Recovery after laparascopic surgery

Pain: Abdominal cramps and bloating, and shoulder tip pain, are common in the first 24 hours. Worsening pain after this period can be a sign of complications.

Other symptoms of complications: Loss of appetite for food or fluids, reluctance to mobilise, N&V, poor urine output.

Possible signs of complications: Pyrexia, tachycardia, abdominal tenderness or distension.

Time off work: There are no clear guidelines; play it by ear according to the person’s occupation, procedure, and recovery. As a rough rule of thumb, smaller procedures such as lap chol or appendicectomy typically only require a couple of weeks off. Larger procedures are likely to require more time off/more gradual return to work.

Return to driving: Requires the ability not just to do emergency stops, but to turn around enough to check blind spots and to react quickly. Might take one or two weeks for lap chol or appendicectomy and longer for groin surgery or more major procedures.

Heavy lifting: Not that much data. The advice is to avoid lifting anything heavier than a kettle/a shopping bag, and also to avoid pushing and pulling activities such as vacuuming, mowing the lawn, and hanging up heavy washing. One or two weeks should be enough for smaller procedures and four weeks for larger procedures.

Eating and drinking: Normally no restrictions, although a few procedures (gastric banding, anti-reflux surgery, surgery for oesophagogastric cancer) can require a liquid-only diet initially.

Recovery generally: Patients should expect to notice an almost daily increase in how much they can do without pain or discomfort.

Travel: Patients are advised not to fly for 24 hours after laparoscopy because of the possibility of expansion of carbon dioxide in the abdominal cavity. It’s considered sensible to use thromboembolic stockings if flying within the first month.

Swelling at the site: Might be due to haematoma, abscess, or seroma; important as seromas may be treatable conservatively, but abscesses and large haematomas are usually going to require surgical intervention.

  • Haematoma: Usually shows up within 24 – 48 hours of surgery. May be painful and there may be bruising present. Overlying skin temperature is normal.
  • Abscess: Typically 3 – 7 days after surgery. Likely to be very tender with hot, red overlying skin and sometimes visible purulent discharge.
  • Seroma: Usually show up over a week post-op and cause only slight discomfort. Skin colour and temperature are normal.

Note that superficial wound infections can probably be treated in general practice, but contact surgery if there is any concern about possible deeper infection.

Thromboprophylaxis: In cancer patients, and normally in patients who’ve had bariatric surgery for morbid obesity, this is continued for a month.

 

BMJ: Management of patients after laparoscopic procedures.

About Dr Sarah

I'm a GP with a husband and two young children.
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