Laparoscopy: Pre Operative Counseling

INDICATION
:

SKIN PREPARATION

* Use a cotton bud to clean the inside of your naval after every shower starting one week before the operation. Clean right to the end of the naval.
* If the area below the umbilicus is hairy please shave  until the level of your pubic bone. Do this 3 days prior to the operation IF the doctor advises.
* An antiseptic solution will be prescribed. dilute 30ml in 1L tub and pour over body the front and back. Spread it with hands focusing on the front of the belly where the surgical cut is going to be made. Do this for 3 days prior to surgery and for 3 days after

DIET AND BOWEL PREPARATION

Why do you need a bowel preparation?
In many instances, a complete “bowel prep” the night before surgery is required for endometriosis surgery. A bowel prep is also required for colonoscopy and sigmoidoscopy, procedures that are also often required of endometriosis patients whom the physicians suspect may have endmetriosis on the bowel. Complications can occur with an inadequate bowel prep, so you’ll want to make sure you follow your doctor’s directions precisely.

What it does: A “bowel prep” cleanses the bowel so that bowel surgery (if needed) can be performed safely. It usually includes a liquid diet and various preparations to empty your bowels. This is not a pleasant process, but is necessary if any bowel work is anticipated.

How to survive a bowel prep: Many of us have endured this process before you, and here is what we have learnt:

  1. Prepare yourself mentally! Decide you’re going to do it, and just do it!
  2. Eat lightly a couple of days before the bowel prep. Eat more fruit and green vegetables and reduce meat and dairy products. This will make it easier for your bowels to empty.
  3. THE MIXTURE
  4. Some find that the mixture tastes best ice cold. One way to cool it quickly is to put it in the sink with ice all around it.
  5. As soon as you have drunk the mixture, follow-up with something strong tasting, such as your favourite flavoured chewing gum, hard candy, or a spoonful of chicken broth to get the taste out of your mouth. Make sure whatever you follow-up with is on your physician’s list of “approved liquids”.
  6. At some point the mixture will begin to “work.” This may take some time. It seems to help things along if you drink approved liquids in between the “cocktails.” Liquids such as ginger ale, chicken broth, lemonade, apple juice, are usually the most appealing. Remember to check with your physician for a list of what liquids are allowed.
  7. Use baby wipes to wipe your bottom. Get the all-natural, alcohol-free, aloe vera, unscented version. These will really save your bottom once you begin going often.
    If you have a tendency to develop haemorrhoids, be sure to have a haemorrhoid cream on hand. It contains a little bit of “local anaesthesia” to ease the discomfort. You’ll be happy you did so!
  8. If you feel yourself getting sick after drinking the umpteenth glass, try holding a sachet pillow to your nose, or a handkerchief scented with your favourite perfume or essential oil. If other drinks are allowed (check with your physician), try a slice of fresh ginger in some boiling water (ginger helps relieve nausea).
  9. Prepare the bathroom for your ordeal. You will spending a lot of time in there! Clean it if you think the corner fuzz balls will make you crazy after a while. Make it cosy with a bunch of flowers or some nice candles.
  10. Stock up on your favourite, easy-to-read books and magazines. You will need something to pass the time away.
  11. Station yourself near the bathroom. Make yourself a little nest that’s within a short dash to the bathroom. Have near you the TV, your books and magazines, your bowel prep cocktail, other approved liquids, pillows, and blankets. The urge to go will strike suddenly and without much warning, so be prepared for this little adventure by doing some advance planning. And try to make sure you do not have to “share” the bathroom with others during this time.
NOTE: If any of these suggestions conflict with your physician’s advice, always go by what your physician says! And remember, if you have an adverse reaction to the bowel prep solution, call your physician immediately.

Good luck! And remember: many have gone before you and survived!

PROCEDURE

Position during operation: Flat with legs spread and supported.
Cleaned with povidone (amber colored) - including vagina.
Bladder emptied - later catheterized if necessary
3-4 ports. Vaginal examination is the usual with instrument into the uterus as necessary.
Gas inflation
Operation completed with instruments operating through these ports.
Electricity and heat energy used to cut and stop bleeding - just as in open surgery.
Large mass may have to be morcellated out.

At the end of operation:
The gas is let out.
All ports removed.
Skin stitched.

Medicine (pain killer) may be inserted into the rectum.

Post Operation
Recovery
Pain should be tolerable.
Do not be afraid to move around in your bed.
You can drink once awake so long as you feel well and not nauseous as some can feel after anaesthesia. You can eat soon after trying a drink to make sure you do not vomit.
If you are not on bladder catheter - please ensure you empty your bladder soonest possible. The first wee should be normal init beginning, flow and ending. inform our staff if any of the components are not normal.


Do not worry if you feel like like sitting up or even walking. You can after checking with the staff that thee are no special orders from the doctor.
Laparoscopic surgery has this advantage of allowing people to get out of bed faster as the cuts are very small.

Take the pain killers regularly to avoid feeling pain. Taking pain killers only after feeling pain has a lesser effect than taking regularly to prevent pain.

You also may feel sore in your ankles, hips, calves and vagina.

There may be slight vaginal bleeding.

There may be pain killers put up in your bum at the end of the procedure.

RISKS

Common problems after laparoscopy

1. Pain - this is usually minimal
2. Shoulder pain - caused by gas that is used for distention trapped in the abdomen. This will settle within 72 hours.
3. Bleeding from port sites - rare
4. Infection - This is so rare that it is not a recommendation by most international bodies for antibiotics to be prescribed.

Major complications.

Laparoscopy is a form of operation.
Complications can occur despite routine practices and precautions.
Major complications occur at a rate of 1 in 1000 laparoscopies.

​These include:
1. Bowel injuries - usually 3-5 days after surgery - pain increases
2. Urinary injuries - usually a week after operation - pain increases
3. infection - pain increases. heartbeat racing away. feel feverish.

Return to hospital early if you develop the above
Earlier detection and treatment of complications will help reduce long term problems

OPERATION DAY
Don't wear any makeup, hairspray, body lotion or deodorant. Remove nail polish, jewellery and contact lenses.

Wear loose clothing such a dress without any elastic at the waist.

Choose a suitable underwear so that no fabric rubs against your navel after the procedure. Also, make sure your panties are a size larger than you usually wear; they will be more comfortable if your abdomen is swollen.

Wear shoes that are easy to slip on and off since you will find it hard to bend after the procedure.