Laparoscopy How to Navigate When Viewing This Information Online

RECOVERING WELL

Information for you after a Laparoscopy How to navigate when viewing this information online

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Who is this Starting HRT Getting back to normal information for? (hormone replacement therapy) Around the house About this information Talking with your gynaecologist Exercise after your operation Driving What can I expect after a Tiredness Travel plans laparoscopy? What can help me recover? Having sex Usual length of stay A daily routine in hospital Returning to work Eat a healthy balanced diet After-effects of general Stop smoking anaesthesia A positive outlook Scars Stitches and dressings What can slow down my Vaginal bleeding recovery? Pain and discomfort When should I seek medical Starting to eat and drink advice after a laparoscopy? Washing and showering

Formation of blood clots - how to reduce the risk

About this information This information is for you if you are about to You should read this information have, or you are recovering from, a laparoscopy together with any other information (keyhole surgery).You might also find it useful to you have been given about your choices and the operation itself. This information share this information with your family and friends. gives general advice based on women’s experiences and expert opinion. Every You may be having, or have had, a treatment of severe endometriosis or woman has different needs and recovers laparoscopy: hysterectomy (major procedures) in different ways. Your own recovery will • to help your gynaecologist make - if you are having a hysterectomy, depend on: a diagnosis by looking inside your pelvis you may find helpful information in • how fit and well you are before your - this is known as a diagnostic Recovering well: information for you operation laparoscopy after a laparoscopic hysterectomy. • the reason you are having a • as a treatment - this is known as an laparoscopy operative laparoscopy and includes This information is for you if you • the exact type of laparoscopy that procedures such as: are having, or have had, a diagnostic laparoscopy and/or an operative you have sterilisation or a small amount of • how smoothly the operation treatment of endometriosis (simple laparoscopy where simple or intermediate procedures are performed. goes and whether there are any procedures) complications. removal of an ovarian cyst, Your operation will depend on your treatment of an ectopic pregnancy, personal circumstances and will be removal of one or both ovaries or discussed with you by your gynaecologist division of scar tissue (intermediate before your operation. procedures)

Usual length of stay in hospital After-effects of general anaesthesia If you are having a diagnostic laparoscopy, Most modern anaesthetics are short you should be able to go home on the lasting. You should not have, or suffer same day. This operation is usually done from, any after-effects for more than a as a day case. When you wake from day after your operation. During the the anaesthetic, your nurse will want to first 24 hours you may feel more sleepy make sure that you are not in pain and than usual and your judgement may be that it is safe for you to go home before impaired. If you drink any alcohol, it will you are discharged. This usually takes affect you more than normal. You should between three and four hours. have an adult with you during this time and you should not drive or make any When you go home, make sure that you important decisions. are not alone and that someone can stay with you overnight. Scars If you have had a simple procedure as You will have between one and four part of an operative laparoscopy, you small scars on different parts of your may be able to go home on the same abdomen - one scar will usually be in day, though you may be asked to stay in your tummy button. Each scar will be hospital overnight. between 0.5 cm and 1 cm long. More >

Stitches and dressings Pain and discomfort Starting to eat and drink Your cuts will be closed by stitches or You can expect some pain and If you have had a short general glue. Glue and some stitches dissolve by discomfort in your lower abdomen for anaesthetic, once you are awake, you will themselves. Other stitches may need to the first few days after your operation. be offered a drink of water or cup of tea be removed. This is usually done by the You may also have some pain in your and something light to eat before you go practice nurse at your GP surgery about shoulder. This is a common side effect of home. five to seven days after your operation. the operation. When leaving hospital, you You will be given information about this. will usually be provided with painkillers Your cuts will initially be covered with a for the pain you are experiencing. dressing. You should be able to take this Sometimes painkillers that contain off about 24 hours after your operation codeine or dihydrocodeine can make and have a wash or shower (see section you sleepy, slightly sick and constipated. If on washing and showering). you do need to take these medications, try to eat extra fruit and fibre to reduce Vaginal bleeding the chances of becoming constipated. More> You may get a small amount of vaginal bleeding for 24 to 48 hours.

Washing and showering Formation of blood clots - how to You may also be given other measures You should be able to have a shower or reduce the risk to reduce the risk of a clot developing, bath and remove any dressing 24 hours There is a small risk of blood clots particularly if you are overweight or have after your operation. When you first forming in the veins in your legs and other health issues. These may include: take a shower or bath, it is a good idea pelvis (deep vein thrombosis) after any • daily heparin injections (a blood- for someone to be at home with you to operation. These clots can travel to the thinning agent) you may need to help you if you feel faint or dizzy. Don’t lungs (pulmonary embolism), which continue having these injections daily worry about getting your scars wet - just could be serious. You can reduce the risk when you go home; your doctor will ensure that you pat them dry with clean of clots by: advise you on the length of time you disposable tissues or let them dry in the • being as mobile as you can as early as should have these for air. Keeping scars clean and dry helps you can after your operation • graduated compression stockings, healing. • doing exercises when you are resting, which should be worn day and night for example: until your movement has improved pump each foot up and down and your mobility is no longer briskly for 30 seconds by moving significantly reduced your ankle • special boots that inflate and move each foot in a circular deflate to earw while in hospital. motion or 30 seconds More> bend and straighten your legs - one leg at a time, three times for each leg.

Starting HRT Tiredness (hormone replacement therapy) You may feel much more tired than If your ovaries have been removed usual after your operation as your body during your operation, you may be offered is using a lot of energy to heal itself. You hormone replacement therapy (HRT). may need to take a nap during the day This will be discussed with you by your for the first few days. For many women gynaecologist and together you can decide this is the last symptom to improve. the best way.

Talking with your gynaecologist after your operation Your gynaecologist or another member of the surgical team may come and talk with you after your operation. Because you may still be coming round from the effects of the anaesthetic, it may be helpful for someone to be with you during this discussion. That way you can both ask questions and talk over what was said later on.

information about a smoking cessation It takes time for your body to heal and for you clinic in your area, speak with the nurse to get fit and well again after a laparoscopy. There in your GP surgery. are a number of positive steps you can take at this A positive outlook time. The following will help you recover. Your attitude towards how you are recovering is an important factor in A daily routine Remember to eat at least five portions determining how your body heals and of fruit and vegetables each day! how you feel in yourself. You may want Establish a daily routine and keep it up. to use your recovery time as a chance to For example, try to get up at your usual Stop smoking make some longer term positive lifestyle time, have a wash and get dressed, move choices such as: about and so on. Sleeping in and staying Stopping smoking will benefit your in bed can make you feel depressed. Try health in all sorts of ways, such as • starting to exercise regularly if you to complete your routine and rest later lessening the risk of a wound infection are not doing so already and gradually if you need to. or chest problems after your anaesthetic. building up the levels of exercise that By not smoking - even if it is just while you take Eat a healthy and balanced diet you are recovering - you will bring • eating a healthy diet - if you are Ensure that your body has all the immediate benefits to your health. If overweight, it is best to eat healthily nutrients it needs by eating a healthy you are unable to stop smoking before without trying to lose weight for the balanced diet. A healthy diet is a high- your operation, you may need to bring first couple of weeks after the fibre diet (fruit, vegetables, wholegrain nicotine replacements for use during operation; after that, you may want to bread and cereal) with up to two litres your hospital stay. You will not be able to lose weight by combining a healthy diet per day of fluid intake, mainly water. smoke in hospital. If you would like with exercise.

It can take longer to recover from a recovery, and smoking can delay the • there were any complications laparoscopy if: healing process during your operation. • you had health problems before your • you were overweight at the time of Recovering after an operation is a operation; for example, women with your operation - if you are very personal experience. If you are diabetes may heal more slowly and overweight, it can take longer following all the advice that you have be more prone to infection to recover from the effects of the been given but do not think that you • you smoke - smokers are at anaesthetic and there is a higher risk are at the stage you ought to be, talk increased risk of getting a chest or of complications such as infection with your GP. wound infection during their and thrombosis

You should seek medical advice from • A painful, red, swollen, hot leg or While most women your GP, the hospital where you had difficulty bearing weight on your recover well after your operation, NHS 111 or NHS 24 if legs: This may be due to a deep vein thrombosis (DVT). If you have a laparoscopy, you experience: • Burning and stinging when you shortness of breath or chest pain complications can pass urine or pass urine frequently: or cough up blood, it could be a sign occur - as with any This may be due to a urine infection. that a blood clot has travelled to the Treatment is with a course of lungs (pulmonary embolism). If you operation. antibiotics. have these symptoms, you should seek medical help immediately. • Red and painful skin around your scars: This may be due to a wound • There is no improvement in infection. Treatment is with a course your symptoms: You should expect a of antibiotics. gradual improvement in your symptoms over time. If this is not the • Increasing abdominal pain: If you also case, you should seek medical advice. have a temperature (fever), have lost your appetite and are vomiting, this may be due to damage to your bowel or bladder, in which case you will need to be admitted to hospital.

Around the house that normal physical activity levels are Before you drive you should be: While it is important to take enough rest, in any way harmful and a regular and • free from the sedative effects of any you should start some of your normal gradual build-up of activity will assist your painkillers daily activities as soon as you feel able. recovery. Most women should be able • able to sit in the car comfortably and You will find you are able to do more as to walk slowly and steadily for 30-60 work the controls the days pass. If you feel pain, you should minutes by the middle of the first week, • able to wear the seatbelt comfortably and will be back to their previous activity try doing a little less for another few • able to make an emergency stop days. levels by the second week. Swimming is an ideal exercise and, if you have had • able to comfortably look over your Remember to lift correctly by having no additional procedure, you can start shoulder to manoeuvre. your feet slightly apart, bending your as soon as you feel comfortable. If you It is a good idea to practise without the knees, keeping your back straight and have had other procedures with the keys in the ignition. See whether you bracing (tightening or strengthening) your laparoscopy, you may need to avoid can do the movements you would need pelvic floor and stomach muscles as you contact sports and power sports for for an emergency stop and a three- lift. Hold the object close to you and lift a few more weeks, although this will point turn without causing yourself any by straightening your knees. depend on your levels of fitness before discomfort or pain. When you are ready surgery. to start driving again, build up gradually, Exercise starting with a short journey. The day after your operation you Driving More> should be able to go for a short 10 to You should not drive for 24 hours after a 15 minute walk in the morning and the general anaesthetic. Each insurance afternoon, having a rest afterwards if you need to. You should be able to increase company will have their own conditions your activity levels quite rapidly over for when you are insured to start driving again. Check your policy. the first week. There is no evidence

Travel plans If you are considering travelling during Does your travel insurance cover your recovery, it is helpful to think about: any necessary medical treatment in • the length of your journey - journeys the event of a problem after your over four hours where you are not operation? able to move around (in a car, coach, • whether your plans are in line with train or plane) can increase your risk the levels of activity recommended of deep vein thrombosis (DVT); this in this information. is especially so if you are travelling If you have concerns about your travel soon after your operation plans, it is important to discuss these with • how comfortable you will be during your GP or the hospital where you have your journey, particularly if you your operation before travelling. are wearing a seatbelt • overseas travel: Having sex Would you have access to It is safe to have sex when you feel ready. appropriate medical advice at If your vagina feels dry, especially if you your destination if you were to have had both ovaries removed, try using have a problem after your a lubricant. You can buy this from your operation? local pharmacy.

When you go back to work will depend pressurised by family, friends or your Most women feel on the type of job you do. If you do employer to return to work before you able to return to work heavy manual work, or are on your feel ready. You do not need your GP’s one to three weeks after feet all day, you may need longer than permission to go back to work. The someone who can sit down at work. You decision is yours. a laparoscopy. do not need to avoid lifting or standing after this type of operation, but you may • If you have had a diagnostic feel more tired if you have a physically laparoscopy or a simple procedure demanding job. such as a sterilisation, you can If you are off work for less than one expect to feel able to go back week, you should be able to complete a to work within one week. Although self-certification form for the time you you will not be harmed by doing have been off work. If it is longer than light work just after surgery, it would one week, you will need to obtain a be unwise to try to do much certificate from the hospital where you within the first 48 hours. have your operation. • If you have a procedure as part of You might also wish to see your GP or an operative laparoscopy, such your occupational health department as removal of an ovarian cyst, you before you go back and do certain jobs can expect to return two to three - discuss this with them before your weeks after your operation. If you operation. You should not feel feel well, you will not be harmed by doing light work on reduced hours after a week or so.

© Royal College of Obstetricians and Gynaecologists 2015 Contents Previous view Acknowledgements This information was developed by a multidisciplinary working party on recovery following gynaecological surgery and was peer reviewed by experts in the field and by patients and the public.

The production of this PDF has been funded by an Ethicon Educational Grant. All content has been independently developed by the RCOG (Registered charity no. 213280).