Mr Rahmanou – Gynaecology Surgery

Once you have been booked for the surgery by Mr Rahmanou, arrangements will be made for you to attend a pre-admission clinic with a nurse. You will be asked to complete a health questionnaire and assessment will be made of your fitness for your forthcoming surgery. You will be asked about your general health, past medical history and any medication that you are taking. Any necessary investigations (e.g. blood tests, ECG, chest X-ray) will be organised. You will also receive information about your admission, hospital stay, operation and pre- and post-operative care. You will be given the opportunity to ask any further questions that you may have.

Some patients may require further advice or assessment by an anaesthetist prior to admission. The nurse will make this arrangement if needed.

Ensure that you take a bath or shower before you come in the hospital. For vaginal surgery, shaving the pubic hair is not necessary; however, it is advisable that you trim your hair.

You are usually admitted on the day of your surgery. The nurse will show you to your room and make preparations for your admission. When you are in hospital you will be seen by the consultant anaesthetist and Mr Rahmanou who will explain what will happen during the operation. You will receive an explanation of the purpose of the operation and the risks associated with it, and you will be asked to sign a consent form if you have not already done so. You will also have an opportunity to ask any outstanding questions not covered during the pre-admission period.

The operations are usually performed under a general anaesthetic. Sometimes spinal anaesthetics or epidural anaesthetics may be used. Mr Rahmanou and your anaesthetist will discuss this with you as well as the pain management after the operation.

The following general complications can happen after any surgery:

Anaesthetic problems: With modern anaesthetics and monitoring equipment, these are very rare. The anaesthetist will discuss this with you.

Bleeding/haematoma: Sometimes it is difficult to control bleeding and very rarely you might need a blood transfusion. In some cases bleeding may occur after surgery and return to theatre is required.

Thrombosis: Any period of inactivity will make it more likely that you develop a blood clot in the leg (Deep Vein Thrombosis or DVT). This is a potentially dangerous condition, but we will reduce the risks of this happening to you by providing you with antiembolic stockings and giving you some injections to thin your blood while you are in hospital.

Wound infection: We will give you antibiotics during the operation and keep everything sterile to reduce the risk of infection. Despite this, some people may still develop an infection. This will usually clear with a full course of antibiotics, but you may need to be in hospital for longer than expected.

Urinary tract infections: These are common after any procedure and should respond to antibiotics. Symptoms of a urinary tract infection include burning, stinging, the need to pass urine frequently and in some cases bloody, cloudy or offensive-smelling urine. If you notice these symptoms, contact the hospital or your GP.

After the operation you will be transferred to the recovery area and then to the ward. You will have a drip (small tube in the vein) in your hand to give you fluid, and with some operations a catheter (tube) in your bladder to allow urine to drain. Sometimes with vaginal surgery a pack will be left inside the vagina to stop any bleeding into the tissues. The drip, the pack in your vagina and the catheter are usually removed on the day after the operation. Once the catheter is removed it is important that the amount of urine you manage to pass is measured. You will be asked to urinate into a flask, which will then be measured. If we are concerned, the residual volume is measured by performing several bladder scans to ensure that you can empty your bladder properly. If you are retaining a significant amount of urine, we may need to re-catheterise you or teach you how to drain your bladder by passing a small catheter tube into the bladder.

Most people experience some pain or discomfort after the operation and you will be offered painkillers to help to ease this. Painkillers may be given as injection, tablets or suppositories. You will be encouraged to take painkillers, as being pain-free will speed up your recovery.

Having an anaesthetic, being in pain and having strong painkillers can sometimes make you feel nauseous or sick. This can easily be helped with anti-sickness injections or tablets.

You will be encouraged to get out of bed and take short walks on the first day after your operation. This is to reduce the risk of blood clots and any other complications. Usually a physiotherapist will help you with this.

Most women stay in hospital for a few days following the surgery. Occasionally a longer stay may be required. Most patients will be able to eat and drink soon after a gynaecological operation.

Recovery time varies for each patient and Mr Rahmanou will discuss this with you fully. It is important to remember that everyone’s experience is different, and it is therefore best not to compare your own recovery with that of others.

Initially during the post-operative period, start with light activities and gradually develop to more difficult exercises. Walking is an excellent activity. Gradually increase the length of your walks, but remember only to walk the distance you can achieve comfortably. Cycling and swimming are equally good as they are both low-impact exercises. Try to avoid high-impact exercise or weight lifting especially during the initial phase of recovery.

You should be able to drive once you are comfortable enough to be able to perform an emergency brake.

You will be invited back six to eight weeks after your surgery for a review with Mr Rahmanou to assess your recovery and the immediate outcome of your surgery. An examination will be offered at this stage.

Prior to your operation you will be given a set of questionnaires. These questionnaires will help us to understand your symptoms and how they affect you on a daily basis. About six months after the surgery we will send you a further questionnaire to monitor your symptoms. The results of this will be compared with the pre-operation questionnaires to help us see how the operation has improved your symptoms.

Also known as keyhole surgery, this is a modern surgical technique in which operations are performed either with no cut to the body, or through very small incisions of about 1cm. Keyhole procedures within the abdomen or pelvis are known as laparoscopic, whilst those on the uterus are hysteroscopic.

A laparoscope is a narrow telescope inserted through the abdominal wall, usually using the umbilicus (tummy button) so any small scar will be invisible. A light source and a camera is connected, allowing the surgeon and assistants a magnified view of the surgery. Other special keyhole instruments such as scissors are used through one or two additional very small 5mm incisions.

There are several advantages to keyhole surgery compared with traditional operations for the patient:

• smaller incisions reducing pain and recovery time
• reduced bleeding
• reduced exposure to infections
• shorter time in hospital due to faster recovery period
• reduction in internal scarring (adhesions)
• no visible external scar

Most of the procedures in our unit are routinely performed with keyhole surgery:

• removal of the uterus (laparoscopic hysterectomy)
• prolapse repair surgery (laparoscopic sacrocolpopexy or hysteropexy)
• removal of ovarian cysts, ovaries or tubes (Laparoscopic ovarian cystectomy or salpingoopherectomy)
• removal of internal scarring (laparoscopic adhesiolysis)
• removal of the womb lining (hysteroscopic resection of endometrium)