Fibroid Or Polyp
What can I expect with a hysteroscopy and laparoscopy?
Hi all, I’ve been ttc #1 for 2 years and my doctor found that my HSG had a “filling defect.” She suspects a uterine fibroid or polyp and since I also have symptoms of endomitriosis she wants to me to do a hysteroscopy and laparoscopy at the same time. She will remove any endo adhesions and a polyp/fibriod if she finds either of these.
My question is have you been through this? Is the procedures painful? Also, do you think the risks outweigh the benefits (ex: infection, decreased fertility, etc)?
Any input is appreciated. Thank you.
Laparoscopy is required to confirm a diagnosis of Endometriosis. Anything else is considered uncertain.
It also enables your surgeon to fix anything that is found (i.e. ovarian torsion, adhesions, Endometriosis, fibroids, endometriomas on the ovaries, restore tubal patency, etc. etc. etc.) at the same time. Surgical intervention will almost certainly restore fertility by virtue of the (suspected) underlying cause(s) being treated. Skipping surgery and embarking on costly IVF/ART protocols without fixing the problem(s) is probably not the best approach.
The minimal risks of laparoscopic surgery are outweighed by the benefits it confers (with the obvious exception of the most dangerous risk, which is death – a risk of ALL surgeries and highly unlikely to occur!).
Just make sure she truly intends to truly treat what she finds. Undergoing surgery only to have her say, “well, we got what we could – now take this drug therapy to suppress your cycle for another 6 mons.” only serves to further delay your fertility and does not treat the underlying cause.
Laparoscopy, while relatively “minor,” is still surgery and still hurts. However, it is an excellent diagnostic and therapeutic tool for a vast number of health concerns. Laparoscopy entails visualization of the abdomen and pelvic cavity via an instrument known as the Laparoscope – a thin, lighted instrument fitted with a telescopic lens and a miniature videocamera. During the lap, organs will be manipulated for viewing, diagnoses are made, biopsies are taken, and therapeutic measures are performed as well.
The Laparoscopy is usually performed on an out-patient basis, though some patients find themselves with an unanticipated overnight stay in-hospital. The procedure itself can last anywhere from 45 minutes to 5 hours or more, depending upon the individual and her case. It is performed under general anesthesia.
Prior to surgery, you will likely be sent for lab tests. These generally include blood and urine cultures, and in some instances, cervical cultures, in order to rule out infection and assure that you are physically able to undergo surgery.
The day before surgery, you may be placed on a restricted diet and will likely be asked not to eat at all in the last 8 to 12 hours before the procedure. A bowel prep is typically given in order to thoroughly evacuate the GI tract of waste and bacteria. You will likely be asked to arrive at the hospital at least a half-hour prior to your actual surgery in order to be prepped. Remove all jewelry, nail polish, and hair accessories before leaving your home, as they are not allowed.
Generally, you will be taken to the OR or an Ambulatory Surgery room close to the OR for prepping. There you will have an IV hooked up through which various medications and solutions can be introduced into your body. Most likely, a sedative will be introduced into the IV before anything else is done, and you will go to sleep. Electrodes to monitor heart function are placed on the chest and arm and are hooked up to an electrocardiogram monitor. The anesthesiologist will intubate you with an Endotracheal tube through the mouth into your windpipe, through which oxygen and anesthetics are pumped into the lungs.
If a hysterosalpingography (“dye test”) is also scheduled for that time to determine tubal patency, a cannula will be inserted into the cervical opening to manipulate the uterus and inject dye. Hysteroscopy may also be performed during surgery with the use of a thin, lighted wand inserted into the uterus, so your surgeon can check the endometrium. You will not feel any of this, as you will be under anesthesia.
A catheter will be inserted into the urethra to fully drain urine, even though you may have gone prior to surgery. The operating table will then be tilted so that the head is lower than the feet, which enables the organs to “fall back” and afford the surgeon a better view. This is called “Trendelenberg.”
A small (approximately 1/2 to 1 inch long) incision is made either through or near the navel, into which a needle is inserted. Through this needle, carbon dioxide is injected into the abdomen. This distends the abdominal cavity so that the organs will lift and separate and allow the Laparoscope to be inserted into the cavity. Additional similar incisions will likely be made in the pubic hairline through which surgical instruments can be introduced.
Once all the instruments have been introduced into the abdomen and all the organs have been satisfactorily investigated, biopsy samples will be taken, fluid may be aspirated, and destruction of the Endometriosis or other areas of disease will be performed.
Once the surgeon is confident that all procedures have been performed and adequate samples have been taken, all the instruments will be withdrawn. The abdomen is allowed to deflate and the incisions are closed, usually with a few dissolvable stitches. Scarring from this surgery is generally minor.
You will then be sent to the recovery room and allowed to awaken gradually. You may be offered ice chips to soothe your throat and once you are on your feet (usually within a couple hours if no complications arise), you may be offered a drink and crackers. You will also be asked to urinate. Once you have urinated and you are recovered enough to do so, the OR staff will allow you to leave the hospital.
Recovery time varies from patient to patient. Most likely, you will experience significant discomfort for 1-3 days post-op as a result of the anesthesia and gas. Naturally, your abdomen will be sore. Depending upon how much work was done, you may be back on your feet and pursuing limited activity within a few days. Many patients find that 2 weeks is the general timeframe for which it took them to fully recuperate.
You may experience bruising at the site of the punctures, as well as some bloody discharge. If you are experiencing any symptoms which your doctor did not tell you to expect prior to surgery, or are in extreme pain, be sure to call their office.
Light foods such as broth are easy to digest and might be good to have on hand after surgery. Your appetite will gradually increase in the coming days, and you should adjust your diet accordingly. You may experience constipation after the procedure as a result of the anesthesia and perhaps even your post-op pain medication; check with your doctor to see what measures, if any, you can take to alleviate the problem.
Clothing such as dresses or high-waisted pants is a good idea for the days after surgery, as you will want to keep pressure off the puncture sites. Showering is generally allowed the day after surgery; be sure to keep your incisions clean and dry. Most importantly, do not resume any strenuous activity until you feel up to it.
You should have a post-op appointment with your physician the following week or so in order to discuss findings and any treatment options for the future.
Good luck to you and hope all turns out well.
pictures of fibroids