abdominal Hysterectomy (TAH) Vaginal Hysterectomy (VH) Laparoscopically Assisted Vaginal Hysterectomy (LAVH) Laparoscopic Supracervical Hysterectomy (LSH) or Total Laparoscopic Hysterectomy (TLH) Hysterectomy can have both physical and emotional effects. Some last a short time. Others are long term. You should be aware of these effects before having the surgery. Important Virginia Women s Center Phone Numbers Doctor: Nurse Practitioner: Nurse: Nights/Weekends 8 04.527.3 5 8 8 2 www.virginiawomenscenter.com 804.288.4084 3
4 PREPARING FOR SURGERY Q: How long will I be out of work or unable to perform my normal routine? A: If you are having a laparotomy, total abdominal hysterectomy or vaginal hysterectomy, plan to be on a different schedule for four to six weeks. A: If your procedure is being done laparoscopically, you will need to allow up to 48 hours following your procedure to return to routine activity. Though you may feel better the morning following surgery, you will still need rest. Q: Will I need any testing from the hospital before the surgery? A: You will need certain tests, based on your age, medical history and the type of surgery being done. Tests may include blood work, chest X-ray, EKG, urinalysis and cultures, a pregnancy test and possibly other cardiac tests. If you have medical problems, pre-op medical or cardiac clearance by a physician may be required. In some cases, our scheduler will tell you when to go to the hospital to have the tests done, or someone from the hospital will call you to schedule the visit. The tests are usually done 7 to 10 days before surgery. Q: Do I need to stop any medicines? A: If you take Coumadin, Plavix or any other prescription blood thinners you will have to stop them about four to seven days prior to surgery. You will need to speak with the doctor who prescribes those medicines for you to determine if they would like you to take anything else during that period. If you are taking Aspirin, Motrin, Advil or any other cold/ fever medicine or anti-inflammatory you should stop them one week before the surgery. If you are taking herbal supplements, please stop them one week before the surgery as well, as many have blood thinning properties. Your surgeon or the hospital staff can address questions about any other medications. Q: Do I need to take any medications before surgery? A: Depending on your situation and your surgery, your surgeon may give you an antibiotic to prevent infection, based on Centers for Disease Control guidelines. Q: Do I need to shave my abdomen or pubic area? A: No. Shaving with a razor can increase the risk of infection. We will trim your abdomen or pubic areas as needed. Q: Will I be able to eat before surgery? A: No, you will not be able to eat or drink, including sips of water or coffee, after midnight. You may be instructed to take your regular medications with small sips of water. Q: Will I be given an enema? A: The answer to this varies. Your doctor will discuss specific bowel preparation instructions with you prior to surgery, depending on your type of procedure. Q: Will I have an IV in my arm? A: Yes. This is inserted while you are in the holding area to give you medication and fluids through your arm before and during surgery. It will be in place after surgery while you are in the hospital and removed prior to discharge. Q: Should I pack anything special? A: When you leave the hospital, many women like to wear loose-fitting clothing for the trip home. Stretch pants, draw-string pants or a flowing dress are usually the most comfortable. Do not bring valuable items with you to the hospital. 5
Q: How long will I stay in the hospital? A: For laparotomy, total abdominal hysterectomy and vaginal hysterectomy, you will usually stay in the hospital one to three days depending on the procedure and your insurance. Your insurance will authorize a length of stay for you. If additional days are required, these will also have to be authorized. A: Many laparoscopic procedures are performed as outpatient, so you will go home the same day. Laparoscopic hysterectomies and some other procedures require an overnight stay. If additional days are required, these will have to be authorized. JUST AFTER SURGERY Q: How will I feel when I wake up from anesthesia? A: Anesthesia affects people differently. You may be very sleepy or wide awake. If you experience nausea, the doctor can prescribe medication to treat it. Any nausea usually decreases and disappears within 12 to 24 hours of the procedure. Q: Will I have a urinary catheter when I wake up? A: Following laparotomy, total abdominal hysterectomy and vaginal hysterectomy, you will have a catheter coming from the bladder and draining urine into a bag on the side of the bed. Typically, the catheter is removed the morning after the surgery. A: If you are having a laparoscopic procedure, you will have a catheter during surgery. It may be removed prior to your awakening or the following day. Q: How much or little am I supposed to move after surgery? A: After laparotomy, total abdominal hysterectomy and vaginal hysterectomy, the nurses will encourage and help you to turn frequently in the bed. Later, you will be encouraged to sit up, get out of the bed and walk to the bathroom. Once you can do this, you will then walk in the hall. These activities assist in the healing process and help your body return to normal. Immediately after the surgery, you will be given a small pillow to use to splint your abdomen whenever you move. You will use this for deep breathing, laughing and coughing to help you cushion these muscles as they heal. You will continue to use this pillow for a few weeks upon leaving the hospital. A: After laparoscopy, you should not stay in bed, as prolonged bed rest can cause blood clots in your legs. However you should avoid heavy lifting for one to two weeks. ABDOMINAL DISCOMFORT Q: Will I be in any pain after surgery? A: Following laparotomy, total abdominal hysterectomy and vaginal hysterectomy, most patients are placed on a PCA pump (Patient Controlled Analgesia). The PCA pump gives you the ability to adjust the amount of medication necessary to relieve any discomfort you may have. The pump delivers a set amount of medication which you can control by pressing a button when needed. After one to two days following the procedure, you will no longer need this type of pain relief, and your physician will order a narcotic pain medication that you will take by mouth as needed. A: For laparoscopic procedures, it is not unusual to experience some discomfort under your ribs and/or soreness of your neck and shoulders over the first one to two days. This is due to the gas used in your 6 7
abdomen during the surgery to help your doctor see your pelvic organs. This gas gets naturally reabsorbed. The right shoulder is often more sore than the left. The small incisions will be sore, and you may have some bruising. The belly button is usually the most uncomfortable area. Following a hysterectomy, some women may also feel something like menstrual cramping. This is common, and the pain medication you were prescribed or an over-the-counter pain medication will help. Q: What if I become constipated? A: Usually, you will experience a normal bowel movement two to four days following surgery. However some pain medications may cause constipation. You may be given a stool softener to take while in the hospital and at home. If you do develop constipation, you can try heating prunes in a little water or take Milk of Magnesia, as directed. If these are not enough, you can purchase Magnesium Citrate over the counter once you are home. Drink one-half bottle. If no results occur within four to six hours, drink the other half bottle. This may be repeated one more time. If still no results occur, please call the office. Q: Should I anticipate anything else after my laparotomy, total hysterectomy or vaginal hysterectomy? A: Air and gas are the two common concerns during this time. Air may have collected inside your body cavity during the operation. The body will naturally reabsorb this. While this is occurring, you may notice some achy sensations in your shoulders and upper chest which are harmless and will pass. Due to anesthesia and immobility, the digestive system can stop or markedly slow down following surgery and gas can build up in your intestines. This can cause a bloating feeling in the abdomen. Walking can help the gas to move and to reabsorb or to be expelled. The bloating sensation will resolve and your system will return to normal. AFTER DISCHARGE Q: Do I need to make any adjustments to my diet following surgery? A: When you are discharged from the hospital, you should plan to eat a bland, light diet for the first one to two days. Avoid spicy or greasy foods and high roughage foods such as salads and raw vegetables (these can cause gas and bloating). Drink plenty of non-caffeinated fluids (water is best). You may resume your usual diet gradually. Q: Will I have any vaginal discharge or bleeding? A: It is normal to have some vaginal bleeding or discharge following laparotomy, total hysterectomy or vaginal hysterectomy. There is no need for concern as long as the amount of the vaginal bleeding is just like a normal period and there is no foul odor. If you experience heavy bleeding or note a foul odor, please call the office. A: Following laparoscopy, it is not unusual to have vaginal spotting lasting up to two weeks off and on. Some women do not experience any bleeding at all. You should call your doctor immediately if you ever experience heavy vaginal bleeding or gushes of any liquid coming from your vagina that does not seem like the amount you would expect for your normal vaginal discharge. Q: Can I take a bath? A: You may take a shower 24 hours after surgery, at which time you may remove your dressing (see next question). Please do not take baths until you are seen for your post-operative visit. 8 9
10 Q: Will I need to do anything to the incision site? A: Following laparotomy, total hysterectomy or vaginal hysterectomy, the dressing over your incision will be removed prior to leaving the hospital. If there is any oozing from the incision, a Maxi pad can be placed over the incision for protection. A: There are several ways that your incisions may be closed for a laparoscopic procedure. Most of these do not require the removal of any sutures. Some patients may have skin glue, Dermabond, placed over the incisions. Do not try to peel this off, it will gradually wear off on its own. Other patients will have small paper strips placed over the incisions. Allow these to fall off on their own, or your doctor will remove them. Any dressing on top of the Dermabond or paper strips can be removed 24 hours after surgery. Q: When will the stitches or staples come out? A: Depending on where the incision is, several layers of tissue have been sewn back together to create a strong and safe closure. The deep stitches will slowly dissolve as the body heals. Staples (on the abdomen) may be used to hold your skin edges together for a short time after the operation. The skin rapidly heals and these staples will be removed within three to seven days. Tiny strips of tape will be placed across the incision at that time for reinforcement. Q: Is there anything else I should know about the incision site? A: Bruises may appear around the incisions and will gradually resolve as they heal. The incision cut some of the nerves, which supply sensation to your skin. As the scar heals, you may find areas of the skin are numb. More normal feeling will return to these areas over time. RECOVERY TIME Q: What can I expect once I m home? A: Following laparotomy, total hysterectomy or vaginal hysterectomy, it takes several weeks before you will feel normal following surgery. You will feel tired and have limited energy during the first days and weeks but this will gradually improve. A: Following laparoscopy, it may take several days before you feel like yourself again. Usually women have bursts of energy followed by fatigue. In both cases, be sure to get plenty of rest. Emotional ups and downs are commonly associated with gynecological surgery during this time. Q: What restrictions do I have following surgery? A: Following laparotomy, total hysterectomy or vaginal hysterectomy, you must not perform any household activities such as laundry, vacuuming, shopping or gardening until your physician gives you clearance. You may not lift or pull down anything heavier than a gallon of milk. If possible, avoid climbing stairs more than once a day. Gradually increase your activity. First try walking and doing light activity around the house. Over the next few weeks, you may gradually increase your physical activity, however the restriction of lifting or pulling down anything heavier than a gallon of milk remains. You may walk, but no exercising, jogging, or impact exercises. A: Following laparoscopic surgery, simply avoid heavy lifting or straining. You should be seen at Virginia Women s Center following your surgery. Call 288-4084 for an appointment, if this has not already been arranged. At this appointment, your physician will discuss with you the findings noted at the time of your procedure and/or pathology reports. In both cases, avoid using tampons or inserting anything in the vagina unless you were prescribed a vaginal estrogen cream. You must abstain from sexual activity for at least six weeks or until after your postoperative visit. 11
PROBLEMS Notes Q: What s not normal that I should call the doctor about? A: A doctor is on call 24 hours per day, seven days a week if any problems arise. Please call if you have any of the following problems: Temperature above 101 degrees Redness or drainage from the incision Excessive vaginal bleeding Foul odor from the incision or vagina Yellowish/greenish drainage from the incision or vagina 12 www.virginiawomenscenter.com 804.288.4084
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