Surgery

Many gynecologic ailments are addressed surgically.  Understanding your surgery and what it hopes to accomplish for you is critical to your recovery and in obtaining informed consent.  Even though you may have already discussed some of these points with your doctor, this pamphlet revisits these topics in case you have questions.

Risks: Any surgery carries risks.  Even though our doctors take every precaution to minimize surgical risks, it is important to understand the risks involved with your procedure. Below is a general, but comprehensive list of surgical risks.

1. Damage to surrounding structures (uterus, cervix, vagina, ovaries, fallopian tubes, bladder, bowel, nerves and blood vessels)
2. Bleeding, possibly resulting in need for a blood transfusion or emergency hysterectomy (as a last resort)
3. Failure to achieve the desired outcome
4. Need for additional procedures if complication arises
5. Wound infection
6. Pain due to scarring
7. Formation of a blood clot that can migrate to the lungs (pulmonary embolus)
8. Formation of an abnormal connection between pelvic organs (fistula)
9. In laparoscopy or hysteroscopy, there may be the need to convert to a traditional abdominal incision
10. In hysteroscopy, there may be electrolyte imbalance requiring overnight admission or there may be perforation of the uterus requiring laparoscopy

Types of Incisions & Surgical Approaches:

Preoperative:

Your pre-op visit will be scheduled several days before your planned procedure to answer last minute questions and sign consents. Do not eat/drink anything after midnight the evening before your procedure. Avoid aspirin products and herbal remedies for 7 days preoperatively.  Your doctor may ask you to evacuate your bowels the day prior to your procedure and consume only clear liquids or light meals thereafter. Surgery, anesthesia, and narcotics all cause constipation and straining to have a bowel movement after surgery will increase your discomfort. Please be at the hospital 2 hours before or the surgery center 1 hour before your surgery time.

Expectations for Recovery:

Recovery will depend on surgery being performed. 

• All open abdominal surgeries can have an expectation of 6 weeks post-operative recovery time.  Some of our physicians prescribe abdominal binders, which you may find supportive when moving around.  They should be put on snugly, but not restrictively.
• For most laparoscopic procedures, expect a 1-2 week recovery except for total laparoscopic hysterectomies, which will require light activity for 4 weeks. 
• Hysteroscopy, endometrial ablation and sterilization patients are typically able to return to work the next day. If you undergo an endometrial ablation, expect a watery vaginal discharge for approximately 3 weeks.  It is also not uncommon to have nausea and possibly vomiting the day of surgery postoperatively.  If this is the case, we will provide you prescription for an anti-nausea medicine.  Occasionally, at 4-6 weeks post-op from an endometrial ablation you may see bleeding equivalent to a period.  If you undergo an Essure, it is imperative you use another form of contraception until confirmation of tubal occlusion.  The HSG must be performed 3 months after surgery. 
• Urogynecology procedures and vaginal reconstructions/repairs will need 6 weeks of light activity (no lifting >10 lbs) & pelvic rest (nothing in the vagina). If you undergo a sling procedure, you make awake from surgery with soreness on your inner thigh.  This is transient and will go away within a couple hours to a couple weeks. 
• All open abdominal surgeries and vaginal reconstruction surgery patients should avoid driving post-operatively until they are more than 2 weeks from their procedure and are no longer taking narcotics. The majority of outpatient surgery patients can resume driving once they no longer require narcotics for pain relief.

The On Q pump is a form of continuous pain medicine delivered through 1 or 2 small tubes through the skin.  It provides pain management for 3 days post-operatively.  You will be instructed how to remove it during your hospital stay if the On Q is applicable to you.

Oral pain medicines will be given to you at your preoperative visit so they may be filled and at your bedside when you return home from surgery.  You may also get a prescription for medicines to take preoperatively the night before. 

Postoperatively, notify us if you have pain that is not controlled by pain medicines; nausea and vomiting (except for endometrial ablation as above); fever of 101.0 in the first 2 weeks; purulent discharge, bleeding or any drainage from the incision site; vaginal bleeding in which you soak >1 pad/hr for two hours straight or inability to urinate for 4-6 hours.  When you schedule your surgery, our surgery scheduler will make you an appointment with your doctor for your post-op visit. This visit takes place 2-4weeks post-operatively.