The Women's Health Group

Surgery Education Information

Surgery Introduction:

Scheduling surgery, whether major or minor, is a big step. The following information is to help you become familiar with the procedures before, during and after your surgery. Please use this information to ask your care provider any questions you might have.

Surgery Process:

Your surgery will be scheduled for a certain day and will be either at the Manhattan Surgical Center or at Mercy Regional Medical Center. The times may vary, depending on the schedule. About 1-2 weeks before your scheduled procedure, you will need to have lab tests done either at your primary care provider’s office or at The Women’s Health Group office. During the two weeks before your surgery, you should not take any medications containing aspirin, ibuprofen, or naproxen. You should also stop any herbal preparations that you take and also stop Vitamin E supplements. If you are on blood thinning medications, you need to check with your care provider about when or whether to stop.

If you smoke, you can reduce your risk of postoperative pneumonia or other complications by stopping smoking even 3 days before surgery, and we urge you to do so. You can try over the counter gum, lozenges or patches. If you need a prescription medication to help you stop, ask your primary care provider or your surgeon.

The day before surgery someone from the Anesthesia department will call and interview you about your previous anesthetic experiences, your medications and your health. Follow his or her directions carefully about when to stop eating and drinking. Also, someone from the Surgery department will call you with questions and instructions about when and where to arrive, etc. If you are ill or need to cancel your surgery for any reason, please notify The Women’s Health Group as soon as you know so that schedules can be arranged in a timely fashion.

After arrival at the hospital you will check in with paperwork, get into a hospital gown, have your health history reviewed, and have an IV started. Your anesthesia provider will review the anesthesia plan with you, and soon you will go to the operating room. After monitors are placed and anesthesia is established, you will be positioned and will have the surgical site cleansed and draped.

After the surgery is complete, you will go to the recovery area. If you are on outpatient status, you usually will be able to go home in 1-2 hours. If inpatient, you will go to your room.

It is very important to take deep breaths, move around, and eat and drink as soon as possible after surgery, whether you are at home or in the hospital. This helps to prevent complications and helps you feel better as well. Pain medication can help you to be able to move. Some will automatically be given and, for some medication, you need to ask your nurse when you feel you need it.

A doctor will check on you at least once a day while you are in the hospital and will write prescriptions for any medications you need when you go home. At home, get lots of rest, do lots of walking, drink plenty of fluids, and eat foods with plenty of fiber. Take a stool softener until you are no longer taking pain medicine and bowel function is back to normal. Take a mild laxative like Milk of Magnesia if necessary. You can drive whenever you are no longer taking narcotic pain medication. It is fine to go up or down stairs and to go outside and walk. Avoid heavy lifting, strenuous exercise and sexual intercourse until allowed by your doctor.

After you go home from the hospital, you should contact your care provider if you have any of the following symptoms: 1) temperature 101 degrees or higher, 2) heavy vaginal bleeding, 3) redness, swelling, separation, or other trouble with any incision, or 4) severe pain in your chest or leg or abdomen.

After a hysterectomy, it is normal to have discharge of any color or a small amount of vaginal bleeding off and on for six weeks. It is common to have a little bit of bright red vaginal bleeding a few weeks after surgery when some of the stitches dissolve.

If you need to contact us about a minor post-op problem, you can call (785) 776-1400 during office hours. If it is a serious problem that you think should not wait and the office is close, call the office number, and you will be connected to the answering service. The answering service will contact the doctor on call. Any time you think it is necessary after surgery, you can go to the Emergency Room.

Procedures:

• Laparoscopic Assisted Vaginal Hysterectomy – In this operation a scope is inserted through a small incision just under the belly button and is used to start the hysterectomy, and then the remainder of the surgery is done through a vaginal incision. The uterus is removed; tubes and ovaries may also be removed.
• Vaginal Hysterectomy – The hysterectomy is done completely through a vaginal incision.
• Abdominal Hysterectomy – An incision is made either across the lower abdomen or up and down from the pelvic bone to belly button and the uterus (with or without tubes and ovaries) is removed through the incision.
• TVT-O – In this operation a small length of mesh is threaded under your urethra to support it and prevent urinary leakage with straining.
• Diagnostic Laparoscopy or Tubal Ligation – A slender scope is inserted through a small incision under your belly button. Usually a second and/or third tiny incision is made lower in your abdomen. This can be used to tie tubes, treat endometriosis, cysts, ectopic pregnancies, adhesions, etc.
• D&C – This procedure involves no cutting or stitching; the D stands for “dilate,” to open the cervix, and the C stands for “curette,” which means to scrape. It is used for miscarriage or sometimes to sample uterine lining in abnormal bleeding.
• Anterior and/or Posterior Repair – These procedures are used to restore support to the vaginal walls if they have relaxed, usually due to childbirth. The doctor can just use stitches or insert mesh to help support.

Risks:

Although most surgeries are quite safe and carry a good outcome, any surgery, however minor, carries risk. The risks are usually divided into groups, including anesthesia, bleeding, infection, and damage to other body structures.

• Anesthesia: Modern anesthetic techniques and monitoring make anesthesia safer than ever in history. We have complete confidence in our anesthesia providers and trust that you will follow their instruction to make your anesthetic as safe as possible.
• Bleeding: Most of the time you will lose less blood in your surgery than if you donate a pint of blood at the local blood bank, but there are times in gynecological surgery where there is extra blood loss, even requiring blood product transfusion. Sometimes a stitch will come loose or dissolve too soon and, at times, this may even require a repeat trip to the operating room, although not common.
• Infection: You will be given antibiotics to prevent infection, and this usually does prevent postoperative infection, but there may be infection after surgery in your lungs, your kidneys or bladder, or your operative site. Sometimes it is necessary to take more antibiotics or even repeat surgery to drain infection.
• Damage to Other Body Structures: In performing surgery in the pelvis, we are operating in the area of the bowel, bladder, ureters, kidneys, large blood vessels, and pelvic nerves. Once in a great while, one of these other structures may be injured during pelvic surgery. Sometimes this can be recognized and repaired at the same time. Other injuries may not be apparent right away or may need further surgery at a later time.

This information is not meant to frighten you or make the surgery seem unduly risky, but it is important to be fully informed and have a chance to ask questions. Every time we operate, we do so with the utmost care and try to provide you with a safe and good outcome.

Benefits:

The benefits of pelvic surgery can include stopping abnormal vaginal bleeding; treating or preventing cancer of the cervix, uterus, tubes and ovaries; treating pelvic pain/ restoring normal function of the vaginal walls and bladder; and enhancing or stopping fertility. Most women do very well during and after surgery and are healthy, pleased with the outcome, and able to return to normal activities soon after surgery.