Risk of Entry During Laparoscopic Surgery
Entering the abdomen to prepare for laparoscopic surgery is associated with ~0.1% risk of damage to small or large bowel or to large blood vessels like the aorta or vena cava. There is a 5% chance of death if one of these injuries occurs.
The amount of blood you can expect to lose from your surgery can depend on a variety of factors. Often surgery can be completed with a one or two ounce blood loss. However, there is always a risk of needing a blood transfusion, especially if you are anemic before your surgery begins.
If bleeding becomes uncontrollable, there is a risk we may need to proceed with an open surgery (see Conversion to laparotomybelow).
Infection can occur at any sight you have an incision, including the incision in the vagina. We will give you antibiotics during the procedure to minimize this risk. Either the vaginal incision or the skin incisions can become infected and open days after your surgery is over. This may require readmission to the hospital, a repeat surgery or wound care at home over the next several weeks.
Infection can also occur in the bladder, which would require antibiotics to treat.
Damage to Surrounding Organs
Bladder: Damage to the bladder often occurs during the dissection needed to complete a hysterectomy. If the bladder is damaged, it can often be repaired laparoscopically but you may need to go home with a catheter for 1-2 weeks while it heals.
Bowel: Damage to the bowel can happen at the start or during the surgery. If recognized during the surgery, the damage may be able to be repaired laparoscopically. Sometimes it requires an open incision to repair. Rarely, it could involve the need to remove parts of the damaged bowel. Almost never would damage be so severe to require a colostomy, although this is always possible.
Sometimes symptoms of a bowel injury do not become obvious until several days after your surgery. Symptoms can include abdominal distention, fever, lack of passing gas and / or nausea and vomiting. Contact your doctor if you develop these symptoms.
Ureters: Injury to the ureter, which is the tube that connects the kidney to the bladder, occurs 0.5% of the time during a hysterectomy. The ureter can be burned, lacerated, or completely transected. You may need a stent and catheter placed, which will be removed as an outpatient. Rarely, you may need an abdominal surgery to fix the damage.
Sometimes symptoms of a ureteral injury do not become obvious until several days after your surgery. Symptoms can include abdominal distention, fever and back pain. Contact your doctor if you develop these symptoms.
Large Vessels: As discussed above in Risk of Entry During Laparoscopic Surgery, the large blood vessels can be injured during surgery, and would require open surgery to repair.
Small Bowel Obstruction
During the healing process within the first few weeks after your surgery, the bowel can end up becoming “kinked,” which is defined as an obstruction. This would require another hospital admission and possibly another abdominal surgery to fix.
Conversion To Laparotomy
For a variety of reasons, most of which are listed above, it may become necessary to finish your surgery using an abdominal incision. Most of the time the incision is side to side (Pfannenstiel), but occasionally it may need to be up and down (vertical).
Vaginal Cuff / Fascial Dehiscence
If your cervix is removed during your surgery, the top of the vagina that is sewn together is called the “vaginal cuff.” Approximately 1-2% of the time, this incision can open, which is referred to as a “cuff dehiscence.” If the fascial layer of an abdominal incision opens, this is referred to as a “fascial dehiscence.”
Many things can predispose people to these complications. Uncontrolled diabetes, engaging in intercourse within six weeks of your surgery, and not obeying lifting restrictions are some of the things that can cause this complication. If a dehiscence occurs, it is possible bowel can be injured or irreversibly damaged. If this occurs, a second surgery would be needed to fix the damage as discussed above.
It is VERY important to abstain from vaginal intercourse for AT LEAST 6 WEEKS after your surgery to prevent a cuff dehiscence. Signs of a dehiscence include abnormal vaginal discharge, leaking fluid from the vagina, nausea, vomiting or other abdominal pain. Contact your doctor if you develop these symptoms.
A trocar is a port used during laparoscopic surgery. Rarely, small amounts of bowel can herniate through the location the laparoscopic ports were placed. The symptoms of this would include the same symptoms noted above in Damage to Surrounding Organs, Bowel and Vaginal Cuff Dehiscence. Symptoms could also include a painful lump at the sight of one of the incisions. Call your doctor if these symptoms develop.
Deep Vein Thrombosis / Pulmonary Embolism
Any surgery can lead to the formation of blood clots in the deep veins of the legs and pelvis. These are called a deep vein thrombosis. Sometimes, these clots become very large and can break off and lodge themselves in the large vein that brings blood into the lungs. When this happens, it is called a pulmonary embolism.
These are very serious complications that have a high mortality rate. Fortunately, it is rare given the precautions we take during and after surgery (most notably, the foot and leg pumps you will have on). These can occur several days after surgery. Symptoms include any combination of swelling, redness or pain in one leg more than the other. Call your doctor if these symptoms develop.
Temporary or permanent nerve injury can occur in the arm, hand, leg, foot or groin. These are most commonly caused by retractors used in an open surgery and by the positioning of your body needed to perform the surgery. These injuries present themselves very soon after you are awakened from anesthesia. They are most commonly temporary or minor, but serious cases may require physical therapy and permanent, debilitating injury can occur.
If some of your symptoms are caused by things that are not uterine in origin, like pain from the pelvic muscles, a hysterectomy should not be expected to completely resolve your symptoms. Some women continue to have pelvic pain after their surgery. You should talk with your doctor about what should and should not be expected to be treated by your hysterectomy.
Some studies show that women who have undergone hysterectomy earlier in life reach menopause 1-4 years before women who have not had a hysterectomy. If you are not yet menopausal, removing your ovaries will make you enter menopause.
Other Indicated Procedures
Sometimes we may place a camera into the bladder through the urethra to ensure the bladder and ureters were not damaged during the surgery. If an unexpected finding is encountered during your surgery, like finding cancer, other physicians may need to be called and additional surgical procedures may need to be undertaken. Often this involves removing more than was originally expected. Discuss this possibility with your physician. Know that we only have your best interest in mind and we ask that you trust us to make the best possible decisions for you with the information we have.
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Greenville, NC 27834