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Wednesday, July 26, 2006

Laparoscopic Surgery When Endometriosis is Suspected

By Royalyne

Why would you be having laparoscopic surgery?

Laparoscopic surgery (often referred to as “lap”) is the only real way to diagnose endometriosis. Your gynecologist or even family doctor may have made an assumptive diagnoses based on your symptoms, but a true diagnoses can only be made when the endometrial adhesions are seen. The description of the surgery (-scopic) suggests that the doctor intends to merely look and see if adhesions are present, but once adhesions are found they are removed during the same procedure. Endometrial adhesions are most frequently found on the ovaries and fallopian tubes, but may be present anywhere in the abdomen. Endometriosis on the ovaries can form cysts, called endometrioma.

What you can expect

You will need somebody with you, whom must remain at the hospital throughout your procedure to drive you home.

Each hospital will have its own standard operating procedures (SOP), I can only write from my experience, using the SOP of my hospital. Your lap will be performed in a hospital by a gynecologist as an outpatient surgery. You will be placed under general anesthesia for the procedure. You will be asked to follow their standard pre-op procedures, such as fasting the night before. Beforehand you will have an IV started and provide a urine sample for a pregnancy test. The doctor will brief you on his/her plan for the surgery and what will be done if adhesions are found. The anesthesiologist will also speak to you about the anesthesia that will be used and the endotracheal tube (the breathing tube they put in). A few minutes prior to being moved to the operating room you will be given a shot of a medication in the category benzodiazepines, most likely midazolam (brand name- Versed). This medication is a relaxant and also an amnesic (reduces your memory of events while on the medication). You may begin to feel drowsy and “stoned,” which is normal for this medication. Once you are in the operating room and transferred to the operating table, additional medications will be administered and once you are completely unconscious a breathing tube will be placed in your throat.

A small incision is made in your abdomen to facilitate the insertion of the laparoscope. There is a camera on the laparoscope that allows the doctor to see your internal organs without making a large incision. Another incision, this one much smaller, is made to allow a tube to be inserted. Sterile air is pushed through this tube into your abdomen. Once your abdomen is inflated, the doctor can see the entire area much easier and access areas that would have otherwise been blocked from view. The doctor will basically look around for anything out of the ordinary. Endometrial lesions and endometrioma will be removed with a laser, but also shifted ovaries can be returned to the correct position and anchored, and likely many other beneficial procedures. The doctor will take many pictures, both before and after shots, for your patient file.

Once the surgery is complete, the air is released and your abdomen deflates. The incisions are sealed externally with glue, probably stitches internally, but for the life of me I can’t remember what they said (that darn Versed). The breathing tube is removed and a medication is administered to slightly reverse the affects of the anesthesia. You will be moved to the recovery area until you become more fully conscious, and then returned to the outpatient area that you started in. The doctor will then come speak to you about the surgery: what was found, what was done to treat it, your prognosis, etc. You will be given a prescription for painkillers, and if you are in pain (anesthesia is very much different from painkillers) you will be given a dose of the medication prescribed. Once you are able to sit up and feel ready to leave, you will be taken by wheelchair to the car.

You will be under restrictions for 2 weeks following your surgery. Abdominal surgery requires cutting abdominal muscles, and the abdomen is your core, it is used when moving almost any part of your body. The restrictions are in your best interests, and in the best interests of your healing body.

Problems that may arise and ways to troubleshoot

You may notice pain or cramping in your neck, shoulders, or upper arms for a few days following surgery. This pain is a result of the trapped air from the inflation of your abdomen. Some air gets trapped and is not released when your abdomen deflates. This air “floats” in your body, moving to the highest part of your body. Lying as flat as possible, or with your legs elevated will disperse this trapped air, spreading it out and not allowing it to concentrate in one area. The air is gradually absorbed into your blood stream and released within a few days. A way to encourage that absorption is a heating pad and/or massage. When the area has a greater blood flow the trapped air is absorbed faster.

As with all surgeries, your incisions are very important. If they become more painful, red, swollen, or begin producing a discharge, see your doctor immediately.

My personal tips

My procedure took an incredibly long time due to the amount of adhesions I had and where they were located (one ovary was ripped from its proper location with an endometrioma, minor adhesions on the bladder, lots of adhesions everywhere), but was not difficult at all. When I was awake, though, I did notice an odd taste in my mouth (from the breathing tube) and my mouth felt incredibly dry. Be sure to have a nice cool bottle of water nearby once you get home (or for the drive if it’ll last longer than 10-15 minutes).

The person who drives you should be somebody you trust enough to have with you when the doctor comes to give you the post-op report. You will likely be very groggy (I don’t remember seeing my doctor afterwards, but I’m told he was around for 10-15 minutes telling my husband about everything). This person should also be taking notes, because you will want every detail and their memory may not be perfect enough for your liking if they don’t write it all down.
The trapped air was my biggest complaint afterwards, and the painkillers I got (darvocet) did nothing for that pain. Apparently the main use of darvocet is for incision pain, of which I had almost none. Needing darvocet was my downfall, but I’m allergic to vicodin (apparently their drug of choice post-surgery). I ended up taking either Tylenol or Advil liquigels for the air bubble pain, whichever was closest to the couch. My husband was nice enough to give me twice-daily shoulder rubs and keep my microwavable heat pad nice and warm for me. The pain lasted 3 days, including the day of surgery, but after the second day it was more like the pain of an overworked muscle.

My main incision was less than an inch long, inside the bottom of my belly button. It felt like a cat scratch, and within a week I didn’t feel anything at all. The second incision was un-located for 2 entire days, as it was located below the pubic hair line and caused absolutely no discomfort. The only time I had any pain in my main incision was during the process of changing positions (i.e. sitting to standing and its inverse, rolling over, etc.).

Don’t wear a belt for a while, especially one with a big, cute buckle. Pressure on that navel incision is not a good idea; it hurts. All of my pants are low-rise, but sitting down or bending over with a belt on pushes the buckle right into that incision.

Restrictions exist for a reason. You use your stomach to wiggle your toes and pick up your head off the pillow, and just about everything else. The 20lb lifting restriction extends to the vacuum cleaner, even if you’re just pushing and pulling it across the carpet. Take advantage of your restrictions, they really are in your best interests. I was back to basically my normal routine about 4-5 days after my surgery, except for strictly following the restrictions. Once my restrictions were lifted I had no problem going back to that routine, including shoveling 2 feet of snow in my driveway. You know your body best, you know how slowly to ease into things once the restrictions are lifted. But don’t rush the restrictions, they were put in place by somebody who has seen your insides, and if you trust them enough to let them cut you open you need to trust their judgment on restrictions as well.


C said...

I just had a lap, and wanted to add that if you've ever had PID or other abdominal infection, a lap is a good way to rule out (or diagnose) scar tissue that could be blocking your ovaries from your fallopian tubes.

On the subject of neck/shoulder pain from the trapped air, my nurse told me to cough every hour or every time I felt the pain. I have no idea how or why, but it really worked.

Anonymous said...

I had this done a couple months ago and to be a wuss, it freakin sucked. The actual procedure was nothing, and left me with two small scars - one inside my belly button, and one off to the left that's no longer than the entirety of a fingernail. It was the pain after that surprised me. I went in thinking it'd be nothing, and pain in my shoulders - who cares? I stupidly didn't even pick up my prescription for painkillers until that afternoon when it became awful. I couldn't lay on my side or my stomach without crazy pain in my shoulders and back. I couldn't sit up without feeling like aliens were attacking my shoulders. And standing was useless. I didn't sleep for two days because even with the drugs, I was really really uncomfortable. So pick up the painkillers and in two days if you're like me, you'll get through it. But it was way worse than I cold've ever expected.

Anonymous said...

Hi I had this done a couple of weeks ago. The surgery was fine, the gas in my collar bones was out of this world. I slept sitting up for four days and took gas ex 3 times a day. It eased up 1 side at a time. The incisions were a little infected and the Dr. took out the dissolvable stitches. Only severe itching from healing occurred after that. My left fall. tube was blocked and the Dr.made no mention of trying to clear it. This makes me very nervous since that is the side where a small spot of endometriosis was found.
I had completely regular cycles until Jan. where I just never stopped bleeding.

Ann said...

I just had this done 2 days ago - uterine ablasion w/ tubal ligation.
OMG - I did not see this trainwreck coming!!
I have lived through eight major orthopedic surgeries in the last 5 years with nothing more than a tylenol for the pain (unheard of according to my surgeon at Duke).

So, naturally I thought that this little procedure would be a breeze. OMG WAS I WRONG!!!
I hate to sound so wimpy here, but that freakin' trapped air is the most painful thing I think I've ever experienced!
I had some after my c-sections and I remember this very distinct pain very clearly...but after this small surgery, my neck and shoulders feel like I have major whiplash from a horrible car accident. There is air trapped in my upper right shoulder and in the middle of my breastbone area.
I cannot rest, cannot sleep, cannot take a deep breath, cannot move around without huge pain.

As for the problem whatsoever. No pain at either bellybutton or pubic incision sight. No discharge from the ablation (very lucky I am told)...basically no complaits whatsoever regarding surgery.
Just this horrible, painful trapped air!!!
I am going to try the walking thing as suggested by the rest of you, to try to dissipate or release it. So far simethicone and Gas-X has done very little to relieve it. It sucks!
If this trapped air was gone, I would be feeling probably close to great right now - just 2 days post-op.
I was instructed not to swim for 4 weeks, no tampons, no sex, no exercise, no heavy lifting for the same amount of time. It is VERY important to follow these rules. You might start to feel great, but my doctor said that it is very easy to rupture the surgical site, or herniate something good.
So everyone hang in there, we will all soon be on the road to recovery...wish me luck!

Anonymous said...

I had a lap and hysteroscopy about a month ago to check out uterine conditions and to remove a vaginal septum. I have to agree with the surprise at the pain in my back and shoulders from the gas. It took almost three days to dissipate completely.

I also had lots of pain with the bellybutton incision. All of bottons of my pants, barring seats, hit me right at the bellybutton. For almost two weeks after my surgery I had to unbutton my pants at work. Thank goodness for a desk and a door to my office.

The doctor has declared me all birght, shiny and optimized. The next step is to Clomid or not.

Anonymous said...

Just had thermal ablation and tubal ligation. Glad I found this website. I was in so much pain on my right shoulder and neck also. They kind of down play this trapped gas angle in the hospital huh? I am 4 days out and only have the pain in the morning now. Hoping tomorrow will be all gone. Good Luck everyone!

Michele said...

I know it is an old post, but I think this is a really informative post. I wish I had read it prior to having mine done 1 1/2 yrs ago. I may link to it on my blog just so more people read it!

TRACY1044 said...

i had a tubal done 15 years ago and remember the trapped air was the worst thing ever.  yesterday i had to undergo this again to remove an ectopic pregnancy and the trapped air is still the worst.  The nurses didn't even know what i was talking about which makes me feel like a real wimp around my boyfriend but the pain is excruciating.  One of the sypmtons of an ectopic pregnancy is gastritis which started with me on Sunday before my surgery on Wednesday.  I haven't slept in 5 days and he's in there sleeping away.  My doctor told me to go back to work on Monday which is less than a week after surgery.  Im a retail shoe store manager and do a lot of heavy lifting.  I just don't understand this.  I wanted to stay in the hospital another night but was embarrassed to.  I have no place to get comfortable here at home because of the pain associated with the air.  I hope this helps out others who are looking at this procedure in the future.

Laura said...

I had a diagnostic laparoscopic surgery done yesterday afternoon, but my RE wasn't able to finish the surgery for some reason. I haven't found out yet. When my RE came to talk to me in recovery, I was out of it so I don't remember much of what he said. He mentioned something about my weight. I asked the nurse when I got back down to the same day surgery unit and she tried her hardest to read the doctor's notes, but wasn't able to get much out of them. All she really could read was something about insufflation. I'm not even sure what that all means. They couldn't get the gas in to inflate my abdomen?? I'm around 5'9" and weigh 300 pounds. I know I'm overweight, but I've never heard of this happening before. I had a post-op appointment scheduled for 2 weeks, but called and got it changed to this coming Monday. I can't wait this long for answers! I'm so confused & discouraged about it all. Now I'm scared that he is going to want to do an open laparoscopy. I've searched the net for a long time & haven't really come up with any real explanations of failed laparoscopies. Anyone ever heard of this??

B said...

I had a lap done last month. The hardest part was the no food no water for over 15 hours. Try to get an appointment as early as possible in the day. I had never had surgery and it scared me but it was a failry easy and quick procedure. I thought they would ask me to count backwards from 100 as they do on TV but they didnt. One min I was awake then next I wasnt...
Wear something super comfy to the surgery. Nothing with a tight band around your midsection. Avoid jeans.
Before going to the hospital you should have your pain medication prescription filled out and ready, food like soup ready at home, your bed made up and your fav book or DVD at hand. It sucks if you have to go get take out/stop at the pharmacy on your way home.
As for the shoulder goes from minimal to very painful. The pain medication doesnt seem to help that one, just your tummy region. Lying down with your feet propped up may help, alternate cold & hot packs really help.
By the third day you start feeling almost normal. Within a week you are completely better.

Gina said...

I had my lap 4 days ago, and the trapped air in my shoulders, neck, under my breast and ribs was unbelievably painful. No mention of this by my GYN prior to the surgery. Couldn't lay down my shoulder hurt so much so I took a muscle relaxer and 600 mg of Ibuprofen to sleep. The doc said this pain is unusual as she always gets the trapped air out. Right..

My doc didn't even give me a post-op report, never even stopped by after the operation. I was out of the hospital less than 2 hours after the surgery.

Boy do the nurses want to rush you out. I told them I was having trouble taking a deep breath, my neck was hurting and my legs were shaking, they responded that I should get dressed so I would be out by 11:30am. I would recommend to anyone who goes through this to make sure your not rushed and tell the RN that you want to rest for a while before they throw you out.

Anonymous said...

I had a diagnostic lap in November 2009 and developed cellulitis, a post-operative infection with a creeping red rash and fever. I also had severe pain at the belly incision site for 2 weeks, although my doctor said both situations are highly unusual. Whatever you do, listen to your body. You may be the exception to the rule, and if I had listened to my doctor's lecture on the rule of averages, I may have let my infection linger to the point of danger.

Anonymous said...

I know this post is old, but I have also had terrible experiences with the gas pains after lap surgeries. I ended up in the hospital after one of them for unrelated issues, and the nurse there at the time told me to drink hot tea or hot water to help with the gas pains... IT WORKS!! Heating pad and hot tea are the only things that got me through my subsequent lap procedures. Hope this helps!

Caitlin said...
This comment has been removed by the author.
Anonymous said...

had a lap done two months ago and didn't really notice the gas pains. It was a little difficult to walk the first few days and I slept sitting up for a week. My biggest problem was an infection in my belly button.

Word of advice...keep some peroxide handy! :)

Anonymous said...

WOW! Thanks for all the post. First let me say, I am in pretty good shape from years of running, and I like to think a high pain tolerance. I had this done yesterday, and woke up felling great, sore, but great. However, sleeping was a totally different story!

I wondered if they released even half of the air they put in, because I walked out looking about 6-7 months pregnant. I even walked a little to try to relieve the gas pain and felt a little relief. However, I can not get comfortable enough to rest longer than 2 hours at a time. The air has moved between my shoulders and lungs, my breast plate and skin, and is resting on top of my abdomen. Someone mentioned thier nurse said to cough every few hours, my nurse said the same thing, and I have found that standing or sitting up when coughing helps more.

So if you are planning on having this surgery, then ask them to please take a few extra moments to release as much air as possible.

Anonymous said...

just wanted to thank you for all your comments. I had a lap done yesterday (supracervical hysterectomy)I felt great the day of surgery up until about 12 hours post-op, then the should pain hit so severe that I thought I was dying! walking, coughing nothing worked. pain pills perscriped did nothing. 600 mg of motrin is helping a little. The insicions don't bother me at all.
I feel much better after reading all your posts to know this is normal. My doc call to check on me and did say it was normal, but I was really worried do to the serverity of the pain. Hubby has been massaging my shoulder, keeping the heating packs hot and plenty of hot tea at the ready now. thank you.

Guera! said...

I have had both a laparoscopy and a laparotomy for endometriosis. Even though the laparotomy was a bigger incision, an overnight hospital stay and four weeks off work it was much better than the laparoscopy. I woke up from the laparoscopy in so much pain I could hardly catch my breath. The laparotomy was a breeze in comparison.