What are the post-operative instructions for patients undergoing laparoscopic myomectomy?

Post-Operative Instructions for Laparoscopic Myomectomy

Following a laparoscopic myomectomy, patients should follow a structured recovery protocol that includes early mobilization, multimodal pain management, and gradual return to normal activities, with full recovery of quality of life typically occurring within 2-4 weeks. 1

Immediate Post-Operative Care

• Monitor vital signs including respiratory rate, heart rate, blood pressure, oxygen saturation, level of consciousness, and surgical site for the first 24-48 hours 2
• Early mobilization is strongly recommended, with at least 30 minutes on the day of surgery and 6 hours per day thereafter to prevent complications such as venous thromboembolism and promote faster recovery 2
• Multimodal pain management should include acetaminophen and NSAIDs if no contraindications exist, with opioids used only as a last resort and in low doses 2
• Oral fluids can be started as soon as the patient is lucid after surgery, with solid foods introduced within 4 hours postoperatively if tolerated 2

Pain Management

• A multimodal approach to pain control should include scheduled acetaminophen and NSAIDs as first-line agents 2
• Consider wound catheters or local abdominal wall blocks to reduce postoperative opioid requirements 2
• Opioid-containing medications should be used sparingly to minimize constipation and other side effects 2
• Most patients experience significantly less pain with laparoscopic myomectomy compared to open procedures, with pain scores typically improving significantly by 48 hours post-surgery 3

Activity Restrictions

• Encourage early ambulation starting the day of surgery to prevent complications such as deep vein thrombosis and pulmonary embolism 2
• Gradually increase activity levels over the first week, with most patients able to resume light daily activities within 7-14 days 1
• Avoid heavy lifting (>10 pounds), strenuous exercise, and sexual activity for at least 2-3 weeks 2
• Full recovery of quality of life occurs in approximately 58% of patients by 14 days, 73% by 21 days, and 86% by 28 days post-surgery 1

Wound Care

• Keep incision sites clean and dry for the first 48 hours 2
• Small adhesive strips over incisions can typically be removed after 5-7 days if not already fallen off 4
• Watch for signs of infection including increased redness, swelling, warmth, pain, or drainage from incision sites 2
• Showering is usually permitted 24-48 hours after surgery, but avoid soaking in baths, hot tubs, or swimming pools for at least 2 weeks 4

Venous Thromboembolism (VTE) Prevention

• Continue VTE prophylaxis as prescribed, which may include both mechanical and pharmacological methods 2
• For high-risk patients, a combination of compression stockings and/or intermittent pneumatic compression together with pharmacological prophylaxis is recommended 2
• Early and frequent ambulation is essential for VTE prevention 2

Diet and Bowel Function

• Resume a normal diet as tolerated, starting with clear liquids and advancing as appropriate 2
• Increase fluid intake to maintain adequate hydration (≥1.5 L/day) to help prevent constipation 5
• Consider stool softeners or mild laxatives such as bisacodyl or polyethylene glycol to prevent constipation, especially if taking opioid pain medications 5
• Monitor for return of normal bowel function, which typically occurs within 2-3 days 5

Pregnancy Planning

• Wait at least 2-3 months before attempting pregnancy to allow the uterine incisions to heal completely and minimize the potential for myometrial scar disruption during pregnancy 2
• This recommendation is based on clinical experience with healing of uterine incisions similar to those in cesarean sections 2

Follow-up Care

• Schedule a follow-up appointment 2-4 weeks after surgery to assess healing and recovery 2
• Pelvic rest (no vaginal intercourse, douching, or tampons) is typically recommended for 2-3 weeks 2
• Report any concerning symptoms such as fever >100.4°F (38°C), increasing pain not controlled with prescribed medications, heavy vaginal bleeding (soaking through a pad in less than an hour), foul-smelling vaginal discharge, or signs of wound infection 2

Advantages of Laparoscopic Approach

• Compared to open myomectomy, laparoscopic procedures are associated with shorter hospital stays, less postoperative pain, faster recovery, and lower risk of complications including fever and anemia 3, 6
• The laparoscopic approach has been shown to have a significantly lower risk of Clavien-Dindo grade ≥ II complications compared to open surgery (odds ratio 7.37) 6
• Most patients can be discharged the same day or within 24 hours of surgery 7