Your Guide to a Laparotomy (Major Abdominal Surgery)

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1 Women s Health Unit Your Guide to a Laparotomy (Major Abdominal Surgery) Leighton Hospital Middlewich Road Crewe Cheshire CW1 4QJ November 2005 Impressions Direct Line:

2 This leaflet has been written and produced to inform you, your partner and family in order to assist and support you if you are considering or have been recommended this surgery. It is not intended to replace verbal information with your surgeon and specialist nurse. You can access other information via websites available see end of leaflet. Questions you may want to ask Benefits and reasons for having a laparotomy The aim of this surgery is to give the best possible outcome of your treatment. Your partner and carer may also have concerns and questions about how they can help you, and how your condition and treatment will affect them. Try to find out as much as you can about your treatment options and make a list of questions you may want to ask the doctor. What is a Laparotomy? A laparotomy means an operation to look inside the abdomen. Samples from other tissues such as the lymph glands and a fatty layer, called the omentum, may also be taken. It may sometimes be necessary to remove a small piece of bowel and rejoin the ends. The procedure can involve the removal of organs : For an ectopic pregnancy (a pregnancy outside the womb, in the tubes) this may involve the removal of the tube affected. Ovarian cysts removal of cavity or sac containing liquid or semi solid matter. 2 11

3 Useful addresses Women s Health Concern Ltd 10 Storey s Gate Westminster London SW1P 3AY Tel: Provides information and advice on gynaecological problems. Publishes a wide range of leaflets Wellbeing 27 Sussex Place Regents Park London NW1 4SP Tel: Fax: wellbeingofwomen@rcog.org.uk Reassure women and provide information. The only national charity fund raising for research into women s health at every stage. Myomectomy the removal of fibroids (balls of muscle) which form in the wall of the womb. Adhesions scar tissue which can form between internal organs causing them to stick together, often as a result of infection or previous surgery, but may also be caused by endometriosis. Finding and stopping bleeding. The incision (cut) in your abdomen (tummy) will be vertical (up and down) or a bikini line. This allows the consultant to thoroughly assess your condition. A sample of fluid may also be taken from the area in the operation. Alternatives By the time you have reached this stage, the alternatives will have been explained e.g. laparoscopic procedures. If you have any concerns please ask the nurse at the assessment clinic. Consent to treatment Consent We must by law obtain your written or verbal consent to any operation and procedure. Staff will explain the risks, benefits and alternatives. You may then be asked to sign a consent form, if you have not already done so. If you are unsure about any aspect of the treatment proposed, please do not hesitate to speak to a member of staff. 10 3

4 Risks and complications of surgery Possible complications at the time of the operation. Although we try to make sure that any problems are reduced to a minimum, no surgical operation can be guaranteed free of complications and the operation itself. These may appear unpleasant, but please remember that they occur very rarely. Some can occur during the operation but others may not happen until after you have gone home :- The general anaesthetic may occasionally give rise to difficulties which will may make your stay in hospital longer or your recovery slower. Reaction to general anaesthetic there is always a small risk of a serious reaction of complication associated with having a general anaesthetic whatever the procedure. (If you smoke you have an increased risk of chest infection). Going home what can I do? Once home remember that you are still recovering. Take the opportunity to pamper yourself and let others look after you for a change. It is important to rest, but equally important to have some daily exercise. For the first week or two you should really do as you have been doing in hospital. After that increase your activities as you feel able. Please remember it could take up to 3 months before you are doing as you did prior to surgery. Please contact Ward 18 if you have any worries or concerns during the first week after leaving hospital. Driving can be resumed 4-6 weeks after surgery, however it is advisable to check with your insurance company. The doctor will provide you with up to 28 days supply of medication. Bleeding - As with all operations there is a risk of bleeding (haemorrhage) which may require you to have a blood transfusion. Organ damage there is occasionally damage to other structures (the bowel or bladder or ureter). If this does happen we will repair it immediately while you are still anaesthetised. Return to theatre for additional stitches - these will be checked by staff in the recovery area before you return to the ward. Pelvic abscess or infection. 4 9

5 After your operation When you return from theatre you will normally have an intravenous infusion (drip) into your arm, which provides your body with the necessary fluids until the nursing staff will advise you on when you can start to eat and drink again. Pain Relief You will have some pain and discomfort for a few days. Pain relief will be offered in the form of PCA (Patient Controlled Analgesia), injection or tablet. An information leaflet is available to explain methods of pain relief but nursing staff will help you and this will be discussed at the pre operative assessment clinic. You may have a catheter into the bladder which drains urine into a bag. This is normally removed after hours. In order to prevent blood clot formation (thrombosis) a Flowtrons (cuff) or injections of calciparine will be used, and discussed at the pre operative assessment clinic. You will be encouraged to start moving about as soon as possible after the operation which is essential for your recovery. Leg exercises and deep breathing are important while you are in bed. The physiotherapist will help with these. Your clips/sutures (stitches) are normally removed 5-7 days after surgery. Some stitches are put underneath the skin and will dissolve naturally. Venous thrombosis/pulmonary embolism. Wind pain - the operation does result in wind floating about in the abdomen, which can cause pain in the shoulder, back and abdomen. A few days after the operation eating small quantities of fruit and vegetables, and drinking plenty of fluid will help to re establish your normal bowel movements. Painkillers and moving about will also ease the discomfort. Risks following surgery Frequent risks may include: Wound infection and bruising Frequency of passing urine Delayed wound healing Scar formation (keyloid) The risks will be discussed with you at the pre operative assessment clinic. Providing you recovered well, you should feel able to go home 5-7 days after your operation. 8 5

6 What happens before the operation? Pre Operative Assessment 1-2 weeks before your operation you will be asked to attend the pre operative assessment clinic (POAC). This will give you the opportunity to meet with nursing staff, they will discuss the type of operation you will be having and what you can expect before and after treatment. You will also have the opportunity to ask any questions you may have. At the POAC please bring a list of all your medication with you. You will receive a leaflet about the assessment along with your appointment date for admission. Pubic hair will need to be removed prior to surgery, no sooner than the night before operation. You can remove it by shaving or by the use of depilatory creams, please check for sensitivity if you do not use them as routine. In Hospital - before the operation You will be shown to your bed by a nurse in your team. The nurse will introduce herself and show you the ward layout. (For further information about services and facilities available on the ward please see the information booklet sent with your admission letter). You will normally be admitted on the morning of your operation. You will not be able to eat or drink anything for 6 hours before your operation. If your operation is in the morning you must starve from 12 midnight the night before your operation or if your operation is planned for the afternoon you may eat a light breakfast before 7am. Please will you contact the ward on on the day of surgery to confirm a bed is available for you. We will do our utmost to ensure we do not cancel planned operations, but emergencies will take priority. 6 7