I’m expecting to go in for my third laparoscopy in the next few days. I know how scary the prospect of having a laparoscopy for endometriosis can be, so I thought since I’m about to go through the process again I’d share some of the knowledge that has helped me manage in the past.
This is just my personal experience, your experience with your hospital could be slightly different. Unfortunately there’s a real inconsistency with the information you can receive prior to this operation. So here’s what I’d recommend you do before and after your laparoscopy.
What is a laparoscopy?
A laparoscopy is keyhole surgery, where a surgeon makes a number of small incisions into your abdomen and uses slim tools with a camera on the end to operate and remove your endometriosis. You can find out more about the detail of the surgery on the NHS website.
You may be having a laparoscopy for diagnosis only, but most of the information I write about here still applies.
Generally speaking for endometriosis you’ll have around four cross shaped incisions. One in the belly button. Two at around your underwear line and one just above the pubic region. These four incisions form a diamond shape and give your consultant the best operating area.
It also means that most of your incisions should be relatively hidden once you’re healed up and covered by your underwear or swimsuit. If you have a really kind consultant they’ll reuse the same area each time to reduce the amount of scarring you have. Four years after my last laparoscopy my scars are pretty invisible now.
They’ll also use a tube to inflate your abdomen with gas to give themselves more room to work. More on the side effects this causes later.
Things to do before your laparoscopy
Download and print out my laparoscopy checklist
I’ve collated all of the actions from this post and made a handy checklist to help you prepare for surgery – this way you can get a handle on how much you need to sort out and you can take it with you to make sure that you don’t forget anything.
Try to get an earlier date
First things first, you might have a date for your surgery already. If you’re still on the waiting list call up the hospital where your booking is managed and ask to be put onto the short notice cancellations list. If you’re flexible enough and can drop everything you might be able to get an earlier operation date if someone else cancels.
If someone else can’t make their appointment for surgery for some reason you’ll be called up with one to seven days notice to ask if you can come in. Slots do come up and it’s worth a try.
Ask for copies of all your records and letters
Keep everything about your operation. Your leaflets, your letters, appointment information – everything. You might get great information for your first lap and barely anything for your second, so your letters and leaflets will help if you need to have further operations. Ask to be copied into all of the letters from your consultant to your GP. You’ll often get more information about your operation in those letters than you get in person.
You might have to apply for this information afterwards in writing, or do a freedom of information request. Don’t be put off if someone says you might not be able to understand the information, that’s not the point. It’s your data and you have a right to see it. If anything goes wrong (if you have all the information about your treatment) you’ll be fully equipped to make a complaint or seek a second opinion.
Prepare for seeing your consultant again
Write down all the questions you want to ask before you arrive at the hospital so you can make sure everything you want to talk about is covered. By the time you see your consultant you’ll be tired from being nil by mouth and it’ll be hard to focus and remember what they say.
You should ask that someone else is present to listen to what the consultant has to say. Reason being you’ll be tired and it’ll be extra hard to remember what was discussed after your op. Ask someone to make notes for you if you’re not up to it.
Wash your hair a day or so before the operation
Trust me, you won’t have the energy to do this after the operation. Go into surgery with the cleanest hair you can, so that you feel clean while you rest, and you can spare yourself some of that post-op grotty feeling.
Take the medication you’re on with you in your bag
Firstly you’ll need to try and take it as normal but also it’ll help your anaesthetist know what medication you’re taking already.
Bring your home comforts
Bring your own pads as you’ll bleed for a day or so following surgery. It’s more pleasant if you use your own pads (pack ones for heavy bleeding) as the ones they use in the hospital are really big and uncomfortable.
You won’t be able to drive after surgery, so you’ll need someone to take you to the hospital and come pick you up afterwards. The seatbelt might be uncomfortable for you so bring a small pillow or cushion to rest between your tummy and the belt.
Pack an overnight bag – just incase
You shouldn’t need it, but it’ll be easier when you leave the hospital if you have your own nightclothes, toiletries and what not.
My personal recommendations are clothes with as few waistbands as possible. Basically live in a nightdresses for the next few days (rather than pyjamas).
Pack a face mask (for sleeping) and ear plugs. Reason being that hospitals are very bright and very noisy (and nurses will not tiptoe around you). Unless you’re lucky enough to have your own room, you won’t have much control over your surroundings when it comes to nighttime. So bring these along just incase you do stay overnight, so you can get a comfortable nights sleep.
Put everything you can at waist height or slightly higher
Bending down and reaching up is hugely uncomfortable after a laparoscopy. So surgery proof where you’re going to rest. Get it ready before hand. Move things off the floor and onto chairs. Put a sick bowl on your nightstand. Tape or clip phone charger wires onto your bedside table. If things fall onto the floor it’s going to be really hard for you to reach them. Prepare as much as possible.
Get lots of entertainment ready
For the first few days you’ll be pretty immobile, bear this in mind in your waist height plan and prepare as much entertainment for yourself in advance. Personal experience: avoid comedies. Laughing involves your stomach muscles and can be really painful. I’m sure this is where the phrase “in stitches” comes from. Imagine being paralysed by pain and hysterics, and stick to the serious stuff. 🙂
Try to find someone to care for you
Ideally, someone should look after you for the first few days. This is much easier if you live with someone. If this isn’t possible at least organise someone to pick you up from the hospital and get you settled. You should not drive immediately after surgery.
Have a lovely big shower or bath before your surgery, because you won’t be able to for quite some time. Do anything you need to feel comfortable in the hospital. Enjoy the clean feeling 🙂 And enjoy your favourite food, it’ll be a little while until you can stomach anything other than plain toast.
Other things to know about a laparoscopy
Most laparoscopies are a day case, meaning you’ll go in for surgery say in the morning and be able to leave and go home that same day. However, your operation still involves general anaesthetic so although it seems like really simple surgery from the outside it can be really complex surgery internally. As such it can take a long time to really recover from the surgery. You should get that lovely “feeling better” feeling after two to three weeks, but it can take you around three months to get back to the energy levels you had before surgery.
You may be having your endometriosis excised (cut out), ablated (burned with heat or lasers). I’ve only ever had my endometriosis excised, so that’s the only experience I can impart.
Either way the idea is to remove as much of the endometriosis that shouldn’t be there and where possible (and depending on your situation) start treatment to halt the endometriosis growth. This could be being on the combined pill, or having a mirena inserted.
Some hospitals will ask you to come in beforehand to have a pre-op assessment some hospitals do this on the day.
Waiting for your surgery
Your consultant (or a member of their team) should come and talk through with you beforehand about what they will and will not do, what treatments they’ll start you on after surgery and what the risks and rewards of what your surgery are. All surgery has risks (and these can be unique to you), so it’s really important that you ask as many questions as you can to your consultant pre-op and read and understand any and all pre-operation consent forms and literature you are given. You should also receive a copy of your consent form for your records which details what the consultant will do. If you do not receive one, ask for one.
Your anaesthetist should come and visit you too, they’re normally the people that sign you off for surgery, they’ll ask you a few questions and once they’re satisfied you’ll be good to go.
You should receive instructions from your hospital about how to prepare for a laparoscopy or endometriosis. Follow these instructions to the letter. They’ll generally outline what you can and cannot do prior to and after surgery. For example you will need to be nil by mouth for a certain amount of time before surgery. Do not break these rules. Instructions for not eating before surgery are given to ensure that there is a little as possible in your stomach when you go under to reduce the risk of you throwing up while you’re under anaesthetic. Needless to say this is dangerous.
Bring something to do in the hospital
You’ll likely have a few hours of waiting punctuated by the nurse taking your blood pressure or taking a urine sample. For example for my first surgery I arrived for my appointment at 11:30am and didn’t go into theatre until quarter to four. Don’t assume you’ll have access to a TV or radio, bring your own entertainment. If you have to stay in overnight you’ll have all your own entertainment sorted. Hospitals are boring, and not all of them have wifi. 🙂
Preparing for surgery
Naturally you’ll be asked to change out of your clothes and into a hospital gown, yes you have to be completely naked underneath so get into the hospital bed if you get cold or feel vulnerable. This is normally when your ID tag is put on your wrist. If you have any known drug allergies you’ll get a different colour one than the normal white one that everyone else has.
Don’t be concerned if you’re asked for your name, address and date of birth multiple times by lots of different people. The staff in the hospital have to make sure you’re you because they don’t want to operate on the wrong person. 🙂
You’ll also be asked to put on a pair of very fetching surgical stockings. This is to reduce your risk of Deep Vein Thrombosis (DVT) during and after surgery. You won’t be moving around for a few hours, and as many of us are on a lot of different hormonal treatments that increases our risk of DVT.
Relatives and friends
I mentioned that most laparoscopies for endometriosis are day cases, but occasionally consultants may under estimate the amount they have to do (it’s not their fault, it’s hard to know how much endometriosis is there until they look). Because of this you might want to pack an overnight bag and leave it in with the person who brought you to hospital or will pick you up from hospital, just incase.
Some hospitals (very sadly) don’t have places near your bed for relatives and friends to wait while you’re being operated on, so please bear this in mind. They might have to go to a waiting room away from where you are.
If a relative or friend is going to be picking you up, they should be able to ask the reception where you signed in for the telephone number to find out when you’ll be back in the ward. Ask for an a rough estimate on how long you’ll be as this can help whoever is picking you up too.
Going in for surgery
You’ll be very tired by the time you’re wheeled into the pre op room. You won’t have eaten anything for many hours. There will be nurses or doctors in the room before the operating theatre who will put a needle with a valve on it (cannula) into the back of your hand. This is how your anaesthetic will be administered. There’s no reason to be scared about the anaesthetic, it’s just like falling asleep, and you’ll be wide awake one minute and asleep the next. It’ll happen before you even know it.
It’s hard to say how long your surgery will take because it’s so unique to your case and how much endometriosis needs to be removed. Your consultant should give you an estimate before you start. A basic laparoscopy will take about an hour. Less so if you’re going in purely for diagnosis. A more complicated operation will take about two to three hours. This is because each spot of endometriosis takes a few minutes to operate on, and if you have a lot of them you’re looking at a lot of time.
Side effects of surgery
Once the surgery is over, you’ll be taken into the recovery room. This is where the medical staff keep an eye on you post surgery. It’ll be really hard to stay awake and you’ll be aware of the pain of your surgery for the first time. Luckily the medical staff are there to notice when you come around and give you pain relief into your bloodstream, normally by means of a drip.
You’ll spend around an hour in the recovery room. There’s a chance that if you take too much pain relief from the drip, you may not be able to go home that day as your pain is not under control, so bear this in mind.
When you wake up, there may be some discomfort in your throat because of the tubes put down your throat during surgery (this should pass after 2-3 days). Don’t be alarmed if your voice is a bit croaky.
Your may also be aware of bleeding from your vagina, this is a normal part of your surgery (even if your periods have been stopped). As part of your surgery there should be a pad placed for you there.
Once you’re comfortable and making suitable improvement, you’ll be wheeled back on your bed to your ward or room. Hopefully your relatives will have been informed that you’ve come round. Don’t worry if you struggle to stay awake. Perfectly normal.
You’ll be extremely dizzy once you come around from the surgery. The anaesthetic and painkillers you’ve been given in the recovery room will make it hard to sit up and stand. You should be given some water and something to eat. This is to help you feel better and to make sure you’re ready to go home. Don’t worry if you can’t keep the food down, this is normal.
Remember that gas they used to inflate your abdomen? You might not feel this straight away but a very uncomfortable side effect of the surgery is the gas pushing against your diaphragm. The gas moves around and as it tries to leave your system, it will make it seem like you have a pressure or pain pushing against the top of your chest and tips of your shoulder.
This is because of the the way our nervous systems are wired, it’s how our brain perceives the pain. It’s not actually in your chest or shoulder.
This is normal and will last for a few days. The best way to combat this is to drink peppermint tea or take peppermint oil in the days following your surgery.
It’s normal to feel off your food and feel sick (and be sick) for a few days after your operation. This is because of the anaesthetic leaving your system. I’d recommend keeping a large bowl by your bed (at reach height) near you at all times, so you don’t have to get out of bed to throw up.
- Vaginal spasm and pelvic floor problems (this can be very painful but normally surpasses in a few days)
- Nausea (this can be quite severe at times, so take your meals after surgery very slowly)
Getting ready to leave the hospital
Hopefully your consultant should come around to talk to you about how the surgery went. You’ll be very out of it, so again I recommend having someone else in the room to listen and take notes on your behalf and ask questions. This may be the only chance you’ll get to speak to your consultant after your op and before your followup appointment (which can be up to four months away) I know it’ll be hard to stay awake and listen, but this is why someone else being there is important to help you make the most of it.
You’ll generally be discharged from the hospital once you’re more alert and once you’re able to get out of bed to go to the bathroom. This is to show that you can pass water without difficultly and there’s been no adverse effect to your bladder. The nurse should be able to to show you a way to get out of bed more easily and help you up the first time.
As part of your discharge process, you should be given adequate pain relief. Normally for two levels of pain. Something for moderate surgical pain and something stronger for when it gets bad. You’ll be given enough to cover you while you’re recovering so if you need more you’ll need to go to your doctor or ask someone to go to the pharmacy on your behalf.
They should also give you instructions for what to do in the next few days, what to avoid (bathing, showers or a few days) and some spare dressings as they’ll need to be replaced every couple of days or so.
You’ll want to get changed into your own nightwear (bring slip on shoes) and dressing gown. You should be escorted out of the hospital (hopefully in a wheelchair). Get the person that’s taking you home to wait right outside the entrance (in the short stay area) to reduce how far you have to walk. Take walking slowly, there’s no rush.
- Your painkillers
- Your discharge form (for your records)
- A copy of your consent form (that you signed before the op)
- Your medical leave certificate (so you don’t have to go to work)
- Information from the hospital about what you can and can’t do over the next few days.
Things to do after your laparoscopy – tips for happy healing
Once you’ve gotten home the anaesthetic and recovery room drip can make you feel great after the op – be careful. It’s designed to get you comfortably through the first 24 hours following surgery. After that you’ll start to feel the pain. Take it slow, and don’t overdo things.
Now you’ll appreciate my instructions for pre surgery. Reaching up and bending down is immensely painful when you have stitches in your abdomen. You don’t realise how much you use those muscles until it’s painful.
Look up some tips for how to get out of bed safely when you’re on your own. I personally use this method:
- roll onto your side
- use your arms to push yourself up (start by reaching far from your self then padding your hands closer to yourself while pushing up)
- angle your legs as far as you can over the bed so that you can place them down to help you too.
You’re probably going to have to sleep on your back for a few days, it’s really hard to get comfortable enough to sleep after a laparoscopy.
You want to avoid using harsh movements on your tummy, so use methods that avoid using your abdominal muscles. With that in mind try to keep away from pets and young children for a while – they won’t understand how tender you are, and their sharp, quick movements on or near you will hurt.
Sitting up can be painful so do with one of those back support cushions you use for reading. They can be useful for propping yourself up in bed too.
If you sleep on your side normally this might be uncomfortable try lying with a reading pillow or normal pillows under the upper half of your body to make you more comfortable.
When you’re starting to improve, start to move around when you can, to get your stamina up and to help get the surgical gas out of your system.
Getting ready to get back to normal
- Seven to ten days for stitches
- two to four weeks for dissolvable stitches (although some can remain for up to six months).
If medical cord has been used, you’ll need to book an appointment with a nurse at your doctors practice to have them removed (this will be painful) but once your stitches are out you’ll feel a lot more comfortable.
If you’re going back to work. Ask your employer if you can do a phrased return to your job. If you can’t do this (or don’t want to) try to spend the last remaining days of your recovery increasing the amount you can do. For example if you work in an office, slowly increase the amount of time you can spend sitting up at a desk. (It’s harder than it sounds after surgery).
Get extra leave from your doctor by requesting a medical certificate to say you’re not quite ready to return to work. Ideally you should think about returning when you start to get that nice feeling of feeling better and when your wounds have healed.
Finally use your surgery for a chance to rest. It’s important you move around and try to recover, but how often as busy people do we get a chance to truly rest? Use this as your excuse to do the bare minimum for a change. You deserve the rest 🙂
It sounds dumb but when you’ve had the surgery and you realise how tired you can get afterwards (and so easily) you’ll know what I mean.
Ask for help from people. Think about those people who have offered non-specific offers of help in the past now is you chance to ask. Ask for help cooking meals, buying foods and getting lifts. Surgery is the one time where our pain and discomfort is really visible to people. People around you will understand your pain and tiredness more than ever. Make the most of this.
Lastly, best of luck
I hope your operation goes as well as it can for you and you get some relief from your pain soon. Hopefully this update has given you some ideas for how to prepare and recover more quickly.
Don’t forget to download my laparoscopy checklist for a handy reminder of how to prepare.