Women’s health—laparotomy

What is a laparotomy?

A laparotomy is an operation to examine the inside of the abdomen and the internal organs for any abnormality.

Why is laparotomy performed?

Common reasons for performing a laparotomy include removal of the uterus (hysterectomy), an ovary, fallopian tube, fibroids or as part of therapy for cancer. You should have a clear understanding of your reason for this surgery—if you do not, please ask your doctor.

What are the alternatives?

It is sometimes possible to perform operations by keyhole surgery (laparoscopy) but in certain circumstances a laparotomy is the most appropriate procedure.

How is a laparotomy performed?

The procedure is normally performed under a general anaesthetic. A drip is inserted into your arm. A catheter (a tube for urine drainage) is inserted after you have been anaesthetised. The incision is about 15–20 cm long, usually below the bikini line (similar to the cut made for a caesarean section). In rare cases it may be necessary to cut down the abdomen from the belly button to the pubic area, rather than across. The procedure may take one to several hours depending on the complexity of the operation. 

What are the risks of undergoing this procedure?

You should be aware that every surgical procedure has some risk although the risks associated with laparotomy are low.

There are some specific risks to be aware of in relation to this operation:

• Severe bleeding may occur from large blood vessels about the uterus. This is not common. Emergency surgery may be required to repair the damaged blood vessels. A blood transfusion may be required to replace blood loss. A vaginal pack may be used to control the bleeding.
• Infection in the operation site or pelvis or urinary tract may occur. Treatment may include wound dressings and antibiotics.
• Nearby organs such as the ureter(s) (tube leading from kidney to bladder), bladder or bowel may be injured. This happens to about 1 in 140 women. Further surgery will be needed to repair the injuries. For bladder injuries, a catheter may be put into the bladder to drain the urine away until the bladder is healed. For ureter injury, a plastic tube (stent) is placed in the ureter for some weeks. If the bowel is injured, part of the bowel may be removed, with a possibility of a temporary or permanent colostomy (bag on the abdomen to collect faeces).
• Rarely a connection (fistula) may develop between the bladder and the vagina. This causes uncontrollable leakage of urine into the vagina. This would require further corrective surgery.
• There may be bleeding into the wound internally from surrounding blood vessels. This may require a drain inserted into the wound for a few days and treatment with antibiotics.
• The bowel may not work after the operation. This is usually temporary. Treatment may be a drip to give fluids into the vein and no food or fluids by mouth.
• The layers of the wound may not heal well and the wound can open up. An infection may require ongoing wound care with dressings and antibiotics. A hernia (weakness/hole in the deeper tissues) may form in the long term and may need repair by further surgery.
• The scar can be thickened, red and may be painful. This can be disfiguring and may be permanent.
• Numbness under or around the wound is relatively common and whilst it normally resolves, it may be permanent.
• The operation may result in a change in the sensory nerves of the bladder and bowel. Constipation and bladder problems may occur.

There are some general risks inherent to all operations:

• Small areas of the lungs may collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
• Clots in the legs with pain and swelling. Rarely part of this clot may break off and go to the lungs which can be fatal.
• You may suffer a heart attack or stroke because of strain on the heart. Death is an extremely rare possibility for anyone undergoing an operation.

Some women are at an increased risk of complications, including:

• Women who are very overweight have an increased risk of wound infection, chest infection, heart and lung complications and blood clots.
• Smokers have an increased risk of wound and chest infections, heart and lung complications and blood clots.

Preparation for your surgery

• It is important that you have all the tests, which your doctor has ordered, prior to coming to hospital.
• If you are taking any blood thinning or arthritis medications they may need to be stopped prior to surgery. Please check with your preadmission nurse or pharmacist.
• It is necessary that you have nothing to eat or drink (including water, lollies and chewing gum) at least six hours before your operation. You should stop eating and drinking at the following times on the day of your surgery:
  • at 12 midnight for a morning procedure
  • at 6 am for an afternoon procedure
• It is important for you to shower and dress into clean clothes prior to coming into hospital. No skin products are to be used following your shower (e.g. deodorant, perfume, body lotion, powder)
• You need to bring with you:
  • All X-rays, blood and ECG test results
  • Any medications in their labelled containers or Webster pack
  • your Medicare Card
  • your completed registration form
  • underwear, sanitary pads, toiletries
• In some circumstances your surgery may need to be rescheduled or cancelled. If you are feeling unwell or have developed an illness we advise you to make an appointment with your GP who can then inform you if you are well enough to have surgery. If your surgery needs to be rescheduled or cancelled due to advice from a medical practitioner or unforseen personal circumstances please notify Bookings at Mater Health Services on telephone 07 3163 8244 as soon as possible and provide them with the following information:
  • your name
  • your surgery date
  • reason for cancellation of surgery
  • if you require your surgery to be rescheduled
• On arrival to Mater Adult Hospital, report to the admissions desk on level 5, Day Procedure Unit.

What should I expect after the procedure?

• You will stay in the recovery room within the theatre suite after the operation while you waken from the anaesthetic. You will then be transferred in your bed to the Day Procedure Unit.
• During your recovery your nurse will take frequent observations of your vital signs (e.g. temperature, pulse, blood pressure) for several hours after the surgery. As you become fully recovered, these observations become less frequent but remain regular until you leave hospital.
• A general anaesthetic can cause nausea and vomiting. You will have a drip in your arm which will be removed when you are able to take food and fluids by mouth.
• You will have a catheter draining your bladder which will normally be removed the following day when you are able to move around comfortably.
• Your pain will be controlled.
• You will expect to be going home two to four days after your operation.
• Your nurse will discuss your follow-up appointment and any discharge arrangements that have been made with you.
• You should be eating and drinking normally, and be mobilising.

Discharge advice

• It is important that you stay in the company of a responsible adult within the Brisbane region for 24 hours and:
  • do not drive or operate any heavy machinery
  • do not consume alcohol for the remainder of the day
  • do not drive a car, motorbike or ride a bicycle until you can comfortably operate foot pedals and / or change gears
  • do not sign any legal documents or make any important decisions
  • do not engage in sports or heavy lifting.
• You may require four to six weeks off work, depending on your type of employment and the nature of your illness.
• Your abdominal wound may have staples or stitches covered by a dressing. Your doctor will advise you when these are to be removed.
• You will be given specific discharge medication if required, but you may use paracetamol (Panadol) as required (one to two tablets every four hours up to a maximum of eight tablets per day).
• It is important for you to shower rather than bath.
• It is important for you to use sanitary pads and not tampons.

What to avoid:

Intercourse, swimming and heavy lifting for six weeks.

Contact

Please contact either your General Practitioner (GP); Mater Adult Hospital Day Procedure Unit on 07 3163 8324; or Mater Adult Hospital Emergency Department on 07 3163 8111 IMMEDIATELY if you experience any of the following after discharge:

• a fever or are feeling unwell
• offensive vaginal discharge or heavy bleeding
• wound becomes hot, painful or has offensive fluid draining from it
• nausea and vomiting which does not settle
• unable to empty your bladder or bowel
• severe pain.

© 2014 Mater Misericordiae Ltd. ACN 096 708 922

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