Operative Laparoscopy


An operative laparoscopy is a minimally invasive / key hole operation which is usually undertaken as a day case ie. you go home on the day of the operation. The exact operation performed depends on the condition being treated but it is most commonly used to remove endometriosis, divide adhesions (scar tissue in the pelvis), remove ovaries or ovarian cysts or remove fallopian tubes.


How is the operation performed?
A small telescope is passed through a small incision in the abdomen (usually the belly button).  The abdomen is gently inflated with carbon dioxide to separate the tissues and allow space within the pelvis to operate.

Two or three further small incisions are made to allow instruments to be passed into the abdomen to perform the operation.  These incisions are closed with dissolvable stitches and covered with a small waterproof plaster.

Complications
Injury other structures / organs
There is a risk of accidental injury to the bowel, blood vessels, the bladder or the ureters (the tubes from the kidney to the bladder). The incidence of serious complications for a diagnostic laparoscopy (where the pelvis is simply inspected with no further surgery undertaken) is around 2:1000. The more complex the surgery however, the greater the risk, with the most complex surgery for endometriosis having up to a 10% significant complication rate. If such complications occur, a larger incision (laparotomy) may be required to do the necessary repair.

General Surgical Risks
As with all surgery there is a risk of infection, bleeding, deep vein thrombosis, pulmonary embolism (blood clot on the lung). Keyhole surgery, however, allows  early discharge  and more rapid return to normal activity with the aim to minimise these risks.


Specific post-operative care

  • From theatre you will be taken to the recovery room where staff will monitor your pulse, blood pressure, pain, sickness and wound sites.
  • You will have an intravenous drip in your arm.
  • If you experience some nausea (sickness) this can be controlled with medication.
  • Around half an hour later you will return to the ward.
  • On the ward you will receive regular pain killers and any anti sickness medication you require
  • You will be able to drink and eat as you feel able and to gradually increase what you are able to tolerate.
  • Initially you may experience some shoulder tip discomfort, which is due to trapped gas from the operation.  This will settle as the gas is absorbed.  Gentle mobilisation may also help once you are able.
  • You may have some vaginal bleeding, so a sanitary pad will be provided.
  • Once you have passed urine, are drinking and are able to move about you will be able to go home.
  • Some one will need to collect you and you will need someone with you at home over night


Specific discharge information

Pain Killers - you will need to take regular pain killers at home so it is best to ensure you have a good supply of paracetamol and ibuprofen (if you can take these) at home.

Fluid Leakage – after some operations one litre of a special solution called Adept is left in your abdomen. This is to try to reduce any adhesions / scar tissue formation post operatively and is designed to remain in the abdomen for 3-4 days. You will however notice fluid (usually blood stained) leaking from your incisions as some of this inevitably leaks out. This is nothing to worry about. You will also be aware of a  ‘sloshing’ feeling in your tummy during this time which again is quite normal

Activity - You will feel rather sore and this may continue for a few days. Take regular pain killers as above and, as you feel able, resume normal activity. Most ladies are back to normal activity, including work, in around two weeks.

Lifting / Exercise – avoid heavy lifting and aerobic workouts or strenuous exercise for 2-4 weeks.  You may start again gently when you feel comfortable.

Hygiene – you may shower, but do not soak in a bath until a week post operatively.  Ensure that your incisions are clean and dry after showering or bathing. You may remove the dressings / plasters over your incisions two days after the operation

Stitches -  the stitches used are dissolvable, however the part of the stitch on the outside may take longer than that on the inside to dissolve. Over time the outside part will fall away however if the stitch is irritating more than a week after surgery it can usually be removed by gently pulling on the end or cutting it carefully with scissors. If you have any significant problems with your stitches or if the area becomes sore, red or discharges please contact Mr Carpenter's Secretary or your GP.

Vaginal loss - Some vaginal bleeding / discharge is normal after surgery which should settle over the following week.

Urine – if you experience any discomfort i.e. burning or stinging when passing urine please contact Mr Carpenter’s Secretary or your GP

Diet - try to eat a healthy well balanced diet, including plenty of fibre and drink sufficient water to avoid constipation.  

Driving – you must not drive for 2 days after your anaesthetic, and you should not drive until you feel comfortable and are able to undertake an emergency stop.  

Sexual activity – you may resume sexual activity when you feel comfortable.

Work – you usually require 2 weeks off work.  Please ask for a sickness certificate before you leave hospital.

Follow Up
Follow up will be arranged by Mr Carpenter as appropriate