"Mr Abu's operation" having an operation named after yourself is such an achievement. Gynae Solution

Did you know that Mr Jaf Abu from Gynae Solution is one of the only one who offers trachelectomy operation (fertility sparing procedure) in Nottinghamshire. Also, for a very long time until a few years ago, Mr Abu was the only one offering total laparoscopic hysterectomy. In fact, it used to be called “Mr Abu’s operation” when he introduced it in the Midlands in 2007.

What is a TLH?

TLH (Total Laparoscopic Hysterectomy) is a major surgical procedure which involves removing the uterus and cervix using keyhole (laparoscopic) surgery.

Ovaries and fallopian tubes may or may not be removed depending on the reason for surgery. If the ovaries are removed, depending on your age you will start the menopause (change of life).

This procedure may be combined with other procedures, such as repair of a prolapse or removal of pelvic lymph nodes if surgery is being performed to treat a cancer.

Hysterectomy can be carried out vaginally, abdominally, laparoscopically or in a combination of these. TLH may reduce your recovery period (including hospital stay), reduce the pain and discomfort you experience after your surgery but may have a higher risk of complications, particularly urinary tract injury.

Why am I having a TLH?

Common reasons for TLH surgery include painful or heavy periods, pelvic pain, fibroids, prolapse, endometrial or early stage cervical cancer. Your doctor will explain why you are having this surgery. Before surgery You should carry on taking your usual medications, unless told otherwise. We strongly advise that you stop smoking before your surgery.

What happens during surgery?

During the surgery TLH is normally carried out under a general anaesthetic. A narrow plastic tube called a cannula is inserted into a vein in your arm or hand using a needle; this is used to give you fluids and medications.

After you have been given a general anaesthetic and you are asleep, a catheter (a tube for urine drainage) is inserted into your bladder. A small cut (about 2 cm) is made under your navel (belly button).

The abdomen is filled with gas and an optical instrument, called a laparoscope, is inserted to allow the internal organs to be viewed before 3 further small cuts, about 1 cm each, are made on your abdomen.

These cuts are for other instruments to be inserted. Your ovaries and fallopian tubes may or may not be removed depending on the reason for your surgery. In most cases the uterus and cervix are removed through the vagina.

If the uterus is too large to remove vaginally, or the vagina is too narrow, a slightly larger cut is made on the abdomen and it is taken out that way. The wounds are closed with dissolvable stitches.

The procedure takes about 1 to 2 hours, but you can expect to be in theatre and recovery for 3 to 4 hours.

What happens after the surgery?

You will normally wake up in the operating theatres recovery area, but you may not remember much until you are back on the ward in your own bed. You will be given medication during your surgery to relieve the pain when you wake up. You may have some discomfort following your surgery but we will try to control this in the best way possible using a variety of pain relief.

What risks are there?

Minor risks

• Inflammation, infections and bruising to any wound on the abdomen or in the vagina

• Haematoma (blood collecting in the wound)

• Chest infection

• Urinary tract infections such as cystitis may occur in about 1 in 6 women

• Hernia

• Adhesion (tissue sticking together).

More serious risks

• Injuries to the bladder, ureters (narrow tubes between the bladder and the kidneys), bowel or blood vessels, requiring further surgery, blood transfusion or longer admission

• Blood loss can occasionally be heavy during the surgery and this may mean that you need a blood transfusion

• Anaesthetics carry a small risk and you will be asked by your doctors about any medical problems that might increase those risks

• Thromboses (blood clots in the leg or chest) are uncommon after this surgery. Preventative treatment will be discussed.

What benefits are there?

• Less pain after surgery than having ‘open’ (traditional) surgery

• Fewer wound complications

• Less disruption to bowel and bladder function

• Lower risk of Deep Vein Thrombosis (DVT)

• Shorter recovery period compared to other forms of hysterectomy surgery.

How long will I be in hospital?

You will be discharged 1 or 2 days after your surgery, but if you have had additional surgery you may be in hospital for longer. If you have any concerns about going home after your surgery please discuss these with the staff at the Pre-operative Assessment Clinic.

What happens at my follow up appointment?

You may be given a follow-up appointment at the hospital or will be asked to make an appointment to see your GP Going home You may still have some discomfort when you leave hospital but you will be given a supply of pain relief medication which you should take regularly for the best effect.

You may also be given some laxatives to take home as minor bowel problems are common after hysterectomy. After the surgery you may experience ‘wind pains’ from having medical air inside your abdomen, but these should stop within a few days. Drinking a small amount of peppermint oil in warm water can help. Peppermint oil can be bought in supermarkets and health shops.

You may notice some weight gain during the first few weeks following surgery this is because you are less active. Hysterectomy itself does not cause weight gain. You may have some light vaginal bleeding (spotting) for up to 6 weeks after the surgery, this is normal. If this becomes heavy, has a bad smell or if you are concerned, please contact your GP.

When can I return back to normal?

You may feel more tired in the weeks following your surgery if you do too much. You may also experience a slight aching discomfort at the wound sites. In some cases this can carry on for some months after the surgery, but most women are able to resume normal activity in terms of exercise and daily tasks within 4 to 8 weeks. It is advisable not to swim until all the wounds have healed and any vaginal discharge has cleared up.

When can I go back to work?

We suggest that you stay off work for 4 to 8 weeks; this depends on the nature of your job. Please talk about this with your consultant or GP.

What about my sex life?

The area at the top of the vagina where the cervix was will have stitches which will need about 6 weeks to heal before intercourse is resumed. You will tend to know when you feel ready to resume intercourse, you should find that there is no alteration in the sensation, but there may initially be slight discomfort if you are over enthusiastic. If you experience any pain please seek advice from your GP.

When can I drive?

You should not drive until you feel able to perform an emergency stop comfortably and are not taking regular pain medication. This usually means about 6 weeks without driving. We recommend you discuss this with your insurance company.

Will I need hormone replacement therapy (HRT)?

HRT will have been discussed with you in the Out-patient Clinic before your surgery. Whether it is offered to you will depend on whether your ovaries are removed during the surgery and your age.

• If you have not yet reached the menopause and your ovaries are left in place there is a possibility that they may stop working at an earlier age than normal. If you do develop hot flushes or other menopausal symptoms before the age of 45 you should seek advice from your GP about the possible need for HRT to prevent osteoporosis (premature thinning of the bones)

• If your ovaries are removed at the time of hysterectomy, before you reach the menopause, you will be offered oestrogen replacement therapy until the age of 50. This will depend on your diagnosis

• If you have already reached the menopause before your surgery your need for HRT will not change. If you were not taking it before the surgery you should not need it afterwards

• You may wish to have a discussion about the advantages and possible disadvantages of HRT with the gynaecology team or with your GP before, or shortly after your surgery. If it has been decided that you will need HRT after your surgery you will be given a month’s supply to take home, after that further supplies can be obtained from your GP.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

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