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Preparing for abdominal surgery – Laparoscopy, Laparotomy

Cynthia Young

You are probably reading this because you or someone you know is about to have abdominal surgery by laparoscopy or laparotomy.

I was terrified in the lead up to my surgery. Not knowing how the operation would go or what would happen on the other side. But I have to tell you I have felt stronger than before my surgery since about 6/7 weeks post surgery.  My experience gave me a chance to really have to be present, focus on the important stuff, rest, recharge and come back stronger.

I had a Salpingo Oophorectomy, removal of an ovary by laparoscopy.

Initially a hysterectomy was discussed but it was agreed that only an ovary would be removed, unless anything urgent was found during the operation and if not, we would wait for the biopsy results.  A large cyst had been found which after some initial tests my gynaecologist was concerned could be cancerous.

I now have one ovary which works harder and has taken over for the right ovary, and touching wood so far, I wouldn't know anything has changed.  If you are having both ovaries removed you will experience surgical menopause as the ovaries will no longer be producing hormones. Your gynaecologist/doctor should discuss this and HRT options with you.

Preparing for abdominal surgery

If your surgery is planned you will have time to think about it and prepare, a double edged sword.

I knew for two weeks I would be having abdominal surgery and had 6 days notice of the surgery date.   Some of you will wait longer.

The window of time when you know you are about to have your surgery but are waiting for a date is a weird and humbling period.

I was trying to continue to enjoy my body (run, practice Pilates, teach Pilates, play with the kids, stay relaxed) and what it could do but know that overnight that was going to completely change.  You're just not entirely sure to what extent.

I had to be ready to change my expectations, go slow and recover wisely knowing if I didn't I would only regret it.  I felt strongly that I needed to be kinder to myself and this was a wake up call.

I have always exercised and eaten fairly healthily but like everyone I struggle with making time and space to rest and recharge.

Stress, our emotions and how we deal with them have a profound effect on the body.  On its capacity to function, to deal with pain, on illness, some diseases and our bodies ability to recover.  I decided I wanted to eliminate as much stress in my life as possible from here on out.

So to help you with this time pre-surgery I am sharing some of the things I did and some information that was useful to me from my research.  I am, some may say a Pilates expert, but I am not a nutritional expert or psychologist.    I have recommended a couple of books, podcasts I found particularly helpful at the end (1).  

The best piece of advice I received in the lead up was from an anaesthetist friend, who said, "you need to have the surgery as soon as possible so that you can you move on."

This was like a light bulb moment, a moment of acceptance of the situation I was in.  I was going to have surgery whether I liked it or not, it was about dealing with this whole situation day by day, surgery and beyond.  It made it feel like actually the surgery was a proactive positive step in the right direction, a part of my recovery, part of moving forward, and I felt a little less scared because it was a step in the right direction of taking care of me.

Thinking about the Surgery, the recovery process and what happens afterwards is daunting and while you are waiting for the day of surgery, you end up thinking about it a lot, whether it's about how you feel or the logistics of life/work/family immediately afterwards.

So we have to be careful how we think, how we spend our time and who we spend our time with because you need mentally, emotionally and physically to be in as positive a place as you can be.  Thinking positively will reduce stress and anxiety which will help to lower inflammation in the body.  This will help with your surgery recovery and the level of pain you experience.

Your abdominal surgery will be carried out either by Laparoscopy or Laparotomy.

What is a Laparoscopy?

With a Laparoscopy (2) you will have between 1 to 4 incisions ( a couple cms each) around your abdomen depending on the reason for your surgery.  It can be used to diagnose conditions (e.g. endometriosis, some cancers, appendicitis, fibroids) where less incisions will be necessary and may not require an overnight stay in the hospital.  Or to perform surgeries (appendix removal, hysterectomy, hernia, oophorectomy, cholecystectomy), which will probably require at least one night in hospital and more than two incisions.  For my Oophorectomy I had 4 incisions, one below my bikini line, one either side of my abs and one from my belly button.

The morning after my Oophorectomy getting ready to leave hospital.

You will have a general anaesthetic and the surgeon will fill your abdomen with carbon dioxide gas to get a better view of your internal organs.  This gas will cause some pain/discomfort under your ribs and your shoulder blades post surgery, which will take a few days to subside.   Your recovery will depend on the reasons for your laparoscopy.  A diagnostic laparoscopy will last around 30-60 mins and you may be able to get back to your usual activities within 5/6 days.  A surgical laparoscopy will last a couple of hours and it will probably take more like 5/6 weeks before you feel comfortable doing your usual activities.

What is a Laparotomy?

With a Laparotomy (3) a single incision is made horizontally (bikini line) or vertically (midline).  It is similar to a C section in that way, but without a further incision of your uterus.  If you have had a C-section previously the same scar may be used for a laparotomy rather than a laparoscopy if you are having surgery.    Sometimes a general anaesthetic is used but for most procedures hernia repair for example you may have a local anaesthetic.  You will have a single scar of around 4-6 cms and will probably stay in hospital one night at least possibly longer depending on the reason for your surgery and how it goes.  This surgery does generally mean a longer recovery time and you will probably feel comfortable to return to your usual activities around 5/6 weeks.  More on recovery in my next blog post.

How can I get myself prepared for abdominal surgery?

 

A few ways to help you accept and have a more optimistic outlook on surgery and recovery:

  1. Thinking positive thoughts about the surgery.
  2. Accepting the surgery is a good thing and will be helpful to whatever your situation is especially where it has taken a long time to get to this point.
  3. Focusing on the outcome, next steps and talking with anyone that helps.
  4. Having confidence in your surgeon, doctors, and yourself.  So don't be afraid to ask your doctors questions, don't leave any niggling questions or doubts to fester in your mind, ask it will be better for your mind.
  5. Avoid comparing your recovery process with others.  Focus on your own recovery, listen to your body, let it rest and trust it will be progress as and when its supposed to.  Perhaps your body needs this rest.
  6. Focus on maintaining a healthy lifestyle.

Why is it important to think positively about your surgery?

It's going to help you through the surgery, recovery and whatever happens next. Positive thinking affects your state of mind, decision making processes, mood, influences your cardiovascular and immune system health; and your short and long term surgery recovery. (4)

So I researched and tried to do anything that would help me to feel positive.  But first, I completely crumbled.  I had no space in my mind that morning for the gynaecologist to tell me I was going to be having an operation. Then to hear I was having an ovary removed, pardon, perhaps both of them and my uterus..... I was shocked and scared.

I cried.  I tried to figure out a way that this didn't have to happen and then I had to accept the situation and try to deal with it as best as I could.

So my top tips for feeling positive about and preparing for your abdominal surgery.

 

Get some sleep and make sure you are well rested.  We know when we haven't had enough sleep we can feel a little moody and irritable!  But lack of sleep exacerbates feelings of anxiety, tension, stress and depression.  So getting enough sleep is key to a positive mindset before and after surgery.  While you sleep your immune system is helping your body to renew, heal/repair and processes information from the day, forming memories and learning.   You may be receiving information that is stressful and uncertain so try to get enough sleep so you body can stay well and you can make informed decisions.

Rest is also vital, you do not have to be asleep to lie down.  Read a book with your feet up, watch tv, allow your body to relax and your mind will rest, allowing your mind to rest will relax your body.

Eat well - If you haven't in the past now is the perfect time to start eating foods that will help promote healing and aid digestion.   Post surgery your digestion will be sluggish from a combination of the general anaesthetic, lying down/being less mobile, feeling bloated post surgery and the fact that you will have had surgery in or around your abdomen.   So eating well now will be better for your digestion post surgery and will set you up well in your road to recovery.  The stronger you go in the better you will come out.  Here's a little something to help you think about what you are nourishing your body with.

Vitamin C Eat more citrus fruits, strawberries, kiwis, brassicas, red, yellow & green peppers, tomatoes

Wholegrains Try swapping white bread, rice, pasta for wholewheat, oats, bulgur (I could only think of Tabbouleh salad)

Vitamin K Have more dark green leafy veg, chicken, kiwis, prunes and avocados

Vitamin D Get outside for a walk during the day, eat eggs, salmon, leafy green veg, yoghurt and milks fortified with Vitamin D plant based or not.  Some doctors, like my gynaecologist, recommend taking a supplement.

Vitamin A Include cheese, eggs, yellow, red and green fruits and vegetables

Collagen & Elastin For your body to produce Collagen your body needs water, protein rich foods like lean meat, beans, eggs, vitamin C, Zinc (wholegrains, legumes, nuts) and Copper (chickpeas, nuts, dark chocolate, Avocados).

Vitamin E Eat dark green leafy vegetables, kiwis, tomatoes

There is kind of a theme here.  Limit the amount of processed foods you eat, try to have meals that have been freshly cooked/made.  Eat a varied colour and variety of fruit, vegetables, nuts, lean meat and legumes.

I started by adding oats & nuts to my smoothies in the morning made with fortified plant milks, eating a grapefruit a day, making vegetable/lentil soups (which actually are pretty easy once you get a couple under your belt), eating a handful of nuts a day, limiting processed foods and swapping out white pasta and rice for brown/wholewheat.

Stay hydrated Keeping well hydrated will help your digestion, help relieve constipation, protect your organs, flush bacteria from your bladder and well hydrated skin will heal faster. When we are not well hydrated we lack energy, feel hungry, irritable, anxious, tired and stressed.  Not conducive to feeling positive and wanting to look after ourselves!  Staying hydrated does not mean only drinking water, all fluids count towards your hydration needs over the day https://www.health.harvard.edu/staying-healthy/how-much-water-should-you-drink

Start practising some breathing exercises or meditate More and more research and time is invested in both of these practices.  Both have been shown to help bring you to the present, help you gain clarity on situations, lower blood pressure, decrease anxiety and help your mind and body to relax.  All important in keeping you healthy.  Breathing exercises will also be fantastic in aiding your recovery post surgery. Try a mixture of meditations and breathing exercises and see what feels most beneficial to you.  There are numerous podcasts offering guided meditations and breathing exercises, Youtube Videos, you may also find it interesting reading James Nestor amazing book "Breath" or watching this short video from Michael Mosley https://www.bbc.co.uk/programmes/m000wc07

Talk about it How are you feeling? what are you thinking or are worried about? Now is the time to be honest.  All of your feelings about this are important and many of them will be transient.  So its OK to feel all the feelings (good, bad, embarrassing, shameful, seemingly irrelevant). It's an important part of processing and working through the whole experience.  Let people you feel you can talk honestly with support you.  My husband, friends and even my children were an amazing support in talking about all of this, giving me different insights and helping me to see things differently where I needed to.

I wondered how I would feel afterwards, did I have cancer, would I go into menopause, would my body change massively, would I be less of a woman, would I look less of a woman.  I hated I was being vain when I should be grateful this had been caught and was being dealt with, but how would I recover from the surgery, would my body still be able to move the same, would I be able to do Pilates the same.  I knew I needed to be positive but also prepared, could this just the beginning of more procedures? I was also confused.  I had no symptoms and if I had not had a pelvic ultrasound I wouldn't have known anything about this.  My smear test was clear and its unusual to have a pelvic ultrasound in the UK at your smear tests.  So if I had my smear test in the UK instead of Spain I would have received my results in the post that my smear test was clear and that would have been in the end of it.

If you would rather not say out loud some of your thoughts, journalling or writing a diary may be a good way for you to express how you are feeling, perhaps before you start to verbalise it.  Writing things down can help you prioritize your thoughts, relax, gain clarity, helps memory, help you come up with ideas/solutions and people who write their goals down and far more likely to achieve them!

Exercise, now is not the time to start a new exercise regime, you don't want to go into surgery with muscle soreness from a new workout or even a possible injury.  But as far as you are able to try to maintain your existing exercise workouts.  For a few days I though 'whats the point, it's all going to pot next week'  and I avoided posting anything on my social media accounts of my workouts so I didn't have a comparison.  But I then realised I would compare myself anyway and I couldn't give up on myself.  What I was doing now was an important part of my rehab on the other side.  So try not to get despondent, do try to keep moving doing whatever you do you are investing in the other side of your surgery.   Walk, if you do no other exercise in the lead up to your surgery, get outside and go for a walk.  Listen to music, an audio book, podcast, walk with someone, a pet or be alone in your own thoughts.  Walking will give you some time to think, is great movement and will be the first and only movement/exercise you will be comfortable'ish doing post surgery.

You will benefit from getting outside, fresh air, sunlight which will benefit your state of mind, Vitamin D, release tension, relax you and get you moving.  And don't forget your breathing exercises will also be working a little your abdominals, back muscles and pelvic floor.

How can you help someone prepare for abdominal surgery?  Try to support them in all of the above where you can, you could make space for them to relax and rest, perhaps not literally but by providing childcare or helping with admin/chores,  prepare them some nutritious food, let them talk or help them prepare the logistics for the start of their recovery when they are first home.

What will happen before your abdominal operation?

If you have not had them already you will probably have some or all of the following; blood tests, a MRI, a chest x ray, ECG and some contact with the anaesthetist and your doctor/surgeon again.  They will explain what will happen on the day, how many people will be in the room, what will happen afterwards.  If you have any questions, ask, now is not the time to be shy/reserved/polite and you don't actually get many opportunities to talk with these people.  If you have any doubts/questions get them cleared up so your mind can be free to relax.

For my operation I was admitted to the cancer ward, which was a little disconcerting. So bear in mind that you are going to a hospital and may encounter something triggering.

You may wait a long time once you arrive at the hospital depending on their schedule and any emergencies. So be prepared to wait.  Be patient, stay calm, take someone to talk to if you want, have something to read/watch, perhaps there are emails or correspondence you need to catch up on, listen to music, audio books, guided meditations, breathing exercises, podcasts, be prepared so you have a choice.   You will probably get bored, may feel impatient and anxious, and you cannot eat anything, go anywhere or drink anything.  You just have to wait as patiently and calmly as you can.

A doctor/your surgeon will come and check on you, check if you have any questions, go over what is going to happen.

About 30 mins before your surgery you will be taken to the anaesthetic room, where you will receive your anaesthetic before being transferred to the operating theatre.  Depending on the nature of your surgery, it could take anything from an hour, a few hours to several hours.  I was gone apparently for about 4 hours including being anaesthetised and woken up.

What to pack for the hospital?

Have comfortable knickers that will either go over your stitches loosely or under.

Sanitary Towels

Loose fitting pyjamas or just a top to make it easy for you when you go to the toilet and the doctor will check you stitches.  I stayed in one night and actually didn't change out from the gown.  I just put on some knickers.  I was tired and couldn't be bothered to do anything more.

Comfortable clothing easy to get on that will not press against your stitches and easy shoes to put on for when you leave the hospital.  I didn't think about this and had to leave with my trousers unbuttoned.

Charger for your phone.

Something to watch/read/do.  Although any time I tried to read or watch anything I felt suddenly exhausted and had to sleep but you may feel differently, may have to wait a while to be discharged or may be in for more than one night.

Water, just in case so you have some to hand

Someone to take you home as you will not be able to drive.

A pillow between you and the seat belt, your stomach may be bloated and you will have stitches.  I didn't have a pillow and held the seat belt away from my stomach, but a pillow would have been a good idea.

A positive mindset.

With time your body will recover and if this surgery does lead onto another surgery or treatment your body will recover from that too.  But, we need to assist our body in doing its job to help us recover.  Be kind to yourself, respect your body, nourish your body with foods that are good for you, rest, sleep, move, use body lotion/oil and start massaging your stomach when you feel ready.   If you didn't before, now really is the time to start to enjoy your body, appreciate it and see how marvellous it can be.

I hope your surgery goes well and I would love to hear from you if you have any further book, podcast recommendations or if you just want to reach out.

I honestly can say I am stronger physically and mentally then I was before this experience, blog post on recovery on it's way now I have had the all clear from my post 6 month check up I feel happy I won't jinx myself by speaking too soon!

Cynthia x

 

(1) Some further reading/resources I found helpful.  Two books that got me in the right head space feeling confident in myself pre surgery were "Untamed", Glennon Doyle and Brene Brown's "Daring Greatly". Both of these books in different ways gave me confidence to face whatever curve ball may come my way and know I had the strength to get over it.  "Upside" by Jim Rendon, I strumbled across this book week 6 into my recovery while I was researching why I could be feeling so good.  A really interesting podcast that covers inflammation, stress, pain, health and breathe work https://drchatterjee.com/dr-andrew-weil-on-how-to-reduce-inflammation-and-create-health/ Gabor Mate's work is also interesting on all this you can catch one of his talks here https://www.youtube.com/watch?v=ajo3xkhTbfo or his book "The cost of hidden stress" I am sure will encourage you to manage your body differently.  Monty Lyman's book "The painful truth" is also brilliant showing you a different view of your body and mind relationship.  

(2) https://www.nhs.uk/conditions/laparoscopy/

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/laparoscopy

(3) https://www.rdehospital.nhs.uk/media/xynlihro/patient-information-leaflet-having-a-laparotomy-for-gynaecological-surgery-rde-19-091-001.pdf

(4) https://www.logan.edu/mm/files/LRC/Senior-Research/2012-dec-24.pdf

 

 

 

 

 

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