Endometriosis surgery – frequently asked questions for laparoscopy patients

Our endometriosis columnist Emma Kemsley continues to answer all of your questions about surgery. Click here to access part 1 of this five part series.

How long will the procedure take?

On average a laparoscopy takes 30-60 minutes. However, it depends on your personal circumstance. It may take a little longer for more complex cases.

For example, my first lap showed stage 4 endo and 15cm+ ovarian cysts and took two and half hours. My second was similar at just under three hours. My third to remove my fallopian tubes took five hours. I have severe stage 4 endo, my organs are fused together, there is extensive scar tissue and adhesions to my bowel, bladder and rectum, which makes removal challenging. I was absolutely fine afterwards, and recovery was quick.

How long will I stay in hospital?

Most laparoscopy is day surgery. You will be home the same day. If the surgery is longer than expected, you may stay overnight.

I have stayed overnight as a precaution with all three of my surgeries, but they do take longer than the average laparoscopy.

Will I stay in overnight?

This depends on individual circumstances. If more work has been required during your surgery or you have side effects from anaesthetic, you may be required to stay overnight.

Can someone stay with me?

Unfortunately, your partner, relative or friend will be required to leave during your procedure. Due to COVID restrictions, visitors are not currently allowed to attend hospital with patients. You should check the current COVID guidelines for details about visitor access

Previously during my surgeries, pre-COVID, my husband was allowed to be with me during recovery. During my two private surgeries he was allowed to wait in my hospital room. At my private surgery in Barcelona, he was with me all day until 11pm at night and returned at 7am the next morning. He even had his own bed to nap on while I was in theatre and the nurse bought him snacks!

What happens on the day of a laparoscopy?

On the day of the laparoscopy, you will arrive early in the morning, usually between 7am-9am. The consultant will see you for a quick chat and run through everything that will happen. He will advise how long you will wait to be seen. You may be first on the list, you may be fourth. There is no way of telling. You will also be visited by the anaesthetist who will ask medical questions and explain the process. They will make you feel at ease. You will change into the hospital gown. A cannula will be inserted into your hand or arm for the anaesthetic.

You may be given an anti-sickness and relaxant shortly before your procedure. You will then either be wheeled on the bed or escorted and walk to theatre.

In theatre, the team will introduce themselves. You will state your name and date of birth. Staff will check your wrist band. The anaesthetist will then administrate the anaesthetic via the cannula. You may be asked to count to 10 or asked to talk about a hobby or similar. You will begin to feel sleepy, almost like you are drunk but in a nice way. The next time you open your eyes you will be in recovery.

How will I feel after general anesthetic?

A nurse will wake you up in recovery. You will feel sleepy and not fully coherent. The consultant may see you at this point and tell you about the surgery. Don’t worry, if you can’t remember what he says. He may see you again or a nurse will fill you in. You might drift in and out of sleep, but within 15 minutes or so you will become more alert and aware. Your mouth will be dry, and a nurse will likely give you water. You may also talk utter nonsense for a bit too (or maybe that’s just me), but that’s all part of the experience. Remember the nurses are used to this and are there to look after you. Some people (me) suffer with nausea after general anesthetic. It usually passes after 24 hours but may last a little longer.

How will I feel after my surgery?

You will feel very bloated and swollen. You may have some pain and discomfort, but it won’t be unbearable. A nurse will ask if you need painkillers. You might feel like you can’t move easily due to pain and swelling. You will have stitches for each incision. Occasionally you will also experience pain in your shoulders from the gas put into your abdomen during surgery. The discomfort will improve over the next 24-72 hours.

How many incisions will I have?

Laparoscopy is a key-hole surgery. To insert a camera, three small incisions are made: one above each pelvic bone and one in the belly button. Incisions will be stitched. They sometimes initially look worse than they are. Depending on the complexity of your surgery, you may have a couple extra incisions.

For example, during my fallopian tube removal I had four incisions, with an extra cut higher up on the left side of my abdomen. This was because the surgeon was unable to remove my tubes via the normal three incisions due to extensive endo.

The stitches are usually dissolvable. Overtime the scars will fade and become virtually invisible. Keep wounds clean and avoid clothes that rub on them while they heal. I find Bio Oil useful for scarring too.

If this is your second laparoscopy, it’s likely the surgeon will use the same incisions, so you won’t have additional scarring.

I have pain in my shoulder after a laparoscopy. Is this normal?

Yes. It’s common to experience shoulder pain after your surgery, but it should ease within 72 hours. It may seem odd to have shoulder pain after gyne surgery but during the laparoscopy CO2 gas is injected below your navel to extend the abdomen so the surgeon can get a better view. Your diaphragm shares nerves with your shoulder, predominantly the Phrenic nerve. This can become irritated and the pain is referred upwards.

Top tips for reducing shoulder pain are walking and movement. Peppermint tea can help ease symptoms too.

Don’t worry if the pain persists longer than 72 hours. During my first and third surgery I had shoulder pain for almost a week, however this is rare.

Will I get my results immediately after my procedure?

The surgeon will visit you in recovery and give you an overview of findings. However, don’t be alarmed if you can’t remember every word. Some surgeons will visit you again before you are discharged and advise on the next steps.

During my private surgery, the surgeon visited me after surgery and the next morning, but NHS doctors are extremely busy so can’t always spare the time to do this for every patient. You will have a follow up consultation post-surgery. It may be frustrating not to be given a full

breakdown immediately, but remember you are there to have surgery. It’s not a consultation appointment. All details will be discussed at a later date. The consultant may even share surgical photos with you at the post-surgery appointment.

How long will it take to recover?

Every individual is different. Every laparoscopy is different. The general guide for recovery is one to two weeks, but for more complex surgeries recovery will take a little longer. You might not feel completely like your usual self in two weeks, but should certainly be well enough to resume normal activities. Avoid any heavy lifting or strenuous activities for two weeks.

To give you an example, after my first surgery I was sick and in bed for 72 hours, but five days post-surgery, I was able to take the dog for a walk and take it easy pottering around at home. I returned to work within eight days. My second surgery, I felt well and back to normal within 48 hours. I hopped on a plane to Sri Lanka seven days later. My third surgery was long and more complexed, and I didn’t bounce back as quickly, which I found frustrating. The fortnight post-surgery, I found myself regularly feeling exhausted or dizzy if I had done too much. However, this surgery was in Barcelona and I was well enough to lounge on the hotel rooftop, walk through an airport and fly home 72 hours later. I took time to rest at home the following week but resumed normal activities at a slower pace within seven days, returning to work on day 10. I started to exercise again six weeks post-surgery.

Can I go back to work after a laparoscopy?

This depends on the demands of your job. I am journalist so the majority of my job is desk based. It was relatively easy for me to pick up the laptop within a week. However, if you’re on your feet all day, two weeks recovery is recommended.

I have been diagnosed with endometriosis, what happens next?

You will have a follow up appointment with your consultant who will advise on the best hormone treatment to manage symptoms. Take this time to ask questions and think about future plans such as fertility and egg freezing, if necessary.

I have been diagnosed with adenomyosis, what happens next?

The same protocol will follow. You will be able to discuss symptom management and hormone treatment with your consultant.

On a side note, no one told me I had adenomyosis after my laparoscopy. I found out when I read my notes as I left the consultants room. The two frequently go together so it’s worth asking at your post-surgery follow up if you have both.

Will surgery affect my fertility?

Endometriosis is one of the biggest causes of infertility. However, many women often find it is easier to get pregnant after a laparoscopy. Surgical treatment to the ovaries can cause a decline in AMH (egg reserve). It is important to discuss your future fertility plans with your doctor before surgery. However, your consultant will always do their best to protect your fertility.

Your consultant will likely mention if your fertility is at risk post-surgery. If he/she doesn’t, then ask. Fertility will be compromised depending on the amount of endometriosis and its location. Don’t underestimate the importance of your fertility. You may not be ready for a baby but discuss precautions such as egg freezing with your doctor if required.

The surgery found no endometriosis, what is the next step?

If you have endometriosis symptoms, no diagnosis after surgery can be disappointing. Take into consideration if your consultant is a gynaecologist or endometriosis specialist. On rare occasions endometriosis can be missed if the laparoscopy is not performed at a BSGE credited clinic.

Will my pain come back?

Unfortunately, there is no cure for endometriosis. A laparoscopy will ease symptoms and, in some cases, solve all issues. However, endometriosis can return. In my personal experience, pain has returned between 6-9 months. For other people, it could be years. The situation is unique to each individual.

*Disclaimer; please note not every surgery is the same and individuals respond differently to medication and treatments. COVID may impact treatment and timescales.