Laparotomy recovery: what to expect in hospital and at home

A laparotomy is the cut, or incision, through the abdominal wall that gives the surgeon open access to the organs inside. It is not a single operation but a way into the abdomen. Chelsea and Westminster Hospital describes it as the incision the surgeon makes to access the abdomen, usually a vertical line. University Hospitals Plymouth says that people who have one may have needed surgery for a number of different reasons, and that the laparotomy may be elective (pre-planned) or an emergency.

That is why recovery is so variable. The National Emergency Laparotomy Audit says that recovery after laparotomy is very different for different people, and for different procedures that may be done during it. Someone having a planned operation and someone having an emergency operation, or someone who needs time in intensive care and someone who does not, are likely to have different hospital stays, different tubes and different timetables.

The recovery information on this page draws on general hospital leaflets for laparotomy. It is a guide to what is common, not a prediction. Follow the advice from your own ward and surgical team, particularly if you have had an emergency operation, a stoma or time in intensive care.

University Hospitals Plymouth says most people having a laparotomy follow an Enhanced Recovery After Surgery (ERAS) pathway, which is designed to get you as well as possible as soon as possible after surgery. After surgery you may return to the ward or need time in intensive care for monitoring or extra support.

It describes the equipment you may find attached: an intravenous drip for fluids, a nasogastric tube passed through the nose into the stomach to remove fluid and ease nausea, patient-controlled analgesia (a button you press to give yourself pain relief into a vein), an abdominal drain for fluid around the operation site, and a urinary catheter. It says these may seem overwhelming but should not stop you moving, and to ask staff for help moving while attached to them.

Chelsea and Westminster Hospital describes a similar picture for its own operation: oxygen through a mask for the first one or two days, a catheter in the bladder, a nose tube to remove excess stomach fluid and a drip for fluids, and a gradual progression from sips of water to other fluids and then solids as the bowel starts to work again. It also notes that after the bowel has been handled in surgery, it sometimes takes a while to start moving again.

On pain, University Hospitals Plymouth says it is important that your pain is well controlled so you can move, do breathing exercises, eat, drink and sleep. You may start with patient-controlled analgesia, then switch to liquid or tablet painkillers, and may also have a local anaesthetic infusion at the wound site. It advises telling staff if pain is not controlled and taking pain relief half an hour before getting out of bed to make moving easier.

Moving early is the central message of both leaflets. University Hospitals Plymouth says it is important to mobilise as soon as possible, that you will be helped to sit in a chair and walk short distances from day 1, and that this decreases the risk of chest infection, blood clots, bowel complications and muscle weakness. Chelsea and Westminster Hospital similarly says moving about as much as possible will reduce the risk of complications and speed up recovery.

Breathing exercises matter because pain and the operation put you at more risk of a chest infection. The Plymouth leaflet describes three techniques: deep breaths (3 to 5 deep breaths in through the nose and out through the mouth, pausing for 2 to 3 seconds), huffing (exhaling forcefully through the mouth without coughing, like steaming up a mirror), and a supported cough with your hands pressing over the operation site for comfort. A physiotherapist will usually show you.

After bowel surgery your team will tell you when to start eating and drinking again. University Hospitals Plymouth says you often start with clear fluids, then free fluids, then small portions of low-fibre, easy-to-chew foods, before gradually returning to your usual diet, and that the pace depends on you and the operation. It suggests small frequent meals, including protein at least twice a day to help healing, and speaking to the team or a dietitian if you are losing weight or struggling to eat.

Chelsea and Westminster Hospital says that for its patients there are no foods you need to avoid after the operation, and recommends a well-balanced diet unless a dietitian has advised otherwise. If you have a stoma, University Hospitals Plymouth says the information may differ and to talk to the team.

University Hospitals Plymouth says that once the surgical team is happy with your recovery you will be deemed fit to go home, which may not be when you feel fully back to normal, and that pacing and little-and-often activity are important. In general there are no restrictions on walking if you feel able, and walking is actively encouraged.

It says that, generally, you are advised to avoid heavy lifting and strenuous exercise for 4 to 6 weeks after surgery. Chelsea and Westminster Hospital gives its own figures for its operation: try to get help with chores such as vacuuming for the first 2 to 3 weeks, do not lift anything heavier than about 3 kg (roughly a full three-pint kettle) for at least two weeks, and do not swim until the wound has completely healed.

Hospital stay and follow-up depend on the operation. Chelsea and Westminster Hospital quotes about 7 to 10 days in hospital for its operation, a two-week supply of medication to take home with any further supply from your GP, and an outpatient check-up 2 to 4 weeks after surgery. Plymouth's leaflet does not give a number of days, because it covers laparotomy generally.

University Hospitals Plymouth says that when you are fit for discharge you are safe to be driven home, that on average it recommends not driving for 4 to 6 weeks to allow the wounds to heal, that you are only insured if you can perform an emergency stop without hesitation, and that some insurance companies ask to be told about the operation before you drive again. Chelsea and Westminster Hospital says not to drive until your strength and speed of movement are back to normal, you are not drowsy from painkillers and your concentration is good.

On work, University Hospitals Plymouth says that when you return depends on the operation and the job, that it is advisable to feel completely recovered before going back, particularly if the job is active, and that many people feel tired and find concentration difficult. It suggests asking your GP for a fit note, contacting occupational health if your workplace has it, and talking to your line manager.

Emotional recovery counts too. The Plymouth leaflet notes that a laparotomy may be related to a serious medical condition and that anxiety, depression, frustration or distressing thoughts are understandable, especially after an unplanned operation or time in critical care, and it asks you to tell the ward team or the ICU rehabilitation team if you feel this way.

University Hospitals Plymouth asks you to contact your GP or NHS 111 out of hours if you are worried about your wound, have a temperature, or have redness, swelling, increased pain, pus or heat at the wound. It says to contact the emergency department immediately if, in the days or weeks after discharge, you have pain or swelling in a leg, a leg that becomes hot or discoloured, larger-than-normal veins near the surface of the leg, shortness of breath, chest pain that gets worse when you breathe deeply, or you cough up blood. These can be signs of a blood clot.

Chelsea and Westminster Hospital asks you to contact your GP or nurse specialist for persistent nausea or vomiting, a temperature of 37.5C or above, pus or increasing redness around the wound, increasing pain, or increasing diarrhoea.

The National Emergency Laparotomy Audit points patients having an emergency laparotomy to a dedicated leaflet that covers when to seek help after discharge, exercises in hospital, when to think about returning to work and driving, and what to do at home. Ask your ward for the leaflet relevant to your own operation.