If necessary, biopsies (small samples of tissue) may be taken during the examination and sent to the laboratory for further investigation.

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1 This booklet is designed to give you information about staging laparoscopy. We hope it will answer some of the questions that you or those who care for you may have. This booklet is not meant to replace the consultation between you and your medical team, but aims to help you understand more about what is discussed. If you have concerns about any issue to do with your recovery, please speak to a member of the medical team. Laparoscopy is a type of keyhole surgery. It allows the surgeon to look at the upper part of the abdomen (tummy) and carry out treatments through small incisions (cuts) just below your navel while you are under general anaesthesia. The operation is done to check whether the cancer has spread into the abdomen from the stomach and oesophagus (gullet). A staging laparoscopy will help your doctors to make a diagnosis or find out how far the cancer has progressed. This information will help your doctors decide on the most appropriate treatment for you. If the cancer has spread to your abdomen, major surgery will not be recommended. Other treatment options will then be discussed with you. We will probably advise that you have an endoscopy at the same time. Endoscopy is a visual examination of the lining of the oesophagus, stomach and duodenum (small intestine). An endoscope (long, flexible tube) is passed through your mouth and down into your throat. Using the light on the end of the endoscope, the doctor is able to look for any abnormalities that may be present. If necessary, biopsies (small samples of tissue) may be taken during the examination and sent to the laboratory for further investigation. A staging laparoscopy is usually done as a day case surgery. This means you should not need to stay overnight in hospital. Most patients will not have problems from having this operation. However, as with any operation, there are some risks. Specific to laparoscopy, there is a risk of: p1

2 Wound infection (less than 5 per cent risk) Risk of damage to the bowel, or perforation (0.1 per cent risk) Bleeding You will receive a letter or a phone call before your operation giving you information about your appointment. Please contact us at least two weeks before your appointment if you are on any blood-thinning medications, such as warfarin or aspirin, as you may need to stop taking them for a few days before your appointment Please also contact us at least two weeks before your appointment if you are taking clopidogrel (Plavix), as you will need to stop taking it for a minimum of 10 days before your appointment Please do not wear make-up, nail varnish or jewellery (including body piercings) when you come in to hospital We advise you to wear loose-fitting clothes after your surgery because during the procedure the doctor will introduce air into your abdomen, which may cause bloating afterwards. The bloating will disappear soon after the operation You will be given an appointment to come to the pre-admission assessment clinic one or two weeks before your operation to assess your fitness for surgery. You will be met by a nurse and, depending on your general health, you may have some tests done, such as a blood test, chest x-ray, ECG (heart tracing) and any other tests that may be required. This is to make sure that you are as fit as possible for the surgery. It is essential that you attend this appointment. It will also give you an opportunity to ask any questions. It may help to write them down before you come. Please come to the admissions lounge, fourth floor, Queen Elizabeth Queen Mother building, St Mary s Hospital at 7:30am. You may wish to bring something to read with you in case you need to wait. Consent You will be asked for your consent before the hospital staff begin your treatment. Your doctor and/or clinical nurse specialist/key worker will carefully explain the procedure. Details will vary according to each individual case. No medical treatment can be given without your written consent. p2

3 If you do not understand what you have been told, let the staff know straight away, so they can explain again. You may also find it useful to write a list of questions before your appointment and to have a relative or friend with you to help you remember the discussion when the treatment is explained. You will receive a copy of all communications sent to your GP. Please let us know if you prefer not to receive this. The anaesthetist will also see you. A member of the team will then collect you from the admission lounge and escort you to the operating theatres. Anaesthesia means loss of sensation. Medications that cause anaesthesia are called anaesthetics. Anaesthetics are used for pain relief during tests or surgical operations so that you do not feel pain or touch. As you will be having a general anaesthetic, it is very important that you do not eat (not even sweets or chewing gum) for six hours before your appointment and you should take clear fluids (water, black tea or black coffee) only from this time until two hours before your appointment If you regularly take medicines in the morning, you should take them before 7:00am on the day of your appointment, unless you have been advised otherwise If you have diabetes, you must not take your insulin or diabetic tablets on the morning of your operation You will wake up in the recovery area before we take you to the surgical ward. One of the surgical team will visit you on the ward and explain the findings of the operation with you. Please tell us if you are in pain or feel sick. We have tablets/ injections that we can give you as and when required, so that you remain comfortable and pain free as much as possible You may feel light-headed or sleepy after the operation. This is due to the anaesthetic and may continue until the next morning You may also feel bloated and generally uncomfortable in the chest, abdomen and around the shoulders. This is due to the gas that was introduced into the abdomen during the operation. Any discomfort will fade over the next few days as the gas is absorbed or passed naturally by your body You will have two or three small wounds which will have been closed with dissolvable stitches and covered with small dressings. You can remove these dressings yourself three days after surgery. p3

4 You will probably be able to go home the same day, provided you have arranged for someone to collect and stay with you overnight. You will need to organise your own transport home by car with someone else driving, as you should not travel home on your own or on public transport. However, if you are very drowsy afterwards, or your operation is done after 3:00pm, you will need to stay in hospital overnight. If you experience any of the symptoms below, please contact your GP or your clinical nurse specialist/key worker as you may have an infection: High temperature or fever Worsening pain Feel sick or are vomiting Inflammation, bleeding or redness around the wound site As you may still be under the effects of the anaesthetic, for the next 24 hours you must not: Drive a car or ride a motorbike or bicycle Operate machinery (including kitchen equipment) Drink alcohol or take any sleeping tablets, cough or cold remedies Make any important decisions or sign any legal documents Participate in sports or do any heavy work or lifting Travel alone on public transport Yes. Your clinical nurse specialist/key worker will arrange your next outpatient clinic appointment but it may be that you need further tests before you are seen in clinic. Your key worker will keep you informed. It is safe to get your wound wet, unless your doctor has told you otherwise. Please do not use antiseptic, bubble bath or anything else in the bath water until the wound has healed, unless instructed by your hospital doctor. p4

5 Your clinical nurse specialist is available Monday to Friday 8:00am-5:00pm on (except bank holidays). If she/he is not in the office, please leave a message with your name and contact number and we will return the call within 24 hours. Messages left on a Friday afternoon will be retuned on Monday. If the call is urgent we can be contacted via the bleep system by dialing St Mary s Hospital switchboard number on and asking for bleep We are also contactable via We are all individuals and cope in different ways and need different lengths of time to adjust to a cancer diagnosis. Your medical team is here to support you. You may want to discuss your worries or concerns with your clinical nurse specialist/key worker who can provide help and advice. Macmillan Cancer Information and Support Service at Charing Cross Hospital The information centre provides vital emotional and practical support to anyone affected by cancer, every step of the way. Our highly skilled and dedicated Macmillan information specialist is here to answer your questions about cancer. He/she can also direct you to other ways of getting the support you need. The service is set in a warm, friendly and confidential environment and is located on the ground floor of the Charing Cross Hospital. The centre is open (except bank holidays): Monday & Friday 9:00-17:00 Tuesday, Wednesday, Thursday 9:00-16:00 Telephone: Maggie s Cancer Caring Centre Maggie s is a cancer charity that provides emotional, practical and social support that people with cancer may need. This drop-in centre combines striking buildings, calming spaces, professional experts offering support, and the ability to talk and share experiences with a community of people who have been through similar experiences. Maggie s West London is located in the grounds of Charing Cross Hospital but please note it is independent of our hospital. The centre is open Monday-Friday, 9:00-17:00. For more information please call Other sources of information Macmillan Cancer Support Helpline This is a free helpline for people affected by cancer who have questions about cancer, need support or just someone to talk to. It is open from Monday to Friday, (interpretation service available). Telephone: p5 Information Prescription Service

6 This service contains reliable and accurate cancer information to help patients manage their health more effectively. Log onto and enter your condition to start using the service. Benefits Enquiry Line The service provides advice and information on the range of benefits available. Telephone: We aim to provide the best possible service and staff will be happy to answer any questions you may have. However, if your experience of our services does not meet your expectations and you would like to speak to someone other than staff caring for you, please contact the patient advice and liaison service (PALS) on (Hammersmith Hospital) or (Charing Cross Hospitals), or (St Mary s Hospital). You can also PALS at pals@imperial.nhs.uk. The PALS team is able to listen to your concerns, suggestions or queries and is often able to help sort out problems on behalf of patients. Alternatively, you may wish to express your concerns in writing to: The chief executive Imperial College Healthcare NHS Trust Trust Headquarters The Bays, South Wharf Road London W2 1NY This leaflet can be provided on request in large print, as a sound recording, in Braille, or in alternative languages. Please contact the communications team on Upper GI Published: Jan 2013 Review date: Jan 2016 Reference no: 2287T Imperial College Healthcare NHS Trust p6