Patient Information. Having a Laparoscopy

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1 Patient Information Having a Laparoscopy

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3 This information has been written to explain your operation, and the benefits and risks. The medical and nursing staff will be happy to answer any questions you may have. What is a laparoscopy and why do I need this operation? A laparoscopy is an operation to allow your doctor to look inside your abdomen. This is done through 2 or more small cuts in your tummy using a telescope while you are asleep under general anaesthesia. A laparoscopy examines your uterus, fallopian tubes, ovaries and pelvic wall. Your doctor will discuss why this is necessary for you. It is a diagnostic procedure; it will not alter symptoms. What are the benefits of laparoscopy? Diagnosis is quick and the examination is relatively pain free. What are the risks, consequences and alternatives associated with having a laparoscopy? Most operations are straightforward; however as with any surgical procedure there is a small chance of side-effects or complications. Risks are divided into those which occur frequently and those which are less frequent but more serious. Women who are obese, have had previous surgery, or who have pre-existing medical conditions have an increased risk of the complications listed below. The doctor will discuss the risks and side-effects with you. Common risks Failure to identify disease to explain your symptoms. Bruising and discomfort around the scars on your abdomen. Shoulder-tip pain which should be short-term and not require more than simple painkilling tablets to relieve it.

4 Rare but more serious risks Damage to internal structures including bowel, bladder or major blood vessels (the risk is 3 in every 1000 procedures). Uterine perforation (accidentally making a small hole in the womb). Approximately 5 women in every 100,000 undergoing laparoscopy die as a result of complications. If complications do occur, the doctor may decide to perform open surgery - a laparotomy. This involves having a larger cut to your abdomen. If necessary, repair of any damage to bowel, bladder or blood vessels would then be carried out. Please be reassured that every effort is made to reduce the chances of this happening. It is possible that the doctor may be unable to gain entry to the abdominal cavity, and therefore will not be able to examine the inside of your tummy. If you are concerned about any of these risks, or have any further queries, please speak to your consultant. Alternatives It is likely that you will have had a pelvic ultrasound scan before this procedure being discussed. Sometimes we try a course of medication to see if this will reduce your symptoms. If you would like more information, please speak to your consultant or one of the nurses caring for you. There is also the option of not undergoing this procedure at all. If you would like more information please speak to your consultant or one of the nurses caring for you.

5 Before your laparoscopy You will be provided with information about how to prepare for your operation, either by staff on the ward or during a clinic appointment. You will be asked to sign a consent form to say that you understand what you have come into hospital for and what the operation involves. Stopping Smoking Smoking greatly increases the risk of complications during and after surgery. The sooner you stop the better. Even a few days before your operation can help to improve healing and recovery afterwards. For free help and advice contact your GP. It is advised that you do not start smoking immediately after the surgery as this can make you dizzy and possibly faint but also make you feel sick and actually vomit. Getting ready for the operation For a time before certain types of anaesthetic you will need to stop eating, drinking and chewing gum. This will be explained to you and you may also be given a booklet about this. If you have any questions please contact the hospital - telephone number on your admission letter. You will be asked to have a bath or shower before coming into hospital (if possible). You will be given a theatre gown to wear. A nurse or porter will take you on a trolley to the anaesthetic room.

6 What sort of anaesthetic will I have? Your operation will be carried out under general anaesthetic, which means you will be asleep throughout. The anaesthetist will visit you before your operation and discuss the anaesthetic with you. What happens during a laparoscopy? A laparoscopy usually takes less than ½ an hour. It is carried out using an instrument called a laparoscope, which is a type of small telescope. Usually 2 small cuts (each about 1cm long) are made in your abdomen (tummy). One cut is made just below your tummy button and the other is made lower down. The laparoscope is inserted through the cut just below your tummy button. It is connected to a video camera and television so that the inside of your abdomen can be seen on the screen. The doctor is then able to get a good view of your pelvic organs. At the start of the operation, gas is introduced through one of the cuts in your tummy to make it swell. This makes it easier to see what is happening through the camera. The gas is released through the cuts at the end of the operation. The 2 small cuts are closed with a clip or stitch - you will be told which. The stitches may be dissolvable. Each cut will then be covered with a small dressing. What should I expect after the operation? It is usual to feel drowsy for several hours. You will be given oxygen through a facemask until you are more awake. Anaesthetics can sometimes make people feel sick. The nurse may offer you an injection if the sick feeling does not go away, this will help to settle it.

7 The general anaesthetic may make you feel lethargic for a few days and you may have some general muscular aching. Your throat may feel dry and sore but this will improve after a couple of days. Pain You will experience some discomfort around the cuts and a feeling of bloatedness in your tummy and aching around your shoulders. The bloatedness is caused by gas collecting under the diaphragm (lower chest) and stimulating a nerve arising in the shoulder area - this is quite normal. The discomfort around the shoulders is due to the gas used during the operation creating pressure on an abdominal nerve that is also connected to the shoulder area. The discomfort should not last more than a day. If severe or the pain persists, you need to see your GP. You may take painkillers such as Paracetamol (do not exceed the stated dose), or peppermint water which will help to relieve it. Please make sure you have an adequate supply at home. Going home The operation is usually performed as a day case, which means there will be no overnight stay. You must not drive or go home by public transport. Therefore, you must make arrangements for someone to collect you. It is not appropriate to go home unaccompanied in a taxi. Please note hospital transport and ambulances are not normally available for day patients. You will need a responsible adult at home with you for 24 hours. You should rest quietly at home for the rest of the day and be aware that it could take 2-3 days before the weariness wears off.

8 DISCHARGE INFORMATION AND AT HOME ADVICE For 24 hours after your general anaesthetic, you must not: Drive a car or any other vehicle or cycle. Operate any machinery/domestic appliance or go back to work. Do any strenuous exercise. Drink alcohol. Please drink plenty of fluids, but not too much tea or coffee. A light diet is advised. Lock yourself in the bathroom or toilet or make yourself inaccessible to the person looking after you. Make any important decisions or sign any important documents. Be responsible for looking after small children. Watch too much television, read too much or use a computer. Dressings The elastoplast or dressings may be removed the morning after your laparoscopy. Plasters may be needed if oozing is present. The following day you may have a bath or shower.

9 Stitches Nurse to delete as necessary Your wound has dissolvable stitches, these do not need to be removed. If however, they have not dissolved and feel uncomfortable, your GP will remove them for you. Please make an appointment to have this done at your GP s surgery. Your wound has non-dissolvable stitches, which need to be removed by the practice nurse at your GP s surgery in 2-3 days time. You will need to take the yellow Sutures Out card to the surgery to make an appointment for this. Driving Do not drive until you can wear a seat belt comfortably and feel able to perform an emergency stop. Your insurance company may refuse to meet a claim if they feel you have driven too soon. It is also advisable to contact your insurance company with regards to cover following a general anaesthetic. Returning to work You can return to work as soon as you feel able. This is often in a few days to a week s time. Follow-up appointment If an outpatient appointment is needed, an appointment will either be sent to you through the post or given to you before you are discharged home. If an outpatient appointment is not needed, you should see your GP in 6 weeks time for a check-up.

10 Points to note You may experience some vaginal bleeding - this is normal and may last a few days. Contact your GP if your wound becomes increasingly painful, red or swollen in the days after you go home or if you develop severe abdominal pain or pain in the shoulder 24 hours after operation. Please show this booklet to your GP if you need to see him/her. References RCOG Consent Advice No. 2. Diagnostic laparoscopy. Royal College of Obstetricians and Gynaecologists. London, October 2004 If you have any queries or require further information please telephone and ask for your ward.

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