Post-Laparoscopic Myomectomy: Managing Umbilical Wound Redness and Pain

Postoperative redness at the umbilical incision site following laparoscopic myomectomy?

Hello, Doctor: I underwent laparoscopic myomectomy a month ago, with a total of four incisions.
My recovery has been good, and after the third week, I started jogging.
(During my postoperative follow-up, I asked the doctor if I could jog, and he said it would be fine after two weeks.) I jogged three kilometers twice, and although I felt fine after the runs, the day after my second jog, I began to experience pain at the site of my belly button incision, so I stopped exercising.
However, the discomfort has not improved and persists as a dull pain (similar to what I felt during the first week post-surgery).
I have since visited a family medicine doctor, who suggested that there might be inflammation and prescribed antibiotics.
After two days of medication, there has been some improvement, but I still experience pain around the belly button, and my abdomen tends to swell in the afternoon, becoming flatter in the morning after waking up.
There is also evidence of scar tissue formation at the belly button incision site.
I am wondering if there is a possibility of other complications.
(Since my primary physician's clinic is fully booked, I hope to seek expert advice first.
If necessary, I will find a way to return to my primary physician for a follow-up.
Thank you.)

Lily, 40~49 year old female. Ask Date: 2024/03/24

Dr. Liu Fuping reply Obstetrics and Gynecology

1.
If the umbilical wound shows signs of infection, such as redness, swelling, heat, and pain, it is recommended to return to the original surgeon for a follow-up examination of the wound.

2.
If the abdomen fluctuates in size but there is no severe abdominal pain, fever, or abnormal bowel movements, it may be due to bloating; however, it is still advisable to follow up with the original attending physician for further evaluation.

3.
Any wound, regardless of size, will heal by forming new fibrous tissue.
If there is an excessive formation of fibrous tissue, it can lead to hypertrophic scars.
If there is a history of keloid formation or a tendency to develop raised scars after injury, it is recommended to use scar treatment products.
Thank you.

Reply Date: 2024/03/24

More Info

After undergoing a laparoscopic myomectomy, it is not uncommon to experience some discomfort and changes in the umbilical wound area. Given your description of symptoms, let's break down the concerns and provide some guidance.

Understanding Your Symptoms
1. Pain at the Umbilical Site: It is normal to experience some pain at the surgical site, especially after engaging in physical activities like jogging. The pain you feel could be due to several factors, including:
- Healing Process: The body takes time to heal after surgery, and the formation of scar tissue can lead to discomfort.
- Nerve Sensitivity: Surgery can affect the nerves in the area, leading to sensations of pain or discomfort as the nerves heal.

- Muscle Strain: Engaging in activities too soon after surgery can strain the abdominal muscles, contributing to pain.

2. Redness and Swelling: The presence of redness and swelling at the umbilical site can indicate inflammation. While some degree of swelling is expected post-surgery, persistent redness and swelling could suggest:
- Infection: If the area is red, warm, and painful, it could be a sign of infection.
- Scar Tissue Formation: Excessive scar tissue (hypertrophic scars or keloids) can also cause localized pain and discomfort.

3. Bloating: The fluctuation in abdominal size you described, where your abdomen appears larger in the afternoon and flatter in the morning, could be due to:
- Gas and Bloating: This is common after abdominal surgery and can be exacerbated by dietary choices or activity levels.

- Fluid Retention: Sometimes, the body retains fluid post-surgery, leading to temporary swelling.

Recommendations
1. Rest and Activity Modification: It’s crucial to allow your body adequate time to heal. If jogging or other strenuous activities cause pain, consider reducing the intensity or frequency of these activities. Gentle walking and stretching may be more appropriate until you feel more comfortable.

2. Monitoring Symptoms: Keep an eye on the redness and swelling. If you notice increased warmth, spreading redness, or if the pain worsens, it would be advisable to seek medical attention.
3. Follow-Up Care: Since your primary physician's schedule is full, consider reaching out to another healthcare provider or a specialist who can evaluate your symptoms. It’s important to rule out any complications such as infection or significant scar tissue formation.

4. Scar Management: If you are concerned about the appearance of the scar or if it is causing discomfort, you might want to discuss scar management options with your healthcare provider. Treatments can include silicone gel sheets, pressure therapy, or topical treatments that may help reduce scar formation.

5. Diet and Hydration: To manage bloating, ensure you are eating a balanced diet rich in fiber and staying well-hydrated. Avoiding carbonated beverages and foods that are known to cause gas may also help.

Conclusion
While some discomfort and changes in the umbilical area are expected after laparoscopic surgery, persistent pain, redness, and swelling warrant further evaluation. It’s essential to listen to your body and adjust your activities accordingly. If symptoms persist or worsen, seeking medical advice is crucial to ensure proper healing and to address any potential complications. Your health and recovery should always be the priority, so don’t hesitate to pursue further evaluation if needed.

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