25 year old woman underwent laparoscopy for endometriosis and infertility. Her bowel has beendamaged and an emergency laparotomy was performed.
On the second day after surgery she has stillnot been given any oral feeds and a nasogastric tube has been inserted. She is very worried.
Role player
Doctor you told me that I would have a Key hole operation and I would be fine by evening. I am not giveneven oral sips and various tubes have been inserted. There is a large painful wound on my tummy. Can youplease explain what you have done and what has gone wrong during the surgery.
Candidate
When doing a key hole surgery we have to insert a tube with a sharp end. We connect the camera to thistube and insert the other instruments through this Because of your disease your intestines were adherent to the wall of your abdomen and your small bowel was accidentally damaged when we were inserting the tube. We have successfully repaired the injury with the help of a senior surgeon.
Tube is necessary to rest your bowel by keeping it empty. Your bowels are recovering as we can hear the sounds of your bowel movements.
We will most probably be able to remove your nasal tube tomorrow and start you on liquids. Solids may be started after 24 hours if you tolerate the liquids and gradually we will allow you to take your normal diet in 3-4 days.
You will recover completely in1—2 weeks.
Role player
But doctor this complication has caused me a lot of pain, loss of work and has disrupted the other familymembers as well.
Candidate
I am sorry. You have been inconvenienced but complications like this can rarely occur especially inpatients with endometriosis where there are dense bowel adhesions. We have explained regarding thispossibility. We have counseled you regarding all the complications which could occur when we discussedabout your operation . This complication occurred because there were unexpected bowl adhesions atsurgery.
Role player
Can I know whether the surgery was performed by a qualified and experienced person?CandidateYes, it was performed by a registrar who has previously performed many such operations. I was present inthe theater and it was done under my direct supervision.Role playerCan you tell me what type of operation you have performed regarding my infertility? Will this complicationaffect my fertility?
Candidate
You have severe endometriosis. We have removed a cyst from your right ovary and cauterized other deposits. Even though there were adhesions your tubes were patent. We have released most of these adhesions. You have better chances of conceiving now than previously. further treatment can be given.However fertility is reduced even though the tubes are patent in those with endometriosis. This complication will not affect your fertility as it has not involved your womb or tubes or ovaries.
Role player
Do I need further treatment for endometriosis?
Candidate
We removed a cyst and cauterized most of the deposits. However the disease can grow again. We can givedrugs to remove the disease completely but these will prevent fertility during treatment. Therefore we willobserve you during our treatment for your infertility.
Role player
How will you treat my infertility?
Candidate
From the second day of your next period we will give you a drug called letrozole for 5 days. We will scanyou from the 12th day and when you have a mature egg we will give an injection to release your egg and 36hours later we will insert your husband’s sperms to your womb. We can do it for 6-12 months .
Role player
What is the next option if it fails?
Candidate
You will have to go for a test tube baby. This is carried out in the private sector and will be expensive. Thesuccess rate vary according to the institution. We will have to refer you to one of the best privateinstitutions with up to date facilities. You can discuss the cost and success rates with them.
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