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Dr. Parker’s Discharge Instructions and Suggestions after Laparoscopic Surgery

UCLA Gyn Subspecialties Group
1450 Tenth Street, Suite 404
Santa Monica, CA, 90401
(310) 451 8144 (phone)

Disclaimer: it is important for you to follow your own doctor’s instructions.

ACTIVITY AFTER SURGERY:

  • No strenuous exercise or intercourse for 2 weeks
  • You may start walking for exercise on day 1
    • Walking is the best activity following surgery.  You can walk up and down stairs, outside, and on a treadmill.  Walking will keep your circulation going and build back your stamina.
  • Fatigue – fatigue is extremely common after surgery and may last many weeks.
  • Iron – to help build back any blood lost during surgery. Either Fergon or SlowFe – 1-3 times a day along with 1,000mg of vitamin C (helps with the absorption of iron)
  • You may start driving when you are no longer taking narcotic pain medication and you   feel it is SAFE for you to drive.
  • Showers only (no baths) for the first 2 weeks.

PAIN/DISCOMFORT MANAGEMENT

  • For pain, we will prescribe either Norco 5/320mg or Percocet 5/325mg for you to take once you get home.
    • Days 2-3 may be worst, pain-wise
    • Some cramping and shooting pains are normal, even in areas away from the incisions
    • Do not drive under the influence of narcotic pain medication
  • Lowering, raising and turning yourself will hurt (try using your arms instead of abs)
  • Urination may burn/pinch initially, but will get easier (avoiding caffeine). Taking D-Mannose helps.
  • Shoulder Pain – In order to see the pelvic organs during laparoscopic surgery, we need to put carbon dioxide gas (CO2) into the abdomen which pushes the bowel out of the way.  If the CO2 is left in the abdomen, it can irritate the nerve under the diaphragms.  This nerve runs close to the nerves for your shoulder and the gas will cause shoulder and back pain.  The pain can be sharp and can last for a day or two.  Sometimes changing position can help, but over time the pain will go away.

INCISIONS

Depending on the type of laparoscopic surgery you have, you will have either 2, 3 or 4 small incisions.  Usually the first 1/2 inch incision is made in the navel.  For a laparoscopic myomectomy, a 1/3 inch incision is made a few inches to the left of the navel and another incision is made a few inches to the right side of the navel.  The last incision is about 3/4 inch and is placed on the right side above the hip bone.  For larger fibroids, the incisions will be higher.  For laparoscopic hysterectomy the right side smaller incision is not necessary.

At the end of the surgery, I inject local anesthesia into the incisions which provides a few hours of some pain relief.  You will likely have some pain in the recovery room and then nurses will give you pain medication as needed. When the local anesthesia wears off, you will have some incisional pain and, during your pre-op visit to the office, we will give you a prescription for pain medication to take at home.  The larger incision on the right side tends to be uncomfortable for a few weeks since it is larger, gets more sutures and is close to a nerve.

  • It is OK to shower with steri-strips (do not scrub the wounds). You can remove the steri-strips after a week. After the steri-strips are removed, I suggest you buy Scar Away at the drug store. Scar away is a silicon bandage (like a large band-aid) that you can cut into small strips and put over the incisions for as many hours a day as you can.  Over time, the Scar Away thins and lightens the incisions so that they heal more nicely.
  • Bruising: bruising around the incision(s) is very common, even beyond the surgery area, for a few weeks after surgery.  Cold packs can keep the incision swelling down and the bruising will go away by itself.
  • Lumpy Incisions – the sutures dissolve by themselves and are replaced by collagen scar tissue.  Initially, the collagen is thick and may be bumpy.  Over the next few months the initial collagen is replaced by a softer type of collagen and the bumps will go away.

DIET AND BOWEL ISSUES

  • No dietary restrictions
    • Avoid foods that cause gas such as broccoli, cauliflower and brussel sprouts
  • No alcohol if taking narcotic pain medications
  • Chewing gum helps with bowel function
  • Walking helps bowel function
  • Constipation is unusual after laparoscopic surgery.  But, if you have constipation you may take Metamucil or Colace as needed (over-the-cunter).
  • Expect some gas discomfort/pain.  Gas pain can be relieved by walking, taking medication (Mylicon, Gas-X) and chewing gum.  Bending your legs while lying on your back may also help.
  • Bloating (“swelly belly”) is normal for up to 2-4 weeks and will go away by itself. Surgery irritates and slows down the intestines and they retain more gas and stool.

PERIODS

  • Some bleeding and/or clumpy discharge is normal for a few weeks.
  • Periods won’t be normal again for 3-4 cycles – they may be heavy, light, long, short – anything can happen while you are healing.

 CALL US AT 310-451-8144 FOR:

Fever over 100.4 degrees F, bad pain unrelieved by pain medications, heavy bleeding, vomiting, dizziness, pus-like drainage from the wound or other concerns.

 SUGGESTED TO WEAR/BRING TO THE HOSPITAL

  • Comfortable slip-on flat shoes
  • Pants or skirt with elastic or drawstring waistband
  • Pillow for the car ride home (leave in car to put between your stomach and seat belt)
  • Lip balm (your mouth may be parched)
  • Your ID
  • Advance directives (optional)

BEFORE SURGERY –  SUGGESTED SHOPPING LIST

  • Throat lozenges: Sometimes the tube placed down your windpipe (trachea) can cause irritation which can feel like a sore throat.   At times, this irritation can lead to a not very pleasant feeling cough.  Lozenges can help soothe your throat and also help minimize the coughing.
  • Stool softener: Many types are available:  Smooth Move tea, Colace, Peri-Colace (stool softener and mild laxative together).  High-fiber foods.
  • Anti-gas pains: Mylicon, Maalox, Gas-X or peppermint tea
  • Three days of groceries/easy-prep foods, since you won’t feel like cooking. Consider broth/soup, fruits + veggies (avoid gassy ones like broccoli, cauliflower and Brussels sprouts), rice, crackers, juice, yogurt.

BEFORE MYOMECTOMY

We ask women to insert 2 tablets (Cytotec) vaginally about  2 hours before surgery. Cytotec has been shown to decrease blood loss during myomectomy surgery. However, it can also cause cramping, vaginal bleeding and, sometimes nausea. If you have any of these symptoms, they are normal (and we apologize), but the medication does help decrease surgical blood loss.

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Disclaimer: The ideas, procedures and suggestions contained on this web site are not intended as a substitute for consulting with your physician. All matters regarding your health require medical supervision.

Fibroid Doctor William H. Parker

Dr. William H. Parker is a board-certified Fellow in the American College of Obstetricians and Gynecologists. Dr. Parker is an internationally recognized expert in fibroid surgery and research. Based in Los Angeles, California, he is considered one of the best fibroid surgeons for abdominal and laparoscopic myomectomy in the United States and abroad. He has been chosen for Best Doctors in America and Top Doctors every year beginning in the late 90's.

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