Surgery Tips

If you you are scheduled to have a laparoscopy and don't know what to expect, these tips will help you.  I didn't compile them myself, but I have added my own comments in peach. Credit goes to Anne DePerty. Just remember, though, another person's experiences won't necessarily be your own. Everybody's different.
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Anne's Laparoscopy Tips

~(Also contains input from contributing members of ASE)~

"This is a document I put together in August 1997, while recovering from my second laparoscopy.   I've compiled a list of things a lap patient can do to make the experience a little less unpleasant, both
before and after the surgery. This is based on my personal  experience, some tips I've picked up from the newsgroups and some really terrific recovery room nurses, and doctor's orders.  Any additional helpful hints and suggestions would be welcomed.

Many of these hints can apply to other minor (!) abdominal surgeries done on an outpatient basis.

If your doctor's orders conflict with these hints, by all means, follow what your doctor says!  I'm not a medical professional, just a patient with some experience.

Advance Planning

To minimize time missed from work, try to schedule your surgery for a Thursday or Friday so you have the weekend to recover. Clear your calendar of any major engagements for at least two weeks afterward
to allow lots of relaxing and napping.  Your doctor will determine what time in your cycle is appropriate for your lap, depending on its purpose, and whether other procedures (hysteroscopy, HSG, tubal ligation or reversal, etc.) are to be performed at the same time.

Engage a responsible adult(s) to drive you to and from the hospital on the day of the surgery, and to spend 24 hours with you after you return home.

Your Pre-op Appointment

Discuss with your doctor exactly what is to be done.  This is the time to ask all your questions, including if and how endometriosis is to be treated, whether diseased organs are to be removed, etc.  Put
your wishes in writing, and be very clear!  You don't want to wake up andifnd that your DH has authorized a hysterectomy if you want to bear children in the future! Indicate your preference in drugs also;
if you want to start trying to get pregnant immediately, you won't want a shot of Lupron before you wake up!

My experience here in Canada is that the pre-op is done by a nurse.  She probably won't know the details of your case so if you have any specific questions she can't answer, by all means, talk to your doctor prior to the day of your surgery!

Discuss all medications you are currently using, and whether they will have any effect on the anesthesia.  Ask for a Rx for post-op painkillers so you can fill it in advance.

I wish I had thought of this.  Fortunately for us, our pharmacist is a friend of our's.  My husband called her before we left the hospital and she said she'd open the pharmacy for us if we got back late.  Not everyone's that lucky!

Ask if you can get a videotape of the procedure (if you want one). This can be pretty gross or pretty fascinating depending on your viewpoint, but it really helps you to visualize and document what's
going on inside your body, and it can be invaluable if you end up changing doctors in the future.

Confirm with your doctor's office that insurance pre-approval requirements, if any, have been met.

If you think you'll need a sleeping pill for the night before surgery, request one now.  The doctor will prescribe something that won't conflict with your anesthesia.

The Day Before

Eat light and healthy, and drink lots of fluids.  You won't be allowed any food or liquids after midnight, so you may want an evening snack to prevent that starved feeling in the morning, especially if your surgery is scheduled later in the day.  Your doctor may ask you to do an enema in the evening to clean out your
bowel.  If more severe endometriosis is suspected, a full bowel prep may be required.  Follow your doctor's instructions.

Go grocery shopping for "instant food" so you won't need to cook for at least three days.  Microwave dinners, cold cuts, fruit, juices, and canned soups are all good.  Avoid anything too spicy or greasy,
your stomach may not tolerate it.  Be sure to have saltine crackers and ginger ale in case you have nausea after the anesthetic.

Buy maxi pads and panty liners; all they have in the hospital is the old-fashioned maternity pads with the belts, and you'll probably be more comfortable with your favorite brand.

My hospital had pads that were pretty nice, but still, better safe then sorry. ;-)

Pick up some Chloraseptic or other throat lozenges.  Intubation will leave you with a terrible sore throat.  (Clear this with your doctor first!)

I think the sore throat  varies from person to person.  No one told me I was going to have intubation... I read it on the internet the day before my surgery.  And you know what?  If I hadn't done that, I still probably wouldn't have known.  I was just barely awake when they removed it... in fact, I thought I dreamt it.  After that, I was just fine.  No sore throat or swallowing problems.  However, like I said, bettter safe than sorry.  But don't assume you'll have probems, you might not!

Fill your painkiller prescription and leave it in a safe place.

Rent a few videos to keep your mind occupied while your body heals. Nothing too funny, though - you don't want to be laughing hard the first day or so!

No, kidding!  My husband's a joker and I couldn't even look at him when he'd talk, I'd laugh so hard.  Bad hubby! ;-)

Clean your house - you won't be doing that for the next few days.  Put fresh sheets on your bed or sofa, wherever you think you'll be spending time. Make sure you have two or three clean, loose fitting
outfits (no snug waistbands!) ready to wear when you get home. Satin pajamas or nightshirts are especially good, because you can just s-l-i-d-e right out of bed with minimal effort.

Choose a soft, loose fitting garment to wear tomorrow that's easy to put on and take off.  Wear comfortable flat shoes that slip on.  Bikini or low rise panties are better because the waistband won't rub
on your belly button after the surgery.

Pack a "hospital bag."  Include:  your insurance card; a blank videotape; a pair of clean socks to keep your feet warm during the surgery; a maxi pad; reading material, in case you're stuck in pre-op for awhile; a paper lunch bag and tissues, in case you feel ill on the ride home; a small pillow, to hug against your belly in the car; a case for your eyeglasses, if you wear them; and anything else you'll need that day.  Plan to leave your wallet and valuables at home.

Remove all nail polish.  Remove and secure jewelry and contact lenses.

If you have false nails, check your hospital's policy.  Most likely you can keep them on as long as you remove the polish.  It's my understanding that they want to be able to observe the skin under your nails in case you aren't getting enough oxygen.

Go to bed early and get a good night's sleep.

Surgery Day

Wake up early and take your time bathing and dressing, so you won't feel rushed. Don't bother doing anything fancy with your hair-you're only going to stuff it into a shower cap anyway!  Don't wear any
makeup, lotion, perfume, hair spray, or deodorant.

Arrive at the hospital or surgery center at least an hour before your scheduled surgery time.  You'll need to fill out more forms and consents before you go into pre-op.

In pre-op, you'll be offered a tranquilizer; they can add it to your IV.  To minimize drug interactions, you can refuse meds at this point.  It's all personal preference.  Your anesthesiologist may order something to prevent nausea.  Again, it's your choice. (Warning!  Liquid Zantac is a taste sensation I never want to
repeat.  Think bug spray.)

I was never offered a tranquilzer.  Maybe it was already in my IV.  Who knows?  If you aren't offered one and think you want one, ask.

When you wake up in recovery, the nurses will offer you something to help you wake up, and once again you can accept or refuse it. (I accepted it once, and the only way I can describe the sensation was
like cold water pouring on my brain - NOT pleasant!)  You have the option to just sleep it off.  One member of ASE had a great suggestion: bring a tape of your favorite relaxation music and record your voice telling you gently to "start waking up".  At the appropriate time after the surgery, the recovery room staff
turned on the tape (she was wearing earphones in her case) and started the music.  She woke up to her favorite classical and new age tunes that she plays when she's feeling a lot of stress.  She said,
"I had an amazingly easy wake-up, no sickness at all."  Great idea!

Again, I was not offered anything to help me wake up.  Ask before surgery (duing your pre-op) if this will be an option for you.

You won't be discharged until you have urinated, so you may be in recovery awhile. This may be difficult if you were catheterized during the surgery.  When you do go into the bathroom, let the nurse help you.  You may think you can walk, but your knees can turn to Jell-O without warning.  If you feel nauseous, waving an alcohol pad under your nose can help.  Ask the recovery nurses for a few to take home with you.

For the ride home, recline your seat part way.  Hug the pillow gently against your belly to soften road bumps.  Your surgeon may offer you an abdominal binder, which is even better for easing the
pain of movement in the car.  Have your paper bag and tissues nearby in case you need to vomit.

Recovery at Home

A laparoscopy usually involves two to four tiny (less than + inch) incisions: one through the navel, where the scope is inserted, and one to three on the lower abdomen near the pubic hairline, to insert
the tools used to manipulate your organs.  The lower abdominal incisions usually heal quickly, and they cause very little discomfort.  My experience has been that they itch more than they hurt.  Your navel area will be tender and swollen for a week or so;     avoid clothing that may rub.  Follow your doctor's instructions on cleaning and dressing the incisions, and watch for signs of infection.

For the first 24 hours, spend as much time as possible lying down or sleeping.  Lie in whatever position is most comfortable.  If it helps to keep your knees bent upward, prop your legs with pillows.  Ask for assistance sitting up at first - those stomach muscles are very shaky right now.  Keep a full glass of water with a flexible straw within reach so you won't have get up or call for help every time you're thirsty.  Leave the TV remote control within arm's length.  Ask your DH to rub your shoulders, brush your hair, paint
your toenails! Feel pampered!

You'll probably bleed (like a period) for a couple of days, then spot for several more days.

Your pillow will become your best friend.  Hugging it helps support the incisions if you prefer to lie on your side.  It also helps if you cough (if you've been intubated), sneeze, laugh, or get the dry heaves.

The amount of surgical pain and cramping you have depends greatly on how extensive your surgery was.  Use your painkillers and/or a heating pad as needed.  You may also have rib and shoulder pain from
the gas used to inflate your abdomen. The gas will also make you belch A LOT.  It will take a few days for the bloated tummy to go back to normal.

If you feel up to it, walk around the house a little bit.  Try not to overdo it, or you may end up exhausted or lightheaded.  The best way is just a little at a time.

Start with liquids and slowly work up to a normal diet, as your stomach will accept it.  Room temperature foods are tolerated more easily than hot or cold foods at first.  Chewing gum or sucking on hard candies can help control nausea.  To prevent dehydration and constipation (common side effects of both general anesthesia and narcotic painkillers), be sure to drink lots of non-caffeinated liquids and include some high fiber fruits and vegetables like prunes and spinach.

You can usually shower the day after surgery.  Have someone stay in the bathroom with you in case you need help.

This was important to me.  I was still having difficulty standing straight and the steam made me nauseous.  I made sure my hubby was there to help in case I fell, and was very glad he was there to get me some cool water to help with the nausea.

If you need to be out in public, carrying a cane can be a visual clue to other people that you need special treatment.  It may convince them to hold doors for you, or be less annoyed that you're
walking slowly.

Returning to Work

It's up to you and your doctor when you return to work.  If you have a sedentary job and you're feeling well, you may be able to return within 3 or 4 days.  A more physically demanding job or more complicated surgery may require longer recovery time.  Your first few days back, take it easy.  If you start feeling puky, leave early.

If your job requires professional attire, try to avoid pantyhose for at least a week.  The waistband can be irritating on your navel. Wear long, loose dresses without waistbands and knee highs if possible.       They'll also help conceal your bloated tummy.

The most important thing is to take it easy, and don't push too hard.  A laparoscopy is a major surgery, and it can knock your feet out from under you.  Your recovery will go smoother if you take care of yourself and don't try to rush it."

Copyright 1997, 1998 Anne DePerty and contributing members of ASE.  All rights reserved. 
Information in this document may be duplicated and distributed with permission, as long as copyright information is attached and use is not for profit.

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