Laparoscopy: before and after tips

by Ellen Johnson

Laparoscopic surgery is different for everyone. Each of us will have a different experience based on our expectations, the extent of surgery, the length of surgery, the surgeon, the facility, the nursing staff, how we respond to pain, and a variety of other factors.

Additionally, each person heals differently. What is true for one person may not be true for another. Medical professionals may tell us it takes only a few days to recuperate from a laparoscopy. Yet most of us have found that true healing takes much longer than that, usually several weeks.

Since few resources exist that discuss laparoscopy from a patient’s perspective, the following information was compiled to give women a better idea of what is involved before and after laparoscopy.

Overview of the procedure

Laparoscopy is usually done under general anaesthesia. Generally, a small incision is made near the belly button and the abdomen is filled with CO2 gas. This lifts the abdomen away from the internal organs, giving the surgeon a better view. The lighted laparoscope is then inserted into the abdomen. Two other small incisions may be made in the abdomen so additional surgical instruments, such as a probe to move organs, can be used during the surgery. Many surgeons also attach a video camera to the laparoscope to enlarge the view, allowing the entire surgical team to see the procedure.

During the laparoscopy, the doctor examines the pelvic organs, looking for obvious and atypical endometriosis lesions as well as endometriomas (endometriosis-filled cysts), adhesions, and scarring. Depending on your history and symptoms, the doctor may also look for fibroid tumours or other abnormalities. Other procedures, such as a hysteroscopy (an examination of the inside of the uterus) may also be performed.

Diagnosis and treatment of endometriosis may take place during the same procedure. Your doctor may also remove the lesions to send to a lab for biopsy. This will document the presence or absence of endometriosis.

Length of stay

Laparoscopy is usually done on an outpatient basis, although an overnight stay may be required if the surgery is complex or lengthy. If a bowel resection or partial bowel resection is performed, your hospital stay may be extended by several days. It’s a good idea to be mentally prepared to spend at least one night.

Fears

Almost everyone has some fears about surgery. We may worry about the risks, the anaesthesia, the pain, or what the surgeon may (or may not) find. If you’re scared, it helps to determine what you’re afraid of, then work toward minimising that particular fear. For example, if you’re afraid of the anaesthesia, talk with your doctor and the anaesthesiologist before the procedure to discuss your fears. If you are afraid of the pain, ask your doctor exactly how your pain will be managed. Many women have found that relaxation tapes before, during, and after surgery also help allay fears.

What should you take to the hospital?

Pack very loose clothing to wear after surgery, preferably something without a waistband. An oversized pullover dress is ideal. You may also want to take mini-pads, socks, and slip-on shoes or house slippers. If there is a possibility you may be staying overnight, consider packing a hairbrush, lotion, bathrobe, toothbrush/toothpaste, and maybe a stuffed animal.

Bowel prep

The surgeon often orders a bowel prep the evening before surgery. The process varies, but usually includes a liquid diet and various preparations to evacuate your bowels. This is not a pleasant process, but it is necessary if any bowel work is anticipated. For more information, see our article about how to survive a bowel prep.

Pain immediately following surgery

When you come out of the anaesthesia in the recovery room, you may be in some pain. If so, be sure to speak up so your pain can be properly managed. Coming out from anaesthesia will also make you feel cold. Ask for more warm blankets if you’re chilled. You may also have a sore throat from the tube that’s put in your throat during surgery. If any symptom becomes bothersome, tell the nurse or doctor. In most cases, you’ll be given a prescription for pain medication to take at home. If possible, have this prescription filled prior to your discharge or very soon thereafter.

Have a buddy

Even if your surgery is scheduled to be on an outpatient basis, you will be required to have someone drive you home. It’s a good idea to choose someone who is helpful and supportive and who can assist you into the house. If they can stay overnight in your home, even better. At least for the first evening, you will be groggy and may have some difficulty getting around.

Shoulder pain

One of the most disconcerting things about laparoscopy is the subsequent shoulder pain. This is caused by the CO2 gas becoming trapped against the diaphragm. Heat and analgesics often bring relief. Be assured that time will take care of this pain. For more information about how to manage shoulder pain, read our article about post-surgery ailments.

Nausea

It seems that most of us experience some nausea after laparoscopy. Many medications exist to help with this. Some can be taken before surgery, some during, and some after. Talk with your doctor and/or anaesthesiologist beforehand about the methods they use to minimise nausea. Many women find that nausea is lessened when they lay flat. Some natural remedies, such as ginger tea, may also alleviate nausea. To be on the safe side, always ask your health care professional before taking any herbs or supplements.

Length of recovery

For the first two or three days following laparoscopy, most women are tired and groggy. During this time, it helps to have a family member or friend remain close by. You may want to put this person in charge of managing your medications for the first couple of days. You will probably also need someone to fix your meals for a short time.

Recuperation during the first two weeks

Your doctor may restrict driving for two weeks following laparoscopy. Intercourse, tub bathing, douching, and swimming will also be restricted. Don’t expect too much of yourself for the first few days. You will probably be very tired and need lots of naps. However, be sure to get up and move around as you’re able. You will recover more quickly if you move about.

Post-op blues

Most of us experience a period of emotional ups and downs following surgery. For some, the blues remain for several weeks. It’s not unusual to cry easily or become anxious, agitated, frightened, or suspicious. Some of us have also experienced nightmares following surgery. All of this will pass in time and you will begin to feel in control again. Be gentle and patient with yourself during your physical and emotional recovery.

Incisional numbness

You may feel a “pins and needles” sensation at the incision site. This is due to the nerves being cut. Over time, the nerves will heal and the sensation will subside. If you have bothersome symptoms at the incision site, such as a knot, swelling, or redness, contact your doctor.

Loose clothing following surgery

Most of us have found that comfy clothes are very welcome during the first few weeks after laparoscopy. The incision site will be tender and the abdomen swollen. Therefore, you probably won’t want to wear anything snug around the middle. If you don’t have many loose-fitting clothes, you may want to purchase a few outfits prior to surgery.

First menstruation following surgery

Experiences with the first menstrual period vary dramatically. If your period is more painful, longer, or heavier than usual, don’t panic. Internal healing takes much longer than external healing. Therefore, your first few periods may be more painful. However, if you are concerned about the degree of pain, or if your pain is severe, contact your doctor.

Talk with others

Talking with others about their experiences is also beneficial. Most women in endometriosis support groups have had a laparoscopy and can provide valuable information to anyone going through it for the first time.