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A must-do preparation step with your doctor before laparoscopic surgery if you wish to recover as quickly and naturally as possible!
Laparoscopic surgery is clearly a wonder of modern medicine.
Who would have thought that such a wide variety of minimally invasive surgical procedures could be performed with the assistance of a video camera as the surgeon’s “eyes”, several thin instruments, and only tiny incisions needed on the patient?
Gall bladder removal, appendicitis, gastric bypass, hernial repair, or GERD treatment are some of the most common reasons for using laparoscopic surgery today.
The benefits for patients are many including a faster recovery, shorter hospital stay, and smaller scars both internally and externally.
While overwhelmingly successful, the laparoscopic surgery experience could be enhanced significantly for the patient with a simple post-operative protocol, which, as of this writing, most doctors sadly don’t bother to perform.
This oversight persists even though solid research has demonstrated a significant reduction in post-operative pain with the need for strong narcotics greatly reduced or even eliminated.
Hence, it is up to the patient to be informed and find a surgeon willing to go the extra post-operative mile when it comes to laparoscopic surgery!.
Laparoscopic Surgery: What Most Patients Don’t Know
When laparoscopic surgery is performed, the first incision that is made allows the passage of a needle into the space of the abdominal cavity, taking care to stay clear of the organs.
Through this long, thin (Veress) needle, gas is pumped directly into the patient’s abdominal cavity.
The addition of gas to the abdomen essentially blows it up like a balloon, lifting the abdominal wall above the internal organs.
This creates a clearer viewing space for the surgeon to perform his/her work.
The addition of gas to the abdominal cavity also creates sufficient room for the laparoscopic instruments without the need for large incisions.
Gas is slowly and continually pumped into the abdomen to maintain this “gas dome” until surgery is complete.
Most surgeons prefer carbon dioxide (CO2) gas for this purpose. CO2 is used because it is a component of breathable air, common to the human body, and can be rapidly absorbed by tissue and blood for removal from the body by the respiratory and excretory systems.
Carbon dioxide is also non-flammable. This is very important because of the electrosurgical devices commonly used during laparoscopic surgery.
While the addition of gas to a patient’s abdominal cavity is important for the success of the operation, the downside is that it causes immense pain and extended suffering after the laparoscopic procedure is over.
This is because it takes time for the gas to be absorbed by the patient’s tissues and released via respiration or the excretory system.
This sometimes excruciating post-op pain caused exclusively by the gas used during surgery, not the surgery itself, can take several forms depending on where the excess gas settles:
- Intraperitoneal pain: If the excess gas is trapped outside of the intestines, but inside the abdominal cavity, it can irritate the lining of the abdominal organs or sometimes the organs themselves causing sharp abdominal pains that can last for days or even weeks after the laparoscopic surgery is complete.
- Shoulder and chest pain: If the excess gas becomes trapped against the diaphragm muscle itself, the vagus nerve can be affected which can cause pain when breathing or intense shoulder and chest pain.
One friend of mine who recently had laparoscopic surgery for appendicitis described the gas pain as much worse than natural childbirth! It was so intense in her shoulder and upper chest area that she thought she was having a heart attack! She also said she was “begging” for the narcotics when the anesthesia wore off.
Unfortunately, the typical treatment for this frequently debilitating pain post-laparoscopic surgery is usually strong narcotic pain meds with their many dangerous side effects and risks for addiction.
In addition, once a patient stops using narcotics for pain, it can take many weeks or even months to detoxify them from the body.
More natural therapies are also used such as walking as quickly after surgery as possible.
Massage will also help release trapped gas and encourage absorption by the body tissues for removal.
However, these don’t work quickly enough in many cases, so strong pain meds are generally required.
Simple Solutions for Post-Op Laparoscopic Gas Pain
The amazing thing about the gas pain experienced by nearly all people who have laparoscopic surgery on the abdominal or pelvic region is that it can be prevented!
Some surgeons are already doing the right thing and routinely removing the gas in a very simple post-op procedure as part of their standard of care, but, believe it or not, most do not!
In my view, there is simply no excuse for this and it borders on malpractice.
I mean, really?
Why would a surgeon condemn their patients to pain that is likely to be excruciating and that will require narcotics to handle until it dissipates several days to a week or more later when all you have to do is something very simple to prevent it that is backed up by solid, causative research?
The only reason that comes to my mind as to why a surgeon wouldn’t voluntarily remove the pumped in gas from the abdomen of his/her patients is because insurance companies typically only pay a certain amount for a common procedure like gall bladder removal.
Anything additional that isn’t strictly required will come out of the hospital or surgeon’s pocket directly or be paid by the patient.
If that’s the case, then at least give the patient the option to pay for it and most likely reduce their need for narcotics during recovery.
What’s happening now is that patients aren’t being told anything about the easy ways to remove the gas after surgery which would spare them a lot of pain and suffering.
These two methods for removing the gas after laparoscopic surgery are: (1)
- Pulmonary recruitment maneuver (PRM) – A fancy term for expanding the lungs fully using a conventional ventilator or high-frequency oscillation device while the patient is in a supine or prone position. This full and complete lung expansion forces the gas out of the abdominal cavity from the open surgical ports.
- Infusion of saline solution – A simpler and probably more cost-effective alternative involves the use of a saline infusion which fills the abdomen with warm saline at the end of laparoscopic surgery. Since CO2 is lighter than saline, it rises and escapes through the open ports. Research suggests that the use of saline is more effective overall than PRM.
Both of these approaches work well and are backed up by research as being highly effective for preventing patient distress from trapped gas.
The Journal of the Society of Laparoendoscopic Surgeons published a study where 40 patients were randomly enrolled into one of the following 2 groups. (2)
Nineteen patients entered Group I where the residual CO2 was evacuated by abdominal compression and served as the study control group.
The remaining 21 patients entered Group II, where the residual CO2 was evacuated by pumping warm saline into the abdomen until it spilled out of the open ports.
Nurses, blind to the patient’s grouping, recorded shoulder pain scores twice daily.
The results were conclusive. “Abdominal filling with saline at the end of laparoscopic surgery effectively evacuates residual CO2 thus preventing post-laparoscopic shoulder pain.”
In another study published by the Journal Archives of Surgery, a randomized, controlled trial was conducted at Taipei Veterans General Hospital over a period of eleven months. (3)
One hundred fifty-eight women undergoing laparoscopic surgery for benign gynecologic lesions were randomly assigned to 3 groups: 53 patients to the pulmonary recruitment maneuvers (PRM) group, 54 patients to the intraperitoneal normal saline infusion group, and 51 patients to the control group.
The pain each patient experienced was evaluated post-op at 12, 24, and 48 hours.
The research concluded that post-op shoulder pain was significantly reduced in the group that received the saline infusion compared with either the PRM or control groups.
Both the PRM and saline infusion approaches significantly reduced the frequency of upper abdominal pain compared with the control group.
Hence, while both pulmonary recruitment maneuvers and a saline infusion into the peritoneal cavity effectively reduced pain after laparoscopic surgery, the saline solution appeared to be better overall for both upper abdominal pain and shoulder pain.
My question to laparoscopic surgeons everywhere is this: “If you aren’t using a simple saline infusion or PRM as part of your standard of care, why the heck not?”
If you truly care about your patient’s comfort and ease of recovery, there seems to be no excuse whatsoever.
References
(1) Maneuvers to decrease laparoscopy-induced shoulder and upper abdominal pain: a randomized controlled study
(2) Prevention of Post-laparoscopic Shoulder Pain by Forced Evacuation of Residual CO2
(3) Pulmonary recruitment maneuver to reduce pain after laparoscopy: a meta-analysis of randomized controlled trials
Considering how many people were murdered by hospitals during the plandemic, due to forcing or coercing them onto ventilators, I’d rather deal with excruciating pain than take the serious risk of having my lungs artificially inflated and permanently damaged. Some surgical procedures not only need to use the gas, but also need to position patients on their back in a rather steep, head down position, allowing gravity to pull the organs away from the surgical area. This position in and of itself has risks, especially for the heart, lungs and eyes. So in some cases, having lungs artificially inflated by a machine after lying in that position for any length of time to release gas would be very risky. I do firmly believe that communication between doctors and patients is subpar at best. Doctors perform surgery regularly, it’s routine for them, but not at all routine for the typical patient. All the usual things that occur in surgery are never explained pre-op, largely I believe because it scares the patient and because people really don’t take any time to fully understand what is going on with their health, how the body works and certainly not all the nuances and techniques involved in surgical procedures and operations. How much time would a physician have to spend with a patient just to cover some basics and how many of those people truly understand what he’s talking about? Sad to say and it might sound unkind, but most aren’t even intelligent enough to grasp those basics. That being said, I do believe the patient has a right to know, in detail, all that’s going
to occur, WELL in advance so they can wrap their head around it, not just a day or 2 before their operation. They could also have a waiver of ignorance to sign, if they’d rather take the ignorance is bliss route. I’d say most here aren’t into the ignorance factor though 🙂
I just had this procedure done today.
I’m sore but it’s tolerable. My shoulder does hurt but that’s tolerable as well.
I’m resting, watching movies and using a heating pad. I haven’t had the need to use my prescription pain killers. If I do t need them, I won’t take them.
I live in Canada and our healthcare is free, not insurance based. If leaving gas in someone is excruciating then my doctor definitely took all the gas out of me.
I had a hysterectomy laparoscopy. I had Excruciating pain , Under my ribs, and in my shoulder. Every time I took a breath excruciating pain. I had never experienced pain like that before, not even with childbirth. Remember when this first started happening, it scared me I couldn’t breath. They couldn’t give me pain meds, because my blood pressure was too low at the time, they introduced a different Saline bag and increased the rate.
I wish I knew this a year ago. I had emergency surgery to remove my appendix and they did not remove the CO2. I suffered for 6 weeks. I was in the hospital for 10 days post surgery. I was in and out of the ER for 5 week. I have had 2 natural births in my family room and this pain had me begging for drugs! I knew my doctors couldn’t help me. Finally, when I started to feel a little better at week 6, I began the Intro GAPS diet. With a few modifications, I stayed on it for 10 months and most of my symptoms are gone now. No thanks to be GI specialist (who thought I may have KROHNS or IBS). Thanks, Sarah!
I found this article interesting, however it seemed one-sided. I am a nurse on a busy surgical floor. No doctor maliciously leaves air in a patient hoping they suffer pain worse than childbirth, and need narcotics.
In my experience, especially with our many skilled advanced laparoscopic surgeons, the doctors use one of the lap sites to suck out,or deflate the abdomen, causing the c02 gas to escape. Not all the gas does, of course, and so as a nurse, we encourage early ambulation to help awaken the body, and help the gases escape. We give heat and cold application as well, and pain meds when needed. We have a high patient satisfaction level as well.
While the introduction of saline to rinse out the gas is a good way to alleviate the excess co2, it is also introducing a possible infection agent which can lead to more postop complications, such as abcesses, leading to longer hospital stays, and often more invasive procedures, such as drains. Do you have any information on this? Other than your personal surgeon, did you interview other laparoscopic surgeons on their methods? I am interested. Interesting article, as a board certified nurse, I am always interested in reading and learning new things for and about the patients I care for.
Thank you for sharing your perspective as a nurse. While introducing saline solution or inflating the lungs may help to remove CO2 from the abdomen, they can cause other problems.