• Reference Number: HEY-325/2023
• Departments: Gynaecology
• Last Updated: 30 November 2023

Introduction

This leaflet has been produced to give you general information about your laparoscopy. Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is a laparoscopy?

A laparoscopy is a surgical procedure carried out whilst you are asleep under a general anaesthetic. It allows medical staff to look inside your abdomen by using a laparoscope. A laparoscope is like a thin telescope with a light source. It is used to light up and magnify the structures inside the abdomen.

The surgeon will make a small cut about 1-2 cms long near to the navel (belly button). Gas is injected through the cut to ‘blow out’ the abdominal wall slightly. This makes it easier to see the internal organs with the laparoscope which is gently pushed through the navel into the abdominal cavity. The surgeon then looks down the laparoscope or looks at pictures on a TV monitor connected to the laparoscope.

Why do I need a laparoscopy?

A laparoscopy may be done to find the cause of symptoms such as abdominal pain, pelvic pain, or swelling of the abdomen or pelvic region. A laparoscopy enables a doctor to see clearly inside your abdomen.

A number of common conditions can be seen by laparoscopy which include:

• Endometriosis – When small pieces of the womb lining (the endometrium) are found outside the womb.
• Pelvic inflammatory disease (PID) – An inflammation of female reproductive organs: the womb, fallopian tubes, ovaries and surrounding tissues.
• Ectopic pregnancy – Pregnancy outside of the womb.
• Ovarian cyst – A collection of fluid within an ovary.

It is possible to take samples, remove small pieces of tissue for examination or to drain small cysts during laparoscopy.

Adhesions (scar tissue which causes pain) can also be divided through the laparoscope.

The operation takes around 20-30 minutes and is usually done under general anaesthetic.

Can there be any complications or risks?

As with all surgery there can be complications. There may be some minor bleeding or bruising around the skin incisions. Possible problems which may occur include the following:

• The overall risk of serious complications from diagnostic laparoscopy is approximately 2 women in every 1000. (Uncommon.)
• Damage to bowel, bladder, womb or major blood vessels which would require immediate repair by laparoscopy or further surgery. (Uncommon.)
• Failure to gain entry to abdominal cavity which may result in an inability to complete the laparoscopy. This occasionally happens and you may be offered a repeat attempt at laparoscopy or an open operation at a later stage.
• Hernia at site of operation. (A hernia is when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall.)
• The incision may occasionally become infected which will require a course of antibiotics.
• 3–8 women in every 100,000 undergoing laparoscopy die as a result of complications. (Extremely rare.)
• As with any operation, there is a small risk of complications of anaesthesia. (See for more information on anaesthesia: www.rcoa.ac.uk/document-store/you-and-your-anaesthetic.)

How do I prepare for a laparoscopy?

Please read the information leaflet. You may like to share the information with your partner and family so that they can be of help and support.

There may be information they need to know, especially if they are taking care of you following the operation.

Please follow all of the following instructions. Failure to follow these instructions may mean that your surgery/treatment is delayed or cancelled:

• Please have a bath or shower just prior to your admission
• Remove all make-up, nail varnish, acrylic/false nails
• Remove your jewellery (wedding rings may be kept on)

We also recommend that you buy a supply of your usual pain relief medication, so that these are available to you when you return home, to relieve any pain or discomfort you may have.

Please bring the following in with you:

• Dressing gown
• Slippers
• Toiletries
• Toothbrush

Please do not bring in valuables for example jewellery or large amounts of money.

What will happen?

You will normally be admitted on the morning of the operation unless you have any existing condition that requires treatment before the surgery.

Before going to theatre you will be seen by the anaesthetist, who will go through the anaesthetic procedure with you.

If you are having a period this will not normally prevent you from having your operation.

Please read your admission letter for information regarding eating and drinking prior to surgery.

Do not eat chewing gum or suck sweets prior to surgery. Inform the nurse/doctor if you have any allergies, for example to medicines, latex or foods, such as nuts.

What will happen afterwards?

After your operation you will be cared for in the recovery room until you are well enough to return to the ward. The nurses will be checking your blood pressure and pulse; they will be checking your wounds for any bleeding. Sometimes there will be bleeding from the vagina similar to a light period. The nursing staff will give you a sanitary pad if necessary.

You may feel tender around the incisions and have some pain in the tips of your shoulders. This is caused by the gas which has been inserted inside the abdominal wall during the operation. The gas irritates the diaphragm which has the same nerve supply as the shoulder tip. This pain soon passes. The length of time to recover can vary, depending on why the procedure was done and what operations were performed.

When you get back to the ward you will be offered something to drink and if you feel well enough something light to eat.

You may experience some mild discomfort, often described as a period type pain. This is usually as a result of the remaining gas (inserted inside the abdomen during the operation) in the abdomen. The discomfort will settle over a 24-48 hour period. The more you move around the quicker the remaining gas will come away. Sometimes you may experience shoulder tip pain which again can be a result of the remaining gas. We will prescribe pain relief medication for you to take during your stay with us. The pain should gradually become easier but if it becomes more severe and does not ease with pain relief once you go home, please contact your GP or the ward.

What happens when I get home?

Before discharge we will inform you of any planned follow up treatment or appointment. The appointment date and time will be posted to you.

You will normally be allowed home on the same day as your surgery. A friend or relative will need to collect you from the ward and stay with you overnight.

It is advised that you rest for a couple of days and have approximately five days off work. Everyone recovers differently so be guided by your own body and how you feel.

You may experience some vaginal discharge for up 1-2 weeks. If you start to bleed heavily or find that the discharge is very smelly please contact your GP.

Sexual intercourse should be avoided until it feels comfortable.

If you take the contraceptive pill and have had a sterilisation/tubal clip please complete the packet of contraceptive pills, to ensure to reduced risk of unplanned pregnancy.

The plasters/dressings on your wounds can be removed after two days. It is quite normal to have a slight ooze of blood at the wound sites which can be easily washed away. The cuts in your abdomen should heal in about 4–5 days.

Bathe or shower as usual but avoid talcum powder or body sprays until the wounds are completely healed.

When to seek medical advice after a laparoscopy?

While most women recover well after a laparoscopy as with any operation complications can occur. You should seek medical advice from either your GP, the hospital where you had your operation or NHS Direct, if you experience any of the following:

• Burning and stinging when you pass urine or if you need to pass urine more often than usual: This may be due to a urine infection which is usually treated with a course of antibiotics.
• Red and painful skin around your scars: This may be caused by a wound infection which is usually treated with a course of antibiotics.
• Increasing abdominal pain: If you also have a temperature (fever), loss of appetite and are being sick, this may be caused by damage to your bowel or bladder, in which case you will need to be admitted to hospital.
• A leg which is either painful, red, swollen, hot or painful when standing: This may be caused by a deep vein thrombosis (DVT). If you have shortness of breath, chest pain or cough up blood, it could be a sign that a blood clot has travelled to the lungs (pulmonary embolus). If you have these symptoms, you should seek medical help immediately.
• There is no improvement in your symptoms: You should expect a gradual improvement of your symptoms over time. If this is not the case, you should seek medical advice.

Useful websites

If you would like information after a laparoscopy, please use the Royal College of Obstetricians & Gynaecologists website:
www.rcog.org.uk/en/patients/patient-leaflets/laparoscopy/.

Information on gynaecology services:
www.hey.nhs.uk/gynaecology.

Should you require further advice about the issues contained in this leaflet, please do not hesitate to contact the following areas:

Gynaecology Outpatients – Women and Children’s Hospital – (01482) 607829

Ward 30 – Women and Children’s Hospital – (01482) 382739/604387

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.