Laparoscopy for Chronic Pelvic Pain

What is a laparoscopy?

A laparoscopy uses a tool called a laparoscope to allow your healthcare provider to look more closely at organs and tissues in your abdomen (belly) or pelvis (the area below your belly and between the hips). A laparoscope is a thin tube with a light and tiny camera. The camera shows a view of the abdominal organs on a TV monitor. It may help your provider find and treat the cause of medical problems you may be having.

When is it used?

This operation may be done to find the cause of chronic pain in your pelvic area. (Chronic pain is pain that lasts for several months or more.) The surgery may also be used to treat the cause of the pain.

Your healthcare provider may first try other things to help the pain, such as anti-inflammatory medicine, pain medicine, hormones, or physical therapy.

You may first have an imaging test to look at your abdomen and pelvis, such as:

• ultrasound scan
• CT scan
• MRI scan

Examples of alternatives to this procedure include:

• more extensive abdominal surgery
• choosing not to have treatment

You should ask your healthcare provider about these choices.

How do I prepare for a laparoscopy?

Plan for your care and recovery after the operation. Find someone to drive you home after the surgery. It’s important to allow enough time to heal and rest after your surgery. Try to find other people to help you with your day-to-day duties. It may take several weeks to recover fully from the surgery.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

Follow any other instructions your provider gives you. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

Your healthcare provider may give you medicine to take the night before surgery to clear out your bowel and make the operation safer.

What happens during the procedure?

You will be given a local, regional, or general anesthetic before the procedure to keep you from feeling pain. Local and regional anesthesia numb part of your body while you stay awake. You may be given a sedative with the local or regional anesthetic to relax you. General anesthesia relaxes your muscles and puts you to sleep. A general anesthetic is usually recommended if tissue may be removed during the laparoscopy.

Your abdominal cavity is inflated with carbon dioxide gas. This helps your healthcare provider see and protect your organs. Your provider makes a small cut (incision) in or just below your bellybutton and puts a laparoscope through this cut. The scope is used to look at the organs and tissues in your abdomen and pelvis. Your provider may make 1 or more other small cuts in the lower abdomen for other tools. The other tools can be used to remove fibroids or other abnormal tissue. If your provider finds a growth that should not be there, your provider may remove the growth or a sample of the abnormal tissue. Samples of tissue will be sent to the lab to be examined under a microscope either during or right after the procedure.

When finished, your provider will release the gas through the tube of the scope and remove the scope and other tools. He or she will close the cuts in the skin with stitches or surgical glue.

What happens after the procedure?

You may stay in the hospital several hours and possibly overnight to recover. You may be sleepy or groggy for a while from the anesthetic. You may have some shoulder pain, feel bloated, or have a mild change in bowel habits for a few days. You may not be able to urinate right away. Your provider may put a small tube (catheter) into your bladder through the urethra to drain urine from your bladder.

You should be able to control any pain you have with pain medicine prescribed by your healthcare provider. The pain should steadily get better.

You should avoid heavy activity such as lifting. Ask your provider how much weight you are allowed to lift.

Your provider will give you other instructions for your recovery and tell you when you should return for follow-up at the office.

What are the benefits of this procedure?

Laparoscopy can find abnormalities that other diagnostic tests may not find. It may be possible to treat the cause of the pain during the procedure.

Laparoscopy allows you to recover quickly from surgery. You are less likely to have complications or develop scar tissue in the abdomen or pelvis. You can avoid a bigger operation and a longer stay at the hospital.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider and the anesthesia specialist.
• Abdominal organs, such as the bowel, bladder, nerves, or blood vessels, may be damaged. They may need to be repaired during this procedure or with a separate operation.
• The cuts in the abdominal wall may become inflamed or infected, or the cuts may open up.
• You may have an internal infection or bleeding that may require a blood transfusion, antibiotics, or more surgery.
• You may have some pain after the procedure.

These risks are rare, but you should ask your provider what risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You have a fever over 100°F (37.8°C).
• You have redness, swelling, pain, or drainage from the incisions.
• You become dizzy, feel like fainting, or faint.
• You have chest pain.
• You have nausea and vomiting.
• You become short of breath.
• You have abdominal pain or swelling that gets worse or does not get better with pain medicine.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.