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This information leaflet is written for women for whom a laparotomy is being considered. The information is of a general nature and your care will be tailored to your own needs.
What does the surgery involve?
A laparotomy simply means opening the abdomen with an incision to allow surgery to be performed. The use of the term implies some degree of uncertainty as to what will be found and what will need to be done to put it right. A common reason for performing a laparotomy is abdominal pain of uncertain origin, especially severe pain with a sudden onset. Causes for such pain include ectopic pregnancy, ovarian cysts, pelvic infection and appendicitis. Another indication for a laparotomy is a pelvic swelling of uncertain origin.
Depending on the suspected cause of the pain and the size of any pelvic swelling, you may require a low transverse (bikini-line) incision or a vertical midline incision from your pubic bone to your umbilicus (and sometimes above this level).
The exact nature of the surgery that I perform depends on what I find and your individual circumstances. I will discuss the range of possibilities prior to surgery but there will always be an element of uncertainty. I will clarify with you beforehand whether there are any particular procedures that you would not want to be performed under any circumstances.
A general anaesthetic is usually required although an epidural is sometimes preferred. More information is available at the Royal College of Anaesthetists website.
After the Surgery
- You will be given appropriate pain relief. This may be given through the intravenous line for the first 24-36 hours and is known as “Patient-Controlled Analgesia” (PCA) because you can increase the dose yourself by pressing a button. Other types of pain relief include injections, suppositories and tablets.
- You may be given an anti-sickness injection if necessary.
- You will be kept 'nil by mouth' at first to enable you to recover from the anaesthetic. You will usually be able to drink the following morning, slowly increasing the amount, and then starting solid foods.
- The drip in your arm will be supplying you with fluids until you are drinking normally.
- A catheter will enable you to pass urine, and is usually removed after 24 - 48 hours. The amount of urine you pass each time will be recorded to make sure you are emptying your bladder completely.
- Any drains in the abdomen will be removed when the amount of fluid being drawn off has settled down.
- You will get out of bed on the day following the operation because this reduces the risk of complications.
- If you have stitches that need to be removed they will be taken out at around 5-6 days after the operation. Your district nurse can do this if you have gone home before they are ready to be removed. If you had a vertical cut during the operation the stitches will need to stay in for longer.
Potential complications of the surgery
Going home - Once you are eating and drinking, passing urine normally and opening your bowels, you may be discharged home. This usually takes around 3-5 days. Your individual recovery and home circumstances will be taken into account when deciding when you can go home.
- All operations carry a risk of complications. Most complications are relatively minor and can be easily put right. Examples include infections of the chest or bladder.
- Bleeding may occur during or after surgery and can usually be stopped without difficulty, although a blood transfusion may occasionally be necessary. Very rarely women need to return to theatre to stop the bleeding.
- Some women find it difficult to empty their bladder properly after surgery. A catheter (tube) may need to be put back into the bladder if this happens.
- Injury to the bladder or bowel is fairly rare and, if recognised, can usually be repaired during the operation. Women who have an injury to the bladder need to have a catheter in their bladder for 1-2 weeks whilst the injury heals. On very rare occasions, such an injury does not heal completely and further surgery is needed at a later date.
- There may be problems with the wound, including infection, rupture during healing and, much later, an ‘incisional hernia’, where the healed wound is weak and bulges out.
- If the ovaries are removed and you have not yet reached the menopause, you may experience hot flushes and night sweats. These can usually be controlled by hormone replacement therapy.
- Rare, but potentially serious, complications of all operations include allergic reactions to anaesthetic drugs, deep vein thrombosis (a blood clot in the leg), pulmonary embolus (a blood clot in the lung), heart attack and stroke. The risk of serious complications increases with age, and also if you have other significant medical problems.
After leaving hospital
- You may be prescribed antibiotics and pain-killing medicines and these should be taken as prescribed.
- You should not drive and you should avoid lifting for 4-6 weeks. You should avoid heavy lifting for 2-3 months.
- You should check with your motor insurance company before driving a car.
- Prevent constipation and straining, and damage to the surgery site, by drinking lots of fluids and eating foods with a high fibre content e.g. fruit, vegetables, wholemeal bread.
- Walking is good for you and you should gradually increase the distance covered, reducing the distance if you develop pain and become very tired.
- You will be given an appointment to see me for a check-up in around 6 weeks time.
- It is normal to have some lower abdominal discomfort for 6-8 weeks following surgery. However, if you have increasing abdominal pain then you should telephone the ward at Fawkham Manor Hospital on: 01474 879900