Part one - Important information on going home and the days immediately after your procedure.
Discharge from Hospital
Most patients after laparoscopic surgery will be discharged home on the same day. In some situations, especially with a history of vomiting after anaesthetic, extensive endometriosis found at surgery or bowel/bladder involvement during surgery, you may required to stay overnight for pain management and observation. In an overnight admission, most patients are able to go home the following morning.
Driver/Pick up person.
Your next of kin, spouse, relative or friend will need to collect you. Your pick up person will be given phone instructions from our discharge team on where to collect you from.
Note: If your pick up person is having trouble locating you after the operation, please ring Epworth Richmond on 03 9426 6666 and speak with our hospital receptionist who can transfer you to the discharge co-ordinator.
Home time Sometimes it feels much better to be in your own bed at home. You will probably be very tired, and need to rest more than you think. Don’t be concerned if you are sleeping during the day, especially with the use of pain medication, sleeping may help to improve your recovery. Be kind to yourself and just do a little bit each day. Some days in recovery will be better than others. Roll out of bed slowly and when going to sit down, do it gently. If you do too much in one day around the home, you may find you have an increase in pain, lethargy and sleeping in the day/s following.
Cramping, bleeding and menstrual hygiene after surgery Some pain is usual after the operation. You may also experience period-like cramping sensations after this type of surgery, especially since small incisions are made in the abdominal cavity. Most patients will experience some light vaginal bleeding or spotting, especially if you have had a curette done during the procedure. The spotting or bleeding may last up to five days. It is best to use pads/sanitary napkins instead of tampons during the post operative recovery period.
Shoulder pain/ Shoulder tip pain This can be painful, and may feel like someone is pushing down sharply along or on your collarbone and shoulders. This pain is thought to be due to ‘referred pain’ from irritation of the diaphragm by residual fluid and carbon dioxide gas used to inflate the abdomen during the procedure. This immediate pain and bloating sensation usually last 1-2 days but in some patients can last longer. Try a heat pack around your neck and shoulders or simple analgesics such as Paracetamol/ Panadeine or Voltaren tablets (50mg). Severe ongoing pain is unusual and should be reported.
Sore throat and nausea These are common side effects. A sore of itchy dry throat afterwards is due to the endotracheal (breathing) tube used whilst you are under anaesthetic. Analgesics and small quantities of fluids will help. Nausea and drowsiness is due to the anaesthetic itself.
Pain relief It is important to follow your pain medication dosages when you leave hospital. Try and keep on a regular timeline with your medication so that the pain relief remains effective. If you wean yourself off any pain medications early and find you are in more pain, it may have been too early for you to reduce these.
•Heat pack, either on your lower back, shoulders or on your abdomen.
•Paracetamol – for mild discomfort. It is available over the counter without a prescription at most pharmacies and some supermarkets.
•Voltaren 50mg – one tablet, three times a day (prescription required), taken with food.
• Panadeine Forte – two tablets, every four to six hours (prescription required) On occasions, myself or your anaesthetist may prescribe Endone or Tramadol (prescription required). Instructions on taking this will be on a patient to patient basis.
Constipation this may occur as a result of taking analgesics containing Codeine. To manage this, it is advisable to take Metamucil or Fybogel daily after being discharged from hospital. If you still find you are constipated, you could try taking Movicol or Coloxyl with Senna to help ease constipation.
Recovery - in the days after your procedure
Showering Hopefully you are feeling well enough to get up and have a shower after you have returned home. You can get the wounds wet the day after the operation, but avoid spas, baths, swimming pools until any glue has fallen off and healed (or if you have sutures – until your sutures are out). Don’t be too rough with your port site scars - pat dry gently after showering.
Wound care and dressings If you have left the hospital with a dressing tape or dressing bandage over your belly button or port sites, leave the dressing/s intact for 24 hours unless soiled or wet. After that you may remove them, and leave the wound site areas clean and dry. If you wish, you can cover the wounds with a clear dressing pad (such as Tegaderm or Opsite), as keeping wounds slightly moist and warm can enhance initial healing.
Do not apply antiseptic creams, Dettol, Betadine, Methylated spirits to the wound site as these are unnecessary and in most cases harmful to healing tissue.
Glue on your port/wound sites The best way to achieve a good scar is to leave the wounds alone until healed. Internally, dissolvable sutures are used and will not require removal. Externally, it is common in laparoscopic procedures to use a topical skin adhesive to close off your port incision sites. This glue provides strength and support required by the skin tissue. It allows the wound site underneath the glue to heal effectively and without exposure to bacteria. Over the course of your recovery, you may see that your glue/ adhesive barrier is starting to come off. Try not to peel it off, leave it as long as you can and let it come off naturally (approximately 7-10 days post operatively).
My wound sites –something is not quite right! If you are finding that any of your port sites are smelly, have a growing area of redness or swelling around the port/wound site, please contact my rooms. It is better to have it checked than leave it unattended, especially if the area has become painful on palpation. You may need a simple course of antibiotics if one of your sites becomes infected. You can also send a picture of your tummy or port site which is troubling you for me to check first before further assessment begins. If you are concerned, ring my rooms nurse and email a copy of your picture (from your phone) to admin@kenleong.com.au
Dizziness/ loss of concentration This may be due to the anaesthetic or analgesics (especially if you have been prescribed Endone or Tramadol by the anaesthetist). Avoid operating machinery, making important decision or driving a car for at least 48 hours.
Time off work At a bare minimum, you should take a week off work, but for most patients I would recommend 2 weeks off work for laparoscopic procedures. The first week of recovery is hard and you will require rest. The second week is not as hard but still important as your internal tissue structures are repairing internally.
Post operative Review Post operative appointments are usually made after the procedure, this is usually done by our rooms nurse during your post operative phone call check up.