Advantages over open surgery
- There is less pain after the operation and less painkiller is needed.
- The hospital stay is short.
- The return to daily life and to work is faster.
- Wound infection and a feverish course are less frequent.
- Fewer adhesions form. Because the abdomen is not opened and the least possible damage is done to the tissue, the risk of adhesions after the operation is much lower — this is particularly important for those thinking of a pregnancy later.
- There is less blood loss during the operation.
- Thanks to the magnification of the camera, deep and hard-to-reach areas within the pelvis are seen much more clearly.
- The scar is very small.
The risks: an honest picture
The great majority of these operations pass without problems. In diagnostic laparoscopy the risk of a serious complication is about two in a thousand.
The riskiest period is the beginning of the operation: the stage at which the instruments are first passed through the abdominal wall and the inside of the abdomen is not yet visible. For this reason the situations that increase the risk are assessed beforehand — such as excess weight, being very thin, previous abdominal surgery, a history of inflammation of the lining of the abdomen and bowel disease.
Serious but rare
- Bowel injury — about 0.4–1.1 in a thousand.
- Major vessel injury — about 0.1–0.2 in a thousand. In young, very thin women with well-developed abdominal muscles who have never given birth in particular, the main artery may be only 2.5 cm below the skin; the risk is higher in this group.
- Injury to the bladder or the urinary tract — about 0.3 in a thousand.
- Development of a hernia at an entry site.
- The operation not being completed by the keyhole method and conversion to open surgery.
- A clot in a leg vein and its travelling to the lung.
- Death — very rare: 3–8 in a hundred thousand.
Be sure to know this: about 15% of bowel injuries cannot be noticed during the operation. These injuries show themselves days later, often after you have been discharged. For this reason you need to watch yourself in the days after you go home and seek help without delay if the symptoms below appear.
Common and mild
- Bruising at the wound sites
- Pain at the tip of the shoulder — caused by the gas remaining in the abdomen irritating the diaphragm; it is temporary
- Slight opening of a wound site
- Wound infection
- Trapped wind — happens because the bowels slow down temporarily; walking relieves it
After the operation: which symptoms mean seeking help?
Go to a health facility without delay:
- Increasing abdominal pain — particularly if accompanied by fever, loss of appetite and vomiting. This may be a sign of injury to the bowel or the bladder and requires admission to hospital.
- Redness and pain around the scars — this may be a wound infection.
- Pain, redness, swelling or warmth in the leg, or difficulty putting weight on it — this may be a sign of a clot in a vein.
- Shortness of breath, chest pain or coughing up blood — this may indicate that a clot has travelled to the lung. Call for emergency help.
To reduce the risk of a clot
- Move as early as possible after the operation.
- Do foot exercises even while resting — moving your ankle, pump each foot briskly up and down for 30 seconds.
- Take your painkiller regularly. If the pain is under control you will get up earlier, stand straighter and move more — this both speeds up healing and prevents clots forming.
What you should be told before the operation
The guideline requires that the following be explained to you before the operation:
- The risks of the entry method to be used — injury to the bowel, the urinary tract and major vessels
- The risk of a late hernia at the entry sites
- Risks increased in your particular situation — excess weight, previous surgery, accompanying illnesses
- That the risk of a serious complication increases if an additional treatment procedure is to be carried out
- That laparoscopy may not find the cause of your complaint
This matters if you have had abdominal surgery before: the rate of adhesions around the navel can be as high as 50% after a midline incision and 23% after a low transverse incision. In that case the surgeon may prefer to make the entry at a different point.
With any surgical procedure, results vary from person to person. You are advised to discuss the procedure with your doctor in detail beforehand.
Frequently Asked Questions
What is the advantage of keyhole surgery over open surgery?
There is less pain and less need for painkillers after the operation, the hospital stay is shorter and the return to work is faster. Wound infection is less frequent, there is less blood loss and the scar is very small. One of the most important: fewer adhesions form — which is particularly valuable for those thinking of a pregnancy later.
How risky is it?
The great majority pass without problems. In diagnostic laparoscopy the risk of a serious complication is about two in a thousand. Bowel injury is 0.4–1.1 in a thousand; major vessel injury 0.1–0.2 in a thousand; injury to the bladder or urinary tract 0.3 in a thousand. Death is very rare (3–8 in a hundred thousand). The risks increase if an additional treatment procedure is carried out.
What should I watch for at home after the operation?
This is very important: about 15% of bowel injuries cannot be noticed during the operation and show themselves days later, often after you have been discharged. Increasing abdominal pain — particularly if accompanied by fever, loss of appetite and vomiting — means you should seek help without delay.
For which symptoms should I call for emergency help?
Shortness of breath, chest pain or coughing up blood — this may indicate that a clot has travelled to the lung; call for emergency help. Pain, redness, swelling or warmth in the leg, or difficulty putting weight on it, may also be a sign of a clot in a vein. Redness and pain around the scars suggest a wound infection.
Why does my shoulder hurt?
This is expected and temporary: part of the gas used to inflate the abdomen during the operation remains behind and irritates the diaphragm, causing pain at the tip of the shoulder. Similarly, trapped wind can occur because the bowels slow down temporarily; walking relieves it.
How can I reduce the risk of a clot?
Move as early as possible. Even while resting, move your ankle and pump each foot briskly up and down for 30 seconds. Also take your painkiller regularly — if the pain is under control you will get up earlier, which both speeds up healing and prevents clots.
I have had abdominal surgery before — will that be a problem?
This is assessed beforehand. The rate of adhesions around the navel can be as high as 50% after a midline incision and 23% after a low transverse incision. For this reason the surgeon may prefer to make the entry at a different point. Excess weight and being very thin also affect the entry plan.
Why is being very thin considered a risk?
Because when the abdominal wall is thin, the deep structures come very close to the skin. In young, very thin women with well-developed abdominal muscles who have never given birth in particular, the main artery may be only 2.5 cm below the skin. Because this is known, the entry method is chosen accordingly in this group.
Can an operation start as keyhole and become open?
Yes, this is a known possibility and it should be explained to you before the operation. It is also part of the information given that laparoscopy (viewing the abdomen with a camera) may not find the cause of your complaint.
Sources
- RCOG Green-top Guideline No. 49 — Preventing Entry-Related Gynaecological Laparoscopic Injuries. Higher-risk patient groups, entry methods, complication rates and information for the patient.
- RCOG Consent Advice and patient information documents — serious and common risks, warning symptoms after the operation and advice on reducing the risk of a clot.
- Guidelines on the management of benign ovarian masses and endometriosis — comparative outcomes of the laparoscopic approach against open surgery.
The information on this page is based on the national and international guidelines listed above. The page is reviewed whenever those guidelines are updated.
Practice and Contact Details
The information on this page is general. Please speak to your doctor about your own situation.
- DoctorOp. Dr. Murat Alpay — Specialist in Obstetrics and Gynaecology
- AddressOp. Dr. Murat Alpay Practice, Tekelioğlu Cd. No:51 B Kat:2, Filo Apt., 07160 Muratpaşa / Antalya
- Telephone0505 351 77 88
- HoursMonday – Saturday 09:00 – 18:00 · Closed on Sunday