Display Patient Information Leaflets

Date issued:  December 2024 

For review: December 2026 

Ref: C-606/RD/Physiotherapy/Post Laparotomy Surgery

PDF: Post Laparotomy Surgery.pdf [pdf] 681KB

Introduction

This booklet is to provide information about your post operative recovery. If you are receiving this booklet, you will have had a laparotomy (an incision into the abdomen). You may have needed this surgery for a number of different reasons.  It is important that you follow the specific advice from the ward team regarding your care and the advice that is in this booklet to aid with your recovery. Please discuss any concerns you have with your ward team. 

Most Laparotomy patients will follow an Enhanced Recovery After Surgery (ERAS) protocol. This is designed to get you as well as possible as soon as possible after your surgery. 

Your laparotomy surgery may be elective (pre-planned) or an emergency.  If you have had your operation as an emergency, we utilise specialist National Emergency Laparotomy Audit (NELA). 

Post-surgery

After your surgery, you may have returned to the ward or required a stay on the Intensive Care Unit (ICU). If you have had a stay on ICU, it is likely to have been for monitoring or any extra support you needed after your operation. If it has been a long stay, the ICU Rehab Team will follow you up on the ward with more support and information.

It is likely that you will have several infusions, drains and/or tubes in place for example (not an exhaustive list):

• An intravenous (IV) drip used to give you fluids until you’re able to drink normally.

• A Naso-Gastric (NG) tube is a fine tube that is placed through your nose and into your stomach to allow fluids to be removed to        alleviate nausea.

• A Patient Controlled Analgesia (PCA) which is an intravenous self-administration of pain relief.

• An abdominal drain to help drain off fluid around the operation site.

• A urinary catheter is a tube put into the bladder to drain urine.

It might seem a bit overwhelming with all the attachments, but they shouldn’t stop you from moving. If you do have multiple attachments, please ask a member of staff to help you when moving to protect your attachments. If they are causing you any pain or discomfort, please inform a member of staff.

Pain Control

It is important that your pain is well controlled to enable you to mobilise, undertake breathing exercises, eat, drink and to sleep well. This will aid your recovery. If you feel your pain is not well controlled at any time, it is important you let a member of staff know.

You may have a Patient Controlled Analgesia (PCA) initially. This is a pain medicine which is delivered intravenously when you press the button. It allows you to decide when you need pain medicine without having to ask the nurse. Once your pain is well managed, you will be switched to oral pain relief which will be given to you by the nurse. This can be in liquid or in tablet form. 

You may also have a Local Anaesthetic infusion (LAI). This provides pain relief to the surgery site and is inserted deep into muscle and provides a constant supply. If you have one of these the pain team will review you to ensure that it is effective. 

Sleeping

Difficulties in sleeping can be caused by changes in your normal routine and restricted movements. Some people are awakened by pain which is caused by sudden movement. If this does occur, it may be helpful to take pain relief before bedtime. Also, you may request earplugs /eye masks as they are available on the ward. Taking pain relief half an hour before getting out of bed can also make this movement more comfortable and manageable.

Mobility

It is important that you mobilise as soon as possible after your operation. This will decrease the risk of you developing complications like a chest infection, blood clots, Deep Vein Thrombosis or Pulmonary Embolism, bowel complications and muscle weakness.

We understand that due to pain and multiple attachments you may find this challenging. However, you will be encouraged and supported to mobilise on day 1 post-surgery with the help of a member of staff.

You will be encouraged to sit in the chair and walk short distances. It is recommended you try and sit in the chair for several short periods of time throughout the day, increasing the time spent out in the chair each day. The staff will help you to gradually increase your walking distance each day. Mobilising will become easier when your attachments start to decrease. If you are struggling with this more than usual, the physiotherapists will come to assess your balance and your rehabilitation (such as building exercise tolerance) with rest. 

Exercises:

You can also complete some exercises to aid your recovery further. 

• Bed Exercises

• Chair Exercises

• Standing Exercises

• Breathing Exercises

 

Bed Exercises (see pdf for images):

• Move your ankles up and down

• Push knee into towel and lift your heel off the bed

• Slide your heel along the bed towards your bottom

• Push your knee down into the bed

• Bend your knees and lift your bottom off the bed

• Pull up your toes and slide your leg out to the side

 

Chair Exercises (see pdf for images)

• March your legs while sitting

• straighten one knee at a time and hold

• Cross your arms and turn your head and body left and right

• Bend your arm to touch your shoulder, and then straighten

• Lift your arm up above your head, then lower.

• Keep your elbows tucked in, move your arms in and out.

 

Standing Exercises (see pdf for images)

• Lift the leg out to the side and back to the centre

• Stand up on your toes and gently back down

• Lift the leg out behind you and back to the centre

• Squat down as able, then stand up tall

 

Breathing Exercises

You may find breathing hard to do due to pain, and post operatively, you are more at risk of developing a chest infection. To reduce the risk of this, along with mobilising, you can complete breathing exercises regularly:

Deep breaths:

• This helps to loosen any secretions.

• Take 3 to 5 deep breaths in through your nose and out through your mouth.

• Pause at the end of each breath in for 2 to 3 seconds before breathing out gently through your mouth.

Huffing:

Exhale forcefully out through your mouth but without coughing. This may be more comfortable than coughing. It’s like steaming up          a mirror. This method can be used a few times before trying a cough to help reduce pain.

Supported cough:

Put pressure over the operation site with your hands to support for comfort and have a cough.

Deep breaths x 3 to 5, Huffs x 1 to 2, supported cough.

Emotional and psychological impact

Recovery following a critical care admission comes with its own set of challenges. The laparotomy may be related to the diagnosis and/or treatment of a serious medical condition, which in itself, may invoke potential anxiety, depression or frustration. It is understandable that you may be or have been apprehensive about the procedure, its recovery and what it may mean for the future. All these feelings are normal.

Unplanned operations and admissions may impact people differently. 

You may feel like you are in a vulnerable position with being in an unfamiliar environment, restricted movement, feeling weak and fatigued and perhaps in pain. This may cultivate feelings of powerlessness and in the hands of your healthcare professionals. You may have distressing thoughts or dreams. If you do feel this way, please flag them to the ward team and/or the ICU Rehab team, who will follow you up on the ward post discharge from ICU.

If you experience any mental health challenges post laparotomy, please let a member of the team know. The team will be able to direct you to the most appropriate support available.

Speech and swallow (SLT)

It may be that after your surgery, you may notice changes to your voice or in swallowing. If this is the case, please let your ward team know, and you will be referred to Speech and Language Therapy (SaLT) for assessment and advice.

Eating and drinking after gastrointestinal surgery

After you have had gastrointestinal surgery, your surgical team will advise you when to start eating and drinking again.  Often you will start with drinking clear fluids only, then gradually progress to eating food.  The time taken to recover after surgery and for you to then start eating and drinking again, will vary from person to person and on the surgery you have had.    

Your surgeon will advise you on how quickly you can build up your diet.  When you are allowed to start eating again you will be advised to introduce small portions of easy to chew and low fibre foods that are simple to digest often referred to as a “light diet”.  The diet is very limited and generally not intended to be followed for long periods of time; some patients may continue to have restrictions after surgery.  

Stages to building up your diet after surgery:

1.  Clear fluids: water, weak squash, weak black tea/coffee, clear soup (Bovril drink) and jelly.  You may be advised to take small ‘sips’ of clear fluids throughout the day.

2.  Free fluids: includes any clear fluids plus tea/coffee with milk, milk and milky drinks such as hot chocolate and ice cream. Nutritional drinks such as Ensure Plus/Complan/Aymes milkshakes/soups are available on the ward. 

3.  Small portions of low fibre and easy to chew foods:  See table below for examples of suitable food choices.

Foods to have and avoid

Food times	Foods to have	Foods to avoid
Breakfast	Smooth yogurt Cornflakes or Rice Krispies with milk White bread or toast with butter/margarine and seedless jam Glass of milk	Wheat or bran-based cereal i.e. Shredded Wheat®, Weetabix®, Ready Brek® Wholemeal bread or toast
Lunch/Supper	Sandwich on white bread with cheese, tuna, ham, or egg Omelette Mashed potatoes Mashed root vegetables Macaroni cheese Cottage/fish pie	Wholemeal or wholegrain bread, pasta or rice Beans and lentils Potato skins Green vegetables, sweetcorn and salad
Snacks and Puddings	Rice pudding Custard Smooth yogurt Mousse Jelly	Fruit with pips, seeds and skins

Return to usual diet: 

Your surgical team will advise you on when to start increasing the variety of your diet.  Have small, frequent meals and snacks to begin with, gradually building up over the weeks.  Try to include protein foods such as meat, vegetarian/vegan protein, fish, eggs, cheese and milk in at least 2 meals per day as this will help with the healing process after surgery. If you have lost your appetite, are losing weight or are struggling to eat, speak to your surgical team or nurse or contact the dietitians on the number at the end of this leaflet for more information. 

If you have had a stoma, this information might be different. Please talk to the team for specific advice. 

Occupational therapy

The occupational therapy team may see you on the ward if you require help with your activities of daily living. If you are needing additional support on the ward the team will assess you and refer you for support at home if required. 

The occupational therapists may also be able to provide equipment to make managing at home easier. 

Hospital discharge and returning home

Once your surgical team are happy with your recovery, you will be deemed fit to go home. This might not be when you are feeling fully back to your normal self, but well enough to be safe to continue your recovery at home. It is important to slowly build yourself back up to your previous levels of function. If you are not ready for home at this point, the ward therapists will discuss options with you to best support your ongoing needs.

Pacing is an important part of your recovery at home. It is important to do little and often to make progress towards your goals. The amount of activity and exercise you are allowed to do when you go home depends on the operation you have had. In general, there are no restrictions on walking, if you feel well and able to do so. In fact, walking is actively encouraged to reduce your chances of developing complications. Your team will inform you if you have any restrictions you must follow. Generally, you are advised to avoid heavy lifting and strenuous exercise for 4-6 weeks after surgery.

Driving

When you are fit for discharge, you are safe to be driven home. You may want to think about how you can improve your comfort during this journey by using pillows or taking pain relief before setting off. On average we recommend that you do not drive for 4-6 weeks to allow for wounds to heal properly. You are only insured if you are able to perform an emergency stop without hesitation. If you hesitate then you are not insured and are putting yourself and others at risk. Some insurance companies ask to be informed of the operation you have had before you start driving again. If you have any questions regarding these restrictions, then please speak with a member of staff.

Returning to work

Returning to work depends on both the operation you have had and the nature of your job. It is advisable to feel completely recovered before returning to work, particularly if your job is active. Many people feel tired and find concentrating difficult. Specific advice will be given to you before you leave. If you do not feel fit enough to return to work, the following steps may support your return and ensure it is more achievable:

• Talk to your GP.

• Obtain a fit note. Please talk to a member of staff if you require this.

• If your workplace has an Occupational Health department contact them to help identify any support/modifications that would        be helpful at work for you.

• Talk to your line manager.

Wound care

Prior to discharge the nursing team will discuss your wound and dressings with you. Wounds will go through several stages of healing:

The following are frequently experienced:

• Sensations such as tingling, numbness or itching.

• A slightly hard lumpy feeling as the new tissue forms.

• Slight pulling around the stitches as the wound heals.

Please contact your GP or 111 out of hours if you are worried about your wound, have a temperature or experience the following at the wound site:

• Redness

• Swelling

• Increased pain

• Pus

• Heat

Signs and symptoms of a blood clot

You should contact ED immediately if you experience any of the following in the days or weeks after discharge from hospital:

• Pain or swelling in your leg.

• The skin on your leg becomes hot or discoloured.

• The veins near the surface of your legs appear larger than normal.

• Shortness of breath.

• Pain in your chest which gets worse when you breathe deeply.

• Coughing up blood.

Useful contact details

Age UK Plymouth: Shop N Drop service, prescription collection service and weekly telephone call with a phone friend to keep you in regular contact with someone enquiries@ageukplymouth.org.uk 

Adult Social Services: 01752 668000

Improving Lives Plymouth: 01752 201890

Community Action Helpline: 07786683074

Extra Help: 01752 424515

Plymouth Labour Force: 07786683074

Nutrition and Dietetic Department, Derriford Hospital: (01752) 432243

Nutrition and Dietetic Department, Estover Health Centre: (01752) 314925

NELA Nurse Derriford Hospital: (01752) 438121