Patient Information

General Surgery Information

Dr Lyn Kenneth performs hysterectomies (vaginal, laparascopic, abdominal), laparoscopies and other common surgical procedures.

If your treatment involves surgery, you will be given a date for procedure. We will do our best to accommodate you at a time that’s most convenient, depending on availability of theatre facilities and the surgical team (unless it is an emergency).

Dr Kenneth operates at Netcare Christiaan Barnard Memorial Hospital on Wednesday & Thursday afternoons. You are expected to obtain authorisation from your medical aid for the procedure and hospital admission. You will be given all necessary codes to facilitate the authorisation process. Depending on your medical aid plan, you may have a co-payment for the doctor’s fee (you may request a quote, prior to confirming your procedure).

Dr Lyn Kenneth Specialist Obstetrician and Gynaecologist

Everything you need to know

Depending on your age and other risk factors you may require blood tests, a chest X-ray, ECG or other investigations to assess your fitness for surgery.

You will be admitted to the hospital on the day of the procedure (unless advised otherwise) usually by 6am if surgery is planned for the morning or by 11am if it is planned for the afternoon. Depending on the procedure, you may be able to go home on the same day or you may have to stay in the hospital for one or more days.

General Anaesthesia: You should not eat or drink anything for 6 hours prior to your allocated surgery time if you are having general anaesthesia.
There is no need for a special diet or bowel preparation, unless instructed otherwise.

PLEASE NOTE: if you do not adhere to the diet prior to your surgery, your surgery will not proceed.

It is very important to report all medications (including food supplements and herbal medicine) you take to Dr Kenneth during your visit. Hormones are to be continued unless advised otherwise. Tamoxifen should be stopped 14 days before the procedure. Non-steroidal anti-inflammatory pain medications such as Nurofen®, Ponstan®, Voltaren®, Aspirin, Clopidogrel need to be stopped 7 days before your surgery. If you are taking Clexane®, Warfarin or any other blood-thinning medication, please discuss with Dr Kenneth who will advise when to stop prior to the surgery. Continue other medications (e.g. heart, diabetes, antihypertensives) – take with a small amount of water on the morning of your surgery. Herbal medicine and nutritional supplements such as omega-3, fish oil, echinacea, creatine, ginger should be stopped 7 days before surgery.

Dr Kenneth works with Cape Anaesthetics (Contact: Sharon on 021 6839244) or Southern Anaesthetics (Contact: Linda/Jan on 0217626277). You will be informed which anaesthetist has been assigned to your case prior to the date of your procedure. Kindly contact their reception staff for any anaesthetic-related queries or queries re. their fees.

  • Diet – You can usually eat and drink immediately following the operation, starting with fluids and then small portions/light meals as tolerating. Keep well-hydrated with water, which will help to prevent clots.
  • Medications – you can re-start your regular medications following surgery. You will be given pain relief (either as injections, suppositories, tablets or a combination). Some of the strong pain medications (opiods) may cause nausea & constipation, hence us weaning them off as soon as possible.
  • Pains after Surgery – it is expected to have pain around the incision site as well as the operative area. Cramps, nausea, distension of the abdomen & shoulder-tip pain can be expected following a laparoscopy, due to gas used and upper abdomen. It is important to remember that the pain should gradually improve and not get worse.
  • Vaginal Bleeding – depending on what procedure you have done, you may have vaginal bleeding for about a week following surgery however this too should get progressively lighter. Your normal menstrual period after surgery may be out of schedule.
  • Bowel function / Constipation – it is common to develop constipation post-operatively due to the surgery itself and some opioid pain medications (codeine, panadeine, morphine, oxycodone). It is important to stay well-hydrated with water, eat a high-fibre diet with vegetables and yogurt, and start mobilising as soon as possible. Sometimes we will use a suitable laxative eg. Movicol® to help with bowel function.
  • Exercise -walking can be started as soon as possible and for as long as you are comfortable. Avoid high impact exercise for 4 weeks following surgery depending on the type of surgery performed. If you would like to re-start your usual exercise prior to your 7-10day post-op visit, please discuss this with Dr Kenneth.
  • Going Home – you are usually discharged from the hospital on the same day or the following day after laparoscopic or hysteroscopic procedure, and in 2 days after an open / abdominal procedure. Your discharge will depend on your general condition, support at home, pain control (you should only need oral medication/suppositories at time of discharge), bowel and bladder function.
  • Driving – please contact your insurance company to find out when you are allowed to drive following surgery in terms of your insurance cover. General medical advice (not related to your individual insurance) is that you can drive when you have no pain, are not using any pain killers and able to press your foot hard on the floor without any pain in your body. If you had minor surgery (for example, hysteroscopy) you can re-commence driving 24 hours following anaesthesia.
  • Sex – you can resume sexual activity as soon as you have stopped bleeding and have no discomfort. If you are trying to fall pregnant you can resume trying to conceive following your next menstrual period.
  • Work – you will be able to return to work in 2 weeks following laparoscopic or vaginal surgery and in 6 weeks following abdominal surgery. You can return to work the day after a hysteroscopy or treatment of an abnormal Pap smear (provided you are pain-free). You should avoid heavy lifting and intense household duties for 4 weeks following surgery.
  • Post-operative Care – Dr Kenneth will see you in the hospital following surgery and will advise you on when to schedule a follow-up visit. You are welcome to contact her for any questions.

WARNING SIGNS

Please contact the rooms if you develop any of the following symptoms after discharge:

– vomiting
– pain in your tummy that is increasing in intensity and is not controlled by the prescribed    medication
– persistent vaginal bleeding, which is becoming heavier
– smelly vaginal discharge
– pus, swelling, redness around incisions
– fever or chills
– pain or burning when you are passing urine or the need to pass urine frequently
– inability to pass urine
– any concerns you may have about your surgery

After hours please call the emergency number 0639754442 or present to the hospital’s Emergency Department.

Theatre procedures

A hysterectomy (surgical removal of the uterus and fallopian tubes) may be offered to treat some benign/non-cancerous gynaecological conditions especially after medical therapy fails and is often the first-line treatment for most gynaecological cancers. The ovaries will be conserved in the premenopausal period to maintain ovarian hormone production unless there is strong suspicion of cancer or unless it is surgically difficult to save them (decision may only be made intra-operatively).

There are various ways of performing a hysterectomy and this will be discussed with you once you have had a thorough examination and have made the decision to proceed with the operation – traditionally most uteri were removed via a large abdominal incision (laparotomy) however the tendency is towards either a vaginal hysterectomy (no abdominal wounds) or a laparascopic hysterectomy (5-10mm incisions). There are pros and cons of the different approaches to surgery which will be discussed with you by your gynaecologist.

A laparascopy/endoscopic procedure is what is now termed minimally invasive or “keyhole” surgery and has become the surgical route of choice for most gynaecological operations. It involves the surgeon placing a camera into your abdomen at the belly-button (usually 1cm incision) with 2-3 additional 5-10mm incisions for additional instruments (depending what surgery is planned). The advantages of laparascopic surgery is less intra-operative bleeding, less post-operative pain, early mobilisation out of bed and quicker return to usual activities/work. Not all patients may be suitable candidates for laparascopic surgery depending on your body habitus, previous abdominal surgical procedures, the actual pathology that your gynaecologist finds.

A laparoscopy may be considered a diagnostic procedure alone eg. to determine the cause of chronic pelvic pain (if other modalities are inconclusive) or it may in fact be therapeutic as well. The following procedures are currently offered laparascopically by this practice:

  • Adhesiolysis (breakdown of any scar tissue that may be causing pelvic organs to “stick” to one another
  • Endometriosis – draining of chocolate cysts/endometriomas, excision of endometriosis
  • Removal of ovarian cysts/ovaries
  • Hysterectomy (removal of the womb) – total laparascopic/laparascopic assisted vaginal hysterectomy
  • Myomectomy (removal of fibroids depending on size, position etc)
  • Treatment of ectopic/tubal pregnancy (salpingectomy/salpingostomy)
  • Tubal ligation (sterilisation)
  • Tests for fertility (laparascopy and chromopertubation)

With the assistance of a urogynaecologist or a gynaecological oncologist, we are also able to offer laparoscopic surgery for severe pelvic organ prolapse as well as certain gynaecological cancers respectively.

A female sterilisation also known as a tubal ligation is considered a permanent form of family planning so a patient must be reasonably certain that there is no future desire for fertility (even if life circumstances should unforeseeably change eg. new partner, loss of a child). If a lady is uncertain then she should rather consider a long acting reversible form of family planning (which your gynaecologist will discuss with you).

A tubal ligation can be done via a laparotomy (large abdominal incision), a mini-laparotomy (smaller approximately 5cm incision below the belly-button if you have just had a vaginal delivery) or most commonly via a laparoscopy (key-hole surgery where two 0.5-1cm incisions are used). The fallopian tubes are identified and then clamped, blocked or tied off so that the egg and sperm cannot meet.

Endometrial ablation is a procedure to surgically destroy the lining of the uterus (endometrium) in order to treat heavy menstrual bleeding or decrease the risk of polyp formation. It is done via the vagina, cervix and uterus and a patient usually doesn’t require overnight admission in hospital. There is a chance that the lining grows again and if heavy bleeding recurs, ablation may need to be repeated Your gynaecologist may advise against an ablation procedure, if you are still considering future pregnancies.

Hysteroscopy is a procedure that involves visualising the inside of your cervix and uterus using a thin lens (hysteroscope) in order to diagnose and treat certain causes of abnormal bleeding. Benign growths such as polyps arising from the lining of the cervix or uterus may be removed and biopsies may also be taken to exclude cancer of the lining. Small fibroids may also be resected via a hysteroscope. Your gynaecologist may recommend other procedures to manage the abnormal bleeding eg. endometrial ablation/destruction of the lining or the insertion of a hormonal intra-uterine system to reduce the risk of the abnormal bleeding recurring.

You are usually able to go home the same day of the procedure or at most stay overnight.

If your pap smear shows any abnormalities that may increase the risk of you developing cancer of the cervix (mouth of the womb) your gynaecologist after performing a colposcopy & biopsy, may recommend the complete excision of the abnormal cells. This can be done under local anaesthesia or conscious sedation (in the office) if the necessary equipment is available and you fulfil the criteria for a in-room procedure, however it is most commonly done in theatre under general anaesthetic. The procedure is termed a LLETZ (Large Loop Excision of the Transformation Zone) or LEEP (Loop Electrosurgical Excision Procedure).

In-Room Procedures

A colposcopy is a non-painful microscopic examination of the cervix with a special instrument called a colposcope that highlights the abnormal cells and helps to exclude cancer. This is usually done in our rooms and takes approximately half an hour. You do not have to do anything special prior to the colposcopy and can eat in the morning and take any chronic medication that you have been prescribed. Remember to mention to your doctor if you have missed a period and may be pregnant, so that a pregnancy test can be done prior to the colposcopy.

One/more biopsies may be taken using local anaesthetic agents (Remicaine ® gel or a small injection). One may return to work on the day of the procedure. It is advisable to avoid intercourse for the next 2-3days till the bleeding has settled (you can expect spotting although not more than with your period). Depending on the results of the biopsy (takes maximum of 5-7working days), your gynaecologist will advise whether further treatment is necessary.

Prior to making an appointment for placement of an intra-uterine devices (copper or hormonal), it is advisable to see your gynaecologist to discuss which device is best suited for you. Most devicesing  are inserted in the rooms unless you have struggled with pain during previous insertions/removals and required a general anaesthetic.

Depending on your pain threshold we may recommend that an in-room insertion be done under conscious sedation (you are drowsy but not asleep and will need someone to drive you home after the procedure) or local anaesthetic (paracervical block ie. injecting local anaesthetic into the mouth of the womb). Only if conscious sedation is going to be used, will you need to starve before the procedure, otherwise you may eat/drink/take any chronic medication that morning).

On your prescription for your device (which you will purchase and bring with you on the day of the procedure), you will also be prescribed 2 tablets. The first is Cytotec ® and you should place 2 tablets under your tongue approximately 6hrs prior to your appointment. The second is an anti-inflammatory – take one prior to insertion as per instructions on the script and the remainder will be for any cramping following insertion.

While most patients will be able to return to work, it is advised that one takes the remainder of the day off as you may experience cramping and spotting thereafter. This should not last more than 48hrs. If you develop a fever, abdominal swelling, severe lower abdominal pain not responding to medication or an offensive discharge, please contact the rooms for an urgent appointment. Likewise, if you see the device being expelled please see us as soon as possible and use alternate contraception in the interim. Most devices are checked 4-6wks after insertion to ensure correct positioning at the top of the uterus (this is done via a transvaginal ultrasound) and then annually.

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