Been booked for a laparoscopy? Heard the term being bounced around in the endo community and have no idea what it means? Consider this your one stop guide to laparoscopies, courtesy of yours truly. However, don't go getting ideas that I'm going to explain to you in precise, scientific detail what a laparoscopy involves from a medical point of view because I'm not. Instead, this is a blog post about how to physically and mentally prepare for a laparoscopic surgery as well as a guide on what to expect and suggestions to help you recover. For my suggestions on what to pack in your hospital bag, see this post.
As you may already know, a laparoscopy is a type of surgical procedure that allows a surgeon to access the inside of your abdomen and pelvis without having to make large incisions in the skin (NHS, 2020), it often involves the abdomen being filled with gas so that your surgeon has better visibility of your organs. Sometimes the procedure will be nothing more than your surgeon using the laparoscope to check for endometriosis but more commonly, a diagnostic laparoscopy will also involve the excision and/or ablation of the endometriosis. Currently, a laparoscopy is the only definitive way to diagnose endometriosis (Endometriosis UK, 2020).
What's been the outcome of your laparoscopies?
I've had two laparoscopies, the first was in August of 2016 and I was officially diagnosed with stage four endometriosis and adenomyosis. During this surgery I had endometriosis excised from my ovaries, uterus, bladder, bowel and my pouch of Douglas, I also had a Mirena IUD inserted at the same time. My second laparoscopy was this year (October 2020) and I had endometriosis excised from my uterer tubes, pouch of Douglas and bowel as well as a few spots of superficial endometriosis ablated. My ovarian cyct was removed and I also had my Mirena IUD replaced.
What should I expect in the run up to my surgery?
After you've had your consultation(s) you might find that you experience radio silence until your surgery is booked into the diary. Once that's finally in place, you'll need to attend a number of pre-op assessments to check your general health and check you're okay for surgery (these usually involve providing samples and/or having swabs done to check for viruses/bacterial infections) and you'll receive lots of information about what to expect from the surgery and the recovery process. At the time of writing, you will also be asked to have a COVID test and then isolate prior to your surgery.
What should I expect on the day of my surgery?
This all depends on how the medical system works in your country, whether you're using the NHS or if you've gone private.
At the absolute minimum you should have a conversation with your consultant/surgeon, the anaesthesiologist and the medical staff who will be looking after you when you're coming round from the surgery. This gives you the opportunity to ask any questions you may have about the surgery, the recovery process, etc. You might find it useful to have a pre-written list of questions that you can refer to or hand over to ensure that you don't forget anything! In addition to this, you'll be asked lots of questions regarding your health, medication, weight, etc. It feels like you answer the same questions over and over again which you probably are but it's a necessary evil.
Furthermore you will have been given information about when you need to stop eating and drinking; do not ignore these instructions! Also be prepared for a lot of waiting, none of my surgeries have ever been at their original scheduled time. Finally, for my first laparoscopy, my mum was allowed to stay with me. However, due to COVID I wasn't allowed anyone with me during my most recent lap and I was temperature tested upon my arrival. If my test had come back positive I obviously wouldn't have been able to have my operation.
What do I wear to the hospital and then going home?
Comfy, stretchy clothing! I favour trousers with a high waistband so they don't rub against the fresh incisions. Layers are great, as well as shoes that are easy to take off and put on. Don't bother wearing make up or nail varnish (some hospitals will refuse to do the surgery if you arrive with these on) and leave any jewellery at home. If you have piercings that you can't take out make sure you bring this to the attention of a member of staff as they should be able to provide you with tape to cover it up.
What will I wear during the surgery?
The hospital will provide you with a gown and compression stockings and tell you when it is time to change into them. You will not wear any of your own clothing in the operating theatre, including your underwear. Depending on your hospital, they may ask you to bring a dressing gown to wear over your gown when being transferred to the theatre. Your compression stockings will need to stay on until you are told otherwise but generally you can change into your own pyjamas/clothing when you feel ready to do so. I usually do this after I've gotten out of bed to use the bathroom for the first time.
What should I expect when I first wake up after my surgery?
This varies from person to person and on their individual circumstances. When you wake up you'll be in a recovery room with a nurse checking to make sure you're okay. Your throat may be sore from having a tube inserted down in it, you may be incredibly thirsty, you might feel disorientated and you might be in pain and need your painkillers upped. What is key is that you explain this to the nurse who is supporting you; they can't do anything to help if you don't let them know that's what you need!
Another common side effect from any gynaecological surgery is deferred pain into your shoulder(s) and/or neck. This is thought to be triggered when your abdomen is filled with gas which stimulates your phrenic nerve and is perfectly normal but it can be bloody painful and a shock if you didn't know to expect it (Center For Endometriosis Care, 2020). You may also feel bloated and have painful gas so as above, let people know so they can best support you!
Depending on your surgery, you may also wake up with the medical equivalent of a puppy pad underneath you to catch any blood. For my first lap, I wasn't told about this and had quite the surprise when I went to use the bathroom; it looked like a murder had taken place in my bed but again, this is usually the result of having endometriosis excised and for the most part is easy to clean up. That being said, I quickly put a night time sanitary towel into my underwear when I felt comfortable to do so just to make life easier and cleaner for myself.
You may also find that you needed to have a catheter inserted but this is again dependent on your surgery and you will be given instructions and guidance should this happen.
What should I do if I have a laparoscopy but no endometriosis is found?
This is a tricky one to answer as I'm not in this situation. However, not finding endometriosis doesn't necessarily mean you don't have endometriosis; it could have been missed by your surgeon, you could instead have adenomyosis (a form of endometriosis where endometrial tissue encroaches into the lining of the uterus) or another gynaecological condition. What's most important is that you know your body best and know when something isn't right. You are entitled to a second, third and even fourth opinion, you can ask to be referred to another gynaecologist and you can ask for more tests to be run. Please don't stop advocating for your own health.
What do I wish I had known before going into surgery?
To take the damn laxatives as soon as I was offered them. Opiate based medications (morphine, codeine, etc.) can be incredibly constipating and if I had known that, I probably wouldn't have allowed morphine to be used as my primary painkiller. That and I now know that morphine makes me hallucinate, so for my most recent lap I asked not to have it.
I'd also wish I'd been told about the deferred shoulder pain. Mine was so bad that I had to ask a nurse to help me out of bed every time I needed to use the bathroom. Second time round I made sure I had muscle balm on hand to help ease the pain!
What should I expect during the recovery process?
A whole variety of things can happen as your body recovers from a laparoscopy. Similar to above, you might find that you have painful, trapped wind or that you're constipated and therefore it's worth upping your water and fibre uptake to get your sluggish bowels moving again. You might also find you have a reduced appetite or that you feel fuller much quicker. The general anaesthetic can make you disorientated, sleepy and incredibly emotional for no apparent reason and you might find that you sleep for longer or end up having lots of naps.
You may have a lot of bruising around your incision sites and your abdomen might feel tender, swollen and sore. This might even make it difficult for you to get out of bed or to move from standing to sitting (and vice versa). The number of incisions is dependent on your surgery and what your surgeon decided was the best approach. Usually your dressings can be removed within 24-48 hours of them originally being applied and you might find that they're itchy as they're healing; resist the urge to scratch them! Personally, I found that I really struggled to lift things or to bend down. I also had a constant sensation of my ovaries being tugged at as well as waves of nausea and anxiety which got progressively worse if I pushed myself too hard and too soon.
Ultimately you have got to listen to your body and don't allow yourself to be fooled; you might feel great in the morning but if you overdo it as a result, you're back to square one again. Just take it easy and genuinely rest, you're not doing anyone any favours by rushing and potentially hurting yourself.
Finally, a quick list of recommendations to make recovery easier:
A pillow to rest across your lap for the journey home.
Green or peppermint tea to help with bloating.
Laxatives/stool softeners (especially if you've taken opiate based painkillers!)
High-waisted cotton underwear to prevent rubbing on your incisions.
Over the counter painkillers.
Muscle rub/balm.
References:
Center For Endometriosis (2020) Post-Surgical Shoulder Pain. [Online] Available from: https://centerforendo.com/post-surgical-shoulder-pain [Accessed 21 October 2020].
Endometriosis UK (2020) Getting diagnosed with endometriosis. [Online] Available from: https://www.endometriosis-uk.org/getting-diagnosed-endometriosis [Accessed 21 October 2020].
NHS (2020) Laparoscopy (keyhole surgery) [Online] Available from: https://www.nhs.uk/conditions/laparoscopy [Accessed 21 October 2020].