Laparoscopy Patient Information Womens Health
What is a Laparoscopy Laparoscopy is a minimally invasive or key hole surgical procedure performed under general anaesthetic. It enables the surgeon to look inside the abdomen and view internal abdominal organs, to investigate pelvic pain, ectopic pregnancy and infertility. This is known as a diagnostic laparoscopy. It is also used as a means of carrying out a number of minor surgical procedures / treatments, such as sterilization and drainage of ovarian cysts. This is an operative laparoscopy. This is usually performed as a day case, and takes approximately 30 minutes depending on the extent of what is being carried out at the time. More extensive procedures can often be performed through laparoscopic surgery, such as removal of one or both ovaries and division of scar tissue. This operation will take more time to perform (approximately one hour) and recovery time will be slightly longer. Usually two small cuts are made into the abdomen. The first cut is made just below the navel (belly button) and the abdominal cavity is filled with carbon dioxide gas. This pushes the bowel and internal organs away, for safe insertion of the laparoscope. The second cut is usually made just above the pubic hair line and a small instrument may be inserted to help view the internal organs. The womb, fallopian tubes and ovaries can now be thoroughly inspected for abnormalities.
If undergoing a laparoscopy for fertility investigations, a dye will be passed through the cervix to see whether it spills through the fallopian tubes if they are open. Most of the gas is removed at the end of the operation, but if there is some remaining within the abdomen, it may cause some discomfort, particularly in the area of the shoulder tips and neck. What are the risks of Laparoscopy? Laparoscopy is considered a safe procedure, but no surgery is without risk. The possible complications are; Infection this can be in the wound, bladder or womb. Bleeding. Perforation of bowel, bladder, womb or blood vessel. The need to proceed to a laparotomy, a bigger cut in the tummy to sort out any complications if they occur. What are the benefits of Laparoscopy? To investigate pelvic pain. To diagnose conditions such as endometriosis, ectopic pregnancy, pelvic inflammatory disease or ovarian cysts. To check fallopian tubes and ovaries. To cure symptoms, such as pain (only with operative laparoscopies).
Preparation for surgery A pubic shave will be required approximately the top two inches should be shaved. Suppositories may be needed if you suffer from constipation prior to the procedure. A pregnancy test will be carried out on admission, but it is important that you are not pregnant at the time of surgery. It is recommended to use contraception for four weeks prior to this. On the day of surgery On arrival to the ward you will be shown to your bed. You will see an anaesthetist to ensure that you are fit for a general anaesthetic. If you have not already done so, you will be asked to read and sign a consent form, talked through with you by a doctor. Prior to your surgery the ward nurses will prepare you for theatre. This will involve you emptying your bladder, changing into a theatre gown, putting on stockings to reduce the risk of clot formation in the legs, wearing one identity bracelet and running through a checklist as a safety procedure. There will also be opportunity for you to discuss any last minute worries or concerns that you may have. You will be escorted to theatre by a member of the theatre staff.
After the operation You may experience some abdominal discomfort and shoulder pain following your operation. This is generally relieved with regular painkillers, which a nurse will discuss with you. You will be kept on the gynaecology ward until you are fit for discharge home. The nurses will ensure that you have had something to eat and drink, you have emptied your bladder and that you are comfortable enough to go home. If you have had an operative laparoscopy you will be advised to stay in hospital overnight. It is recommended that you go home and rest after your operation. It is advised that you take one three weeks off of work (depending on the nature of your surgery) but you may resume everyday life when you feel comfortable enough to do so. The dressings on your abdomen can be removed after 24 hours. It is not uncommon for bleeding to occur from the wound site, if this happens an additional dressing can be added to the one already in place and gentle pressure applied for a few minutes. Once you remove the dressing you will see a couple of stitches near to your navel. These are dissolvable, normally within a couple of weeks, but if they are causing irritation after one week, you should make an appointment with your practice nurse who will remove them for you.
Vaginal bleeding is quite normal following laparoscopy and you should expect to have some light to moderate bleeding for up to a week after your surgery. It is strongly advised that you wear sanitary towels for this and not internal tampons, as this can cause discomfort and increase the risk of infection. Avoid sexual intercourse until you feel comfortable. You will be sent home with a copy of your discharge summary, which explains about the procedure you have had. A copy of this will also be sent to your GP within 24 hours of you going home. Advice following anaesthetic The anaesthetic can remain in your system for 48 hours after your operation, therefore you must be accompanied home by a responsible adult, and have an adult stay with you for the remainder of the 48 hours. You must follow this advice; Do not drive for 48 hours, Do not drink alcohol for 48 hours, Do not operate machinery for 48 hours, Do not sign any legal documents for 48 hours. Normal eating and drinking patterns can be resumed once home. Baths and showers are fine, but it is advised that you do not have the temperature too hot.
Complications Whilst most patients recover well after laparoscopic surgery, complications can occur. The majority of injuries that can happen during the surgery are usually discovered and dealt with at the time, but some may remain unrecognized. For this reason it is important that you seek urgent medical help or advice if you encounter any of the following problems: Abdominal pain / tenderness that does not settle with simple pain killers. Abdominal distension (swelling of your tummy), Not being able to face eating or drinking. Feeling sick or being sick after eating or drinking. Not feeling able or wanting to mobilize. Reduced urine output or not emptying your bladder. Please do not panic if you experience any of the above, it is just important that you get these symptoms checked out. For any urgent concerns you or your carer may have please contact the ward (within 2 weeks of discharge home), where immediate access back to the ward will be available if needed. Womens Health Unit, Basingstoke 01256 313583 Anthony Letchworth Ward, Winchester 01962 824601
Hampshire Hospitals NHS Foundation Trust Winchester site Anthony Letchworth Ward Florence Portal Building Romsey Road Winchester SO22 5DG 01962 824601 Hampshire Hospitals NHS Foundation Trust Basingstoke site Sherborne Building Aldermaston Road Basingstoke Hampshire RG24 9NA 01256 313583 www.northhampshire.nhs.uk JAS Feb 2014