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Gynecologic
Surgery
.com
FrequentlyAsked
Questions
and
What to Expect
Before and
After Your
Abdominal
Surgery
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Two methods of abdominal surgery are
laparotomy and laparoscopy.
This booklet addresses both kinds of surgery.
Laparotomy
• Laparotomy refers to the opening of the abdominal cavity for direct
examination of its contents, for example, to locate a source of bleeding. It
may or may not be followed by repair or removal of the primary problem.
You will be undergoing a surgical procedure
that involves the abdomen. We have prepared
this booklet to put your mind at ease by
addressing how you will feel physically and
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INTRODUCTION
Laparoscopy
• Laparoscopy is a minimally-invasive approach to abdominal surgery
where rigid tubes are inserted through small incisions into the
abdominal cavity. The tubes allow introduction of a small camera,
surgical instrument, and gases into the cavity for direct or indirect
visualization and treatment of the problem. The abdomen is inflated
with carbon dioxide gas to make the area easier to see, and a video
what you can expect as your body heals.
camera is used to show the procedure on a monitor in the operating
For additional resources, we recommend
to perform procedures such as a hysterectomy. The laparoscopic method
room. The surgeon moves the instruments within the abdominal cavity
speeds recovery time and reduces blood loss and infection as compared
you visit www.VirginiaWomensCenter.com.
to the traditional “open” hysterectomy. However, it is not appropriate
for every patient.
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Hysterectomy
TABLE OF CONTENTS
Hysterectomy is a common abdominal surgery that may be performed
using laparotomy or laparoscopy to treat conditions that affect the uterus.
Some reasons a hysterectomy may be needed include: PREPARING FOR SURGERY. . . . 4
• Uterine fibroids
JUST AFTER SURGERY. . . . . . . 6
• Endometriosis
ABDOMINAL DISCOMFORT. . . . 7
• Pelvic support problems (such as uterine prolapse)
AFTER DISCHARGE . . . . . . . . . 9
• Abnormal uterine bleeding
RECOVERY TIME. . . . . . . . . . . 11
PROBLEMS. . . . . . . . . . . . . . . 12
• Cancer
• Chronic pelvic pain
• Total Abdominal Hysterectomy (TAH)
• Vaginal Hysterectomy (VH)
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The type of hysterectomy chosen depends on the reason for the surgery
and the findings of a pelvic exam. Your doctor will discuss the following
options with you: Important
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• Laparoscopically Assisted Vaginal Hysterectomy (LAVH)
• Laparoscopic Supracervical Hysterectomy (LSH) or
Total Laparoscopic Hysterectomy (TLH)
Hysterectomy can have both physical and emotional effects. Some last
a short time. Others are long term. You should be aware of these effects
before having the surgery.
Doctor:______________________________________________________
Nurse Practitioner:_______________________________________________
Nurse:______________________________________________________
__________________________________________________________
Nights/Weekends –
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PREPARING FOR SURGERY
Q: How long will I be out of work or unable to perform my normal routine?
Q: Do I need to take any medications before surgery?
A: Depending on your situation and your surgery, your surgeon may
give you an antibiotic to prevent infection, based on Centers for
Disease Control guidelines.
A: If you are having a laparotomy, total abdominal hysterectomy or vaginal
hysterectomy, plan to be on a different schedule for four to six weeks.
Q: Do I need to shave my abdomen or pubic area?
A: I f your procedure is being done laparoscopically, you will need to
allow up to 48 hours following your procedure to return to routine
activity. Though you may feel better the morning following surgery,
you will still need rest.
Q: Will I be able to eat before surgery?
Q: Will I need any testing from the hospital before the surgery?
A: You will need certain tests, based on your age, medical history and the
type of surgery being done. Tests may include blood work, chest X-ray,
EKG, urinalysis and cultures, a pregnancy test and possibly other
cardiac tests. If you have medical problems, pre-op medical or cardiac
clearance by a physician may be required. In some cases, our scheduler
will tell you when to go to the hospital to have the tests done, or
someone from the hospital will call you to schedule the visit. The tests
are usually done 7 to 10 days before surgery.
A: No. Shaving with a razor can increase the risk of infection.
We will trim your abdomen or pubic areas as needed.
A: No, you will not be able to eat or drink, including sips of water or coffee,
after midnight. You may be instructed to take your regular medications
with small sips of water.
Q: Will I be given an enema?
A: The answer to this varies. Your doctor will discuss specific bowel
preparation instructions with you prior to surgery, depending on
your type of procedure.
Q: Will I have an IV in my arm?
Q: Do I need to stop any medicines?
A: I f you take Coumadin, Plavix or any other prescription blood thinners
you will have to stop them about four to seven days prior to surgery.
You will need to speak with the doctor who prescribes those medicines
for you to determine if they would like you to take anything else during
that period. If you are taking Aspirin, Motrin, Advil or any other cold/
fever medicine or anti-inflammatory you should stop them one week
before the surgery. If you are taking herbal supplements, please stop
them one week before the surgery as well, as many have blood thinning
properties. Your surgeon or the hospital staff can address questions
about any other medications.
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A: Yes. This is inserted while you are in the holding area to give you
medication and fluids through your arm before and during surgery.
It will be in place after surgery while you are in the hospital and
removed prior to discharge.
Q: Should I pack anything special?
A: W hen you leave the hospital, many women like to wear loose-fitting
clothing for the trip home. Stretch pants, draw-string pants or a
flowing dress are usually the most comfortable. Do not bring valuable
items with you to the hospital.
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Q: How long will I stay in the hospital?
Q: How much or little am I supposed to move after surgery?
A: For laparotomy, total abdominal hysterectomy and vaginal
hysterectomy, you will usually stay in the hospital one to three days
depending on the procedure and your insurance. Your insurance will
authorize a length of stay for you. If additional days are required, these
will also have to be authorized.
A: After laparotomy, total abdominal hysterectomy and vaginal
hysterectomy, the nurses will encourage and help you to turn frequently
in the bed. Later, you will be encouraged to sit up, get out of the bed
and walk to the bathroom. Once you can do this, you will then walk in
the hall. These activities assist in the healing process and help your
body return to normal.
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A: Many laparoscopic procedures are performed as outpatient, so you
will go home the same day. Laparoscopic hysterectomies and some
other procedures require an overnight stay. If additional days are
required, these will have to be authorized.
Immediately after the surgery, you will be given a small pillow to use to
“splint” your abdomen whenever you move. You will use this for deep
breathing, laughing and coughing to help you cushion these muscles as
they heal. You will continue to use this “pillow” for a few weeks upon
leaving the hospital.
JUST AFTER SURGERY
A: After laparoscopy, you should not stay in bed, as prolonged bed rest
can cause blood clots in your legs. However you should avoid heavy
lifting for one to two weeks.
A: Anesthesia affects people differently. You may be very sleepy
or wide awake.
If you experience nausea, the doctor can prescribe medication to
treat it. Any nausea usually decreases and disappears within
12 to 24 hours of the procedure.
Q: Will I have a urinary catheter when I wake up?
A: Following laparotomy, total abdominal hysterectomy and vaginal
hysterectomy, you will have a catheter coming from the bladder and
draining urine into a bag on the side of the bed. Typically, the catheter
is removed the morning after the surgery.
A: If you are having a laparoscopic procedure, you will have a catheter
during surgery. It may be removed prior to your awakening or the
following day.
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Q: How will I feel when I wake up from anesthesia?
ABDOMINAL DISCOMFORT
Q: Will I be in any pain after surgery?
A: Following laparotomy, total abdominal hysterectomy and vaginal
hysterectomy, most patients are placed on a PCA pump (Patient
Controlled Analgesia). The PCA pump gives you the ability to adjust
the amount of medication necessary to relieve any discomfort you may
have. The pump delivers a set amount of medication which you can
control by pressing a button when needed. After one to two days
following the procedure, you will no longer need this type of pain relief,
and your physician will order a narcotic pain medication that you will
take by mouth as needed.
A: For laparoscopic procedures, it is not unusual to experience some
discomfort under your ribs and/or soreness of your neck and shoulders
over the first one to two days. This is due to the gas used in your
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Q: W hat if I become constipated?
A: U
sually, you will experience a normal bowel movement two to four
days following surgery. However some pain medications may cause
constipation. You may be given a stool softener to take while in the
hospital and at home. If you do develop constipation, you can try
heating prunes in a little water or take Milk of Magnesia, as directed.
If these are not enough, you can purchase Magnesium Citrate over
the counter once you are home. Drink one-half bottle. If no results
occur within four to six hours, drink the other half bottle. This may be
repeated one more time. If still no results occur, please call the office.
Q: Should I anticipate anything else after my laparotomy, total hysterectomy or vaginal hysterectomy?
A: A
ir and gas are the two common concerns during this time. Air may
have collected inside your body cavity during the operation. The body
will naturally reabsorb this. While this is occurring, you may notice
some “achy” sensations in your shoulders and upper chest which are
harmless and will pass.
Due to anesthesia and immobility, the digestive system can stop or
markedly slow down following surgery and gas can build up in your
intestines. This can cause a bloating feeling in the abdomen. Walking
can help the gas to move and to reabsorb or to be expelled. The
bloating sensation will resolve and your system will return to normal.
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abdomen during the surgery to help your doctor see your pelvic organs.
This gas gets naturally reabsorbed. The right shoulder is often more
sore than the left. The small incisions will be sore, and you may have
some bruising. The belly button is usually the most uncomfortable
area. Following a hysterectomy, some women may also feel something
like menstrual cramping. This is common, and the pain medication
you were prescribed or an over-the-counter pain medication will help.
AFTER DISCHARGE
Q: Do I need to make any adjustments to my diet following surgery?
A: W hen you are discharged from the hospital, you should plan to eat a
bland, light diet for the first one to two days. Avoid spicy or greasy
foods and high roughage foods such as salads and raw vegetables (these
can cause gas and bloating). Drink plenty of non-caffeinated fluids
(water is best). You may resume your usual diet gradually.
Q: Will I have any vaginal discharge or bleeding?
A: It is normal to have some vaginal bleeding or discharge following
laparotomy, total hysterectomy or vaginal hysterectomy. There is no
need for concern as long as the amount of the vaginal bleeding is just
like a normal period and there is no foul odor. If you experience heavy
bleeding or note a foul odor, please call the office.
A: Following laparoscopy, it is not unusual to have vaginal spotting
lasting up to two weeks off and on. Some women do not experience
any bleeding at all. You should call your doctor immediately if you ever
experience heavy vaginal bleeding or gushes of any liquid coming from
your vagina that does not seem like the amount you would expect for
your normal vaginal discharge.
Q: Can I take a bath?
A: You may take a shower 24 hours after surgery, at which time you may
remove your dressing (see next question). Please do not take baths
until you are seen for your post-operative visit.
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A: Following laparotomy, total hysterectomy or vaginal hysterectomy,
the dressing over your incision will be removed prior to leaving the
hospital. If there is any “oozing” from the incision, a Maxi pad can be
placed over the incision for protection.
A: There are several ways that your incisions may be closed for a
laparoscopic procedure. Most of these do not require the removal of
any sutures. Some patients may have skin glue, Dermabond, placed
over the incisions. Do not try to peel this off, it will gradually wear off
on its own. Other patients will have small paper strips placed over the
incisions. Allow these to fall off on their own, or your doctor will
remove them. Any dressing on top of the Dermabond or paper strips
can be removed 24 hours after surgery.
Q: W hen will the stitches or staples come out?
A: Depending on where the incision is, several layers of tissue have been
sewn back together to create a strong and safe closure. The deep
stitches will slowly dissolve as the body heals. Staples (on the
abdomen) may be used to hold your skin edges together for a short
time after the operation. The skin rapidly heals and these staples will be
removed within three to seven days. Tiny strips of tape will be placed
across the incision at that time for reinforcement.
Q: Is there anything else I should know about the incision site?
A: Bruises may appear around the incisions and will gradually resolve as
they heal. The incision cut some of the nerves, which supply sensation
to your skin. As the scar heals, you may find areas of the skin are numb.
More normal feeling will return to these areas over time.
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Q: Will I need to do anything to the incision site?
RECOVERY TIME
Q: W hat can I expect once I’m home?
A: Following laparotomy, total hysterectomy or vaginal hysterectomy,
it takes several weeks before you will feel “normal” following surgery.
You will feel tired and have limited energy during the first days and
weeks but this will gradually improve.
A: Following laparoscopy, it may take several days before you feel like
yourself again. Usually women have bursts of energy followed by fatigue.
In both cases, be sure to get plenty of rest. Emotional ups and downs are
commonly associated with gynecological surgery during this time.
Q: W hat restrictions do I have following surgery?
A: Following laparotomy, total hysterectomy or vaginal hysterectomy,
you must not perform any household activities such as laundry,
vacuuming, shopping or gardening until your physician gives you
clearance. You may not lift or pull down anything heavier than a gallon
of milk. If possible, avoid climbing stairs more than once a day.
Gradually increase your activity. First try walking and doing light
activity around the house. Over the next few weeks, you may gradually
increase your physical activity, however the restriction of lifting or
pulling down anything heavier than a gallon of milk remains. You may
walk, but no exercising, jogging, or impact exercises.
A: Following laparoscopic surgery, simply avoid heavy lifting or straining.
You should be seen at Virginia Women’s Center following your surgery.
Call 288-4084 for an appointment, if this has not already been
arranged. At this appointment, your physician will discuss with you the
findings noted at the time of your procedure and/or pathology reports.
In both cases, avoid using tampons or inserting anything in the vagina
unless you were prescribed a vaginal estrogen cream.
You must abstain from sexual activity for at least six weeks or until after your postoperative visit.
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Q: W hat’s not normal that I should call the doctor about?
A: A doctor is on call 24 hours per day, seven days a week if any problems
arise. Please call if you have any of the following problems:
• Temperature above 101 degrees
• Redness or drainage from the incision
• Excessive vaginal bleeding
• Foul odor from the incision or vagina
• Yellowish/greenish drainage from the incision or vagina
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PROBLEMS
Notes
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