Laparotomy (Open Abdominal Surgery) Surgical Business Unit - Gynaecology

Laparotomy

This information leaflet is to explain what a ‘Laparotomy’ (or open abdominal surgery) is, why this type of surgery is carried out, the risks and benefits of the procedure; and what to expect after your operation. What is a laparotomy? A laparotomy is a way of performing operations by making an incision (cut) across the front of the abdomen (tummy). Your doctor should explain at the time of the operation if you are having up- and-down incision (midline) or bikini line (low transverse) incision. When is laparotomy performed? Laparotomy was the most common way of performing abdominal surgery until the key hole (Laparoscopic surgery) surgery was developed. However, it is still used for some operations, such as:  Removing the womb (Hysterectomy), if it is too large to be removed with keyhole surgery  Removing large fibroids or large ovarian cysts  Some types of surgery for cancer  When it is not possible to stop bleeding or repair damaged structures by keyhole surgery

Are there risks with this procedure? There are some risks of having a laparotomy performed, as there are with any operations. Problems that frequently occur after this type of surgery include:

 Pain is common following such surgery but we will ensure you are given appropriate painkillers to help deal with this during your stay in hospital and recovery at home.  Wound infection  Bruising and thickened scar (Keloid scar) formation.  Numbness, tingling or burning sensation around the scar. This usually resolves over time.  Water infection and the need to empty the bladder frequently.  Early menopause if you have had a hysterectomy.

Some serious complications may include:

 Damage to the bladder and /or ureter (a tube connecting the kidney and bladder)- 7 out of 100 women undergoing laparotomy.  Damage to the bowel in 4 women out of 1000.  Heavy bleeding which requires blood transfusion in 23 women out of 1000.  Return to theatre after surgery because of bleeding or problems with the wound in 7 women out of 100.  Infection in the pelvis in 2 women out of 1000.  Blood clots in the legs or lungs (DVT or PE ) in 4 women out of 1000.  Risk of death within 6 weeks of surgery in 32 women in 100,000 ( rare)  Anaesthetic complications-your anaesthetist will discuss these with you prior to your operation.

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What to expect after operation? You will wake up from the operation in the recovery area and will be transferred to the gynaecology ward when you are well enough. Some patients are transferred to the high dependency unit (HDU) if they have health problems.

You are likely to be able to eat and drink again either later the same day or the following morning.

You may have a catheter in place to empty your bladder. This is usually removed the following day when you are able to walk comfortably to the toilet.

We like to help you get out of bed on the first day following surgery, as this helps you recover quicker and reduces the risk of problems following operation.

We usually suggest giving you blood thinning injection for 7-10 days after surgery to reduce the risk of developing blood clots in the legs and lungs. We will teach you how to give yourself the injections before you leave the hospital.

What to expect during your recovery

It is important to remain mobile after you are discharged from the hospital as this reduces the risk of developing chest infections and blood clots.

Stitches: The stiches used during surgery usually dissolve by themselves after 2-3 weeks but we will advise you if you have stitches or staples that need to be removed at a later date.

Vaginal bleeding or discharge: It is common to have light vaginal bleeding if you have had hysterectomy. Please see your GP, if this becomes heavy or smelly.

Menopause: If you had not entered the menopause before surgery and had your ovaries removed, it is likely you will get menopause symptoms such as night sweats, hot flushes, mood swings and vaginal dryness. Your symptoms will settle down with time, but if it is problem you discuss options for dealing with this with your GP.

Returning to normal activities: For the first 2 weeks you should lift nothing heavier than a kettle half full of water. You should avoid lifting heavy objects and housework for up to 4 weeks as this may affect healing. Thereafter, gradually increase your activity as you improve. It may take up to 3 months to resume your daily routine. The key is to gradually increase your daily activity until you are back to normal.

Driving: Driving should generally be avoided for 6 weeks following surgery. It is sensible to inform your insurer that you have had surgery.

Returning to work: This depends upon your recovery and the nature of your work. Generally you will need 6-12 weeks off.

Sex: We recommend waiting at least 6 weeks before attempting to have sex to allow healing.

3 www.qegateshead.nhs.uk Follow up: You may or may not require a hospital follow up visit and this will be discussed with you before you are discharged home. If no formal follow up is planned, any outstanding results e.g. microscopic examination of tissue removed during surgery will be communicated by letter to you and your GP.

When should I seek help?

Please seek medical advice if you develop any of the following symptoms:

 Burning and stinging when you pass urine.  Red and painful skin around your scars.  Increasing abdominal pain, loss of appetite or vomiting.  If you develop a fever with or without associated chills.  A painful, red, swollen, hot leg or difficulty weight bearing on your legs.  If you have shortness of breath, chest pain or cough up blood (seek help immediately).  If you have any other concerns or feel unwell.

You can get advice from your GP or from ward 27(contact details below). In an emergency please attend Accident and Emergency.

Data Protection Any personal information is kept confidential. There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible. In order to assist us to improve the services available, your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews. Further information is available in the leaflet Disclosure of Confidential Information IL137, via Gateshead Health NHS Foundation Trust website or the PALS Service.

This leaflet can be made available in other languages and formats upon request

NoIL614 Version: 1 First Published: Jan 2018 Review Date: Jan 2020

Author: Dr M De

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