Recovery After Laparoscopy: Day by Day

Laparoscopy — keyhole surgery — is used for ovarian cysts, endometriosis, ectopic pregnancy, fibroids, sterilisation, investigating pain or infertility, and hysterectomy. Recovery is much quicker than after open surgery, but "quick" does not mean "nothing". Most women are surprised by at least one part of it, usually the shoulder pain.

This is a realistic guide to what the days and weeks after a laparoscopy usually feel like, what helps, and the one pattern that means you should not wait.

First, what kind of laparoscopy did you have?

Every laparoscopy uses small cuts, usually one at the navel and one to three lower down. What happens inside varies enormously:

• Diagnostic laparoscopy — looking, perhaps a small biopsy or a dye test of the tubes. The quickest recovery.
• Operative laparoscopy — removing a cyst, treating endometriosis, removing a tube for an ectopic pregnancy, removing fibroids. Recovery takes longer, and more so the more tissue was involved.
• Laparoscopic hysterectomy — the longest recovery of the three, with its own rules. Our guide to recovery after hysterectomy covers it in detail.

Ask your surgeon before you go home exactly what was done. It is the most useful piece of information for judging your own recovery.

Day 0: the day of surgery

You wake in recovery with a sore, bloated abdomen and small dressings. Most women feel drowsy and some feel sick from the anaesthetic. A sore throat is common, from the breathing tube used during the operation.

Many laparoscopies are day-care procedures and you go home the same evening, once you have eaten, passed urine and are walking. After larger operations you may stay one night. Someone needs to take you home and stay with you for the first 24 hours. Do not drive, sign anything important or drink alcohol that day.

Days 1 to 2: the gas and the shoulders

This is usually the most uncomfortable part, and much of it is not from the cuts at all.

• Shoulder-tip pain. The carbon dioxide used to inflate the abdomen irritates the diaphragm, and the nerve involved refers pain to the tip of the shoulder. It can be surprisingly sharp, especially when you sit up. It usually settles within a day or two as the gas is absorbed.
• Bloating and wind. Your abdomen may look swollen and feel tight.
• Wound soreness, usually worst at the navel.
• Light vaginal bleeding or spotting for a few days is common if an instrument was placed in the uterus during the operation.
• Tiredness out of proportion to the size of the cuts.

Days 3 to 7: turning the corner

By now the shoulder pain has usually gone and the bloating is easing. You should be moving more freely, sleeping better, and needing fewer painkillers each day. Wounds are still tender and it is normal to feel tired in the afternoons.

After a diagnostic laparoscopy many women feel close to normal by the end of the first week. After an operative laparoscopy you will still be taking it easy.

This is also the window to watch. Recovery after laparoscopy should go in one direction. If you were improving and then start getting worse — more pain, not less, particularly with fever, vomiting, a swollen tense abdomen, or not passing wind — that needs to be seen the same day. See the warning signs below.

Week 2: getting back to normal life

Most women can do ordinary things around the house, go out, and return to desk work if the operation was minor. Wounds are usually healed on the surface. You may still feel pulling or twinges inside when you twist or lift, which is normal as the internal tissues heal.

Weeks 2 to 4: after larger operations

After cyst removal, endometriosis surgery or fibroid removal, recovery commonly takes two to four weeks, and tiredness can last longer than the pain. Build up your activity gradually. If you feel worse the day after doing more, you did too much — ease back, but keep moving.

Wounds

• Keep them clean and dry for the first day or two. After that, showering is usually fine — pat the wounds dry. Avoid soaking in a bath or swimming until they have healed.
• Stitches are usually dissolvable. If not, you will be told when they need to come out.
• Bruising around the cuts is common and fades over a week or two.
• A little clear or blood-stained ooze in the first days is normal. Increasing redness, heat, swelling or pus is not.
• The scars are small and usually fade to faint lines over months.

Practical questions

Warning signs: call the same day

The reason the first sign matters most: laparoscopy occasionally injures the bowel, bladder or a blood vessel. It is uncommon, but according to the Royal College of Obstetricians and Gynaecologists, up to 15% of bowel injuries are not recognised at the time of the operation. They show themselves in the days afterwards — typically as a recovery that goes into reverse. Found early, they are treatable. Waited out, they become dangerous.

How safe is laparoscopy?

Laparoscopy is one of the commonest operations in gynaecology, and it is very safe. The Royal College's consent guidance gives these figures for gynaecological laparoscopy:

• Frequent, minor: bruising, shoulder-tip pain, wound gaping and wound infection.
• Serious complications overall: about 2 in every 1,000 — injury to the bowel, bladder, ureter or a major blood vessel, which may need a larger operation to repair.
• Hernia at a cut site: less than 1 in 100.
• Death: between 3 and 8 in every 100,000, which is very rare.

Risks are higher in women who have had previous abdominal surgery, who have significant endometriosis or adhesions, or who are very overweight. Your surgeon will talk through your own risk before the operation.

Feelings after surgery

Feeling low, teary or flat for a few days after an operation is common, especially if the surgery was for something upsetting, such as an ectopic pregnancy, or if the result was not what you hoped. It usually passes. If it does not, talk to your doctor.

What happens where

The laparoscopy itself — including ovarian cyst removal and endometriosis surgery — is carried out at an NABH-accredited hospital in Gurugram, where admission, anaesthesia and any emergency care also happen. Any scans needed before or after surgery are arranged by referral.

The consultation before the operation, blood tests, the follow-up visit afterwards — including a wound review and going through what was found — and any histology results are handled at the clinic. If something does not feel right during your recovery, call. It is always better to be checked and reassured than to wait.