Making an appointment and preparing for your Consultation
Mr. Khazali’s clinics are usually filled 6-8 weeks in advance but sometimes appointments become available sooner due to cancellations or extra clinics. If you wish to be seen sooner, make sure you get a provisional appointment confirmed but ask Emma to add your name to our cancellation list. This means that you will be contacted as soon as an earlier appointment becomes available.
Having a GP referral is highly recommended and is considered good practice. It is important that your family doctor is aware that you are seeing Mr. Khazali and they can include important and relevant previous history in their referral letter.
Most insurance companies would require you to see your GP first before making an appointment with a Consultant
If for whatever reason it is not possible for you to get a GP referral, please contact our office and let us know. In most cases, you can still see Mr. Khazali.
Mr. Khazali runs private clinics in three different hospitals. These include The Lister Hospital in Chelsea, London, BMI Runnymede in Chertsey, Surrey and Woking Nuffield Hospital in Woking, Surrey. Please let the office know if you have a preference. You will receive a clinic confirmation letter, which specifies the location and time of your appointment.
Yes. Mr. Khazali needs to review your notes before your appointment so that he can spend more time during the Consultation talking to you and listening to your story. Please scan the following essential documents as one PDF documents and email them securely to PA@gynaecology.me so that these can be uploaded to our system.
These essential documents include (if available):
- A short (one or two paragraphs) summary of your history in your own words.
- Images from your previous surgery. If you don’t have these, we recommend that you contact your previous Consultants or the hospitals you had those procedures and request those images. These images are very important in understanding the extent of your problem, understanding what has been done and to formulate a plan.
- Reports from previous ultrasound scans or MRIs. Images from these are not essential and reports usually suffice but if you have been given a CD of your MRI, bring it with you to your appointment, in case Mr. Khazali needs to view them. You don’t need to post the CD of your MRI to us.
We will send you a consent form and a pain and health questionnaire via email when confirming your appointment. Please print, complete and bring these with you on the day of your appointment.
The questionnaire is particularly important. It gives Mr. Khazali essential information about the nature of your problem, your general health and severity of your symptoms. This saves time during your Consultation so that he can spend more time understanding your condition and discussing options.
Please also bring all the relevant documents (even if you have already emailed them) with you as we have learnt, the hard way, that technology can not always be trusted!
We will need you to provide your membership and the pre-authorisation code from your insurers (if you have the pre-authorisation code at the time of booking your appointment, if not, please provide this as soon as practicable). If you have private medical insurance, please contact your insurer before your consultation to check the terms of your policy, particularly the level and type of outpatient cover you have, including any reimbursement limits on individual fees. Please note that you are responsible for any fees (or shortfall) which may not be covered by your insurer.
It depends on the complexity of your history and whether or not you need to have an ultrasound scan during your consultation. Mr. Khazali gives each patient as much time as they need and some patients may need much longer than others to discuss their options and ask their questions.
Please allow at least 1.5 hours from the time of your appointment and keep in mind that clinics can sometimes run late.
Absolutely. This is always a good idea.
Yes. That shouldn’t be a problem and you can still have an internal examination and ultrasound. However, if you prefer not to be examined while you are on your period, we can reschedule your appointment.
Mr. Khazali listens to your story and goes through your history with you. He will then examine you (this includes a vaginal examination) and may also do an ultrasound scan. He will then suggest the next step and goes through available options with you. You will have the opportunity to ask as many questions as you or your partner have. He will then dictate a letter, while you are in the room, to you and your GP that summarises what was discussed.
Yes. Mr. Khazali will dictate a letter to you and your GP. He usually does that while you are still in the room.
It depends. If you have had a recent ultrasound scan of acceptable quality, a repeat ultrasound scan may not be necessary. Mr. Khazali does perform his own ultrasound scans, particularly when he suspects severe endometriosis. This enables him to look specifically for endometriotic nodules and to assess for adhesions and perform pain mapping.
If you are self-funding, you may want to ask your GP to organise a transvaginal (internal) ultrasound scan for you before your appointment. If you have an ultrasound scan during your consultation, the hospital will charge you separately for this.
If you cannot make your appointment, please let us know at least 48 hours in advance so that we can offer the appointment to others who are waiting for a sooner appointment. If you don’t give enough notice, you may be charged for the full consultation fee.
You can have your outpatient appointments at any of the private hospitals that Mr. Khazali works out of and you are not required to continue being seen at a specific hospital because that was where you were seen last. On some occasions it might be more appropriate for you to have your operation at a specific hospital, but this would be discussed with you at the time you are booked.
Mr. Khazali is recognised by all major insurers. These include (but not limited to) Alliance Worldwide, Aviva, AXA PPP, BUPA and BUPA International, Cigna and Cigna International, CS Healthcare, The Exeter, Healix, Police Mutual, The Permanent Health Co., WPA and Vitality.
Please note that you may need to pay a shortfall for some complex surgery and/or Consultation. This depends on your policy and our agreement with your insurer. You will be fully informed of potential costs and shortfalls before these costs incur. You will never get an invoice from us without having agreed to it before your Consultation or your procedure.
NHS or private?
Last Tuesday, after 17 years of employment in the NHS, I did my last procedure at Ashford & St. Peter’s Hospitals NHS Foundation Trust, as an employed Consultant. I will still help and support the wonderful CEMIG team at ASPH as an Honorary Consultant whenever I can and as and when required but I will no longer have a regular NHS clinic or NHS operating list and my practice will be (almost) solely private.
This is an emotional moment for me as ASPH and CEMIG are like a second family to me and I enjoy working with the amazing, kind and hardworking people there. I love the idea of NHS and I am proud to live in a country where everyone can get excellent care, for free, regardless of their means.
In the last few years, however, it became clear that to maintain a healthy work-life balance I had to reduce my work commitments. I had two incredibly busy practices (NHS and private) consisting almost exclusively of complex endometriosis patients. In 2020, I was running the busiest BSGE-accredited endometriosis centre in the UK (CEMIG at the Lister hospital-my private practice base) and worked at the second busiest endometriosis centre (CEMIG at ASPH-my NHS base), the latter with the help of my two amazing Consultant colleagues Mr. Minas and Mr. Erritty.
On top of that, I had multiple responsibilities in various national and international societies (until March last year, I was the Honorary secretary of the BSGE, Honorary secretary of the International society of Neuropelveology, member of international advisory boards of the European Society of Gynaecological Endoscopy and the European Endometriosis League). I had teaching commitments at the Royal Holloway-University of London and I was travelling abroad, multiple times a year, to lecture at international conferences or to train endometriosis surgeons.
Clearly, something had to go. I have a young family. My wife works for the NHS and is a very busy GP and we have two adorable kids 12 and 10 who really need both of us to be around more. We have no family in the UK to help us.
So, I started with cutting down some of my society commitments and decided not to stand for election for Vice President of the BSGE, after 9 years on the BSGE council in various roles. I started turning down more lecturing invitations and tried not to initiate new projects (this last one was the most difficult- established the first and currently the only neuropelveology service in the UK, validation of a new endometriosis staging system, developing an app for surgical data collection, staring robotics and so on!) but it wasn’t enough.
After a long period of thinking and rethinking my options, I gave my notice to ASPH in September so that I can reduce my NHS workload. I did not announce the decision here as I was hoping we could find a way for me to stay on a reduced NHS contract after March as opposed to leaving completely but it is unlikely that the Trust can make that work.
The reason I chose to give up my NHS practice rather than my private practice was partly financial but that wasn’t the only reason. The management of the Lister hospital in London (my private practice base), has proven that they are very serious about building a great international endometriosis centre. They have done everything possible to create a truly exceptional service. I have access to the best experts in Thoracic surgery, transplant surgery and Neurosurgery, services we don’t have at Ashford and St. Peter’s hospital and services we need for treating some of the most advanced endometriosis cases. We also have the latest Robotic technology at the Lister Hospital which can be very useful in some cases. Again, something we have not been able to acquire at ASPH so far.
I am leaving the NHS with the knowledge that our patients will be in excellent hands, despite all challenges. I trust my two consultant colleagues (Vasilis Minas and Matt Erritty) and our two specialist endometriosis nurses (Luz Hughes and Paula Chaplin) at CEMIG and I know they will find a suitable replacement for me and together they will continue to provide excellent care to our patients. With the help of our fantastic colorectal and urology and radiology teams, they are more than capable to look after our complex endometriosis patients and if they ever need my help, I will be there.
Just get in touch with our office the usual way. If you prefer, your initial consultation can be done using videolink. Mr. Khazali goes through your history and recommends additional investigations if needed. Your physical examination can be done as soon as you are in the UK. This way, you can do most of required investigations and preparations in your own country. In many countries, Mr. Khazali can recommend a trusted colleague with an interest in your condition, who can assist in the process of preparing you for your treatment in the UK.
Having surgery away from home has its challenges, both logistically and emotionally. Our team is used to these challenges as many of our patients travel from far. The team will do their very best to make you feel supported and well-informed at every step.
If surgery is decided upon, you will need to travel to the UK at least two days before your surgery to meet with Mr. Khazali and be examined and have your pre-assessment at the hospital.
In most cases, it will be possible to do everything during one trip. Rarely, it will be necessary to travel twice. Once for Consultation and physical examination and once for surgery, if needed.
Yes. Once the process of booking your surgery is finalised with the hospital, we will provide a “confirmation to treat” letter that will assist in your visa application. We do not have any influence in the visa process and the decision is made solely by the British consulate in your country. We will of course be happy to be contacted by them if required to provide further information.
This depends on how far you have to fly, the complexity of your surgery and availability of suitable medical care in your home country. Most patients can safely travel back home after two weeks but some may need to stay longer.
About Mr. Khazali’s Experience and Approach
Mr. Khazali is internationally renowned for his expertise and experience in highly complex laparoscopic pelvic surgery, in particular endometriosis surgery.
He is particularly skilled in dealing with very severe forms of endometriosis when the disease has invaded important structures such as bowel, bladder, ureters and pelvic nerves. Mr. Khazali is known for his methodical and structured approach to complex surgery, breaking down very complex processes into small components and perfect those components to achieve the best end results.
Mr. Khazali has pioneered multiple surgical techniques, tips and tricks that help achieve better results in surgery and increase safety.
He has trained numerous gynaecologists from across the world, many of whom are now leading endometriosis surgeons in their countries.
He is one of very few surgeons worldwide with formal training in neuropelveology, which is a new discipline in medicine that deals with pathology of and surgery on the nerves of the pelvis, for example when endometriosis has invaded into the nerves of the pelvis. He is currently the Honorary Secretary of the International Society of Neuropelveology (ISON).
Mr. Khazali has performed thousands of procedures for advanced endometriosis, both in the UK and abroad with complication rates that are in some categories much lower than national and international published rates.
He is a regular invited speaker at international conferences on endometriosis and minimally invasive gynaecology.
His practice is almost exclusively dedicated to severe endometriosis but he accepts patients with common benign gynaecological problems, such as fibroids, ovarian cysts, menstrual disorders.
This has an interesting history. In the UK, male surgeons are called Mr., a 16th century derivative from the word “Master”. So they start from being a “Mr.”, then they become a “Dr.” when they finish medical school and after 7 or 8 years of specialty training, they become “Mr.” again when they pass all the exams of the Royal College and usually are called “Mr.” Only when they become a Consultant.
The reason behind this strange system is the fact that in the middle ages, surgery was done by barbers. Doctors had to have a University degree but surgeons were apprentices to more experienced barbers so they were not allowed to call themselves Doctors.
Mr. Khazali believes in patient-centres care. Each person is different and there is no one size fit all solution. Surgery is only part of the solution for endometriosis and other complex gynaecological problems. It is the whole “care” package that makes the difference. The trick is to treat the person, not the disease.
He has a reputation for being a good listener. His patients often comment on how they felt listened to after meeting him. They often feel that they have been well-informed about their options and that they have been very much in charge of their own care.
No matter how busy he is, Mr. Khazali gives patients as much time as they need to ensure they have asked all their questions and understood the options and that they have all they need to make an informed decision about their care.
Mr. Khazali firmly believes that complete removal (excision) of all endometriosis is the optimal way to increase the chance of success and reduce the risk of recurrence of the disease. This can sometimes mean a much more complex procedure and operating jointly with other surgeons such as transplant surgeons, urologists and colorectal surgeons.
Yes. We now have a new Da Vinci Xi robot at the Lister hospital. Mr. Khazali uses the Robot for a selected number of cases. For some procedures, using the robot can have significant advantages.
Yes. Over the years, Mr. Khazali has been fortunate to join forces with some excellent colleagues who have the right skills and interests and share his philosophy of care. When necessary, he operates jointly with Consultant Colorectal surgeons (for example when a segmental bowel resection is necessary), Consultant cardiothoracic surgeons (for example when diaphragmatic endometriosis excision is required), Consultant transplant surgeons or Consultant Urologists (for example when re-implantation of the ureters are required).
Yes. Mr. Khazali sees patients with other benign gynaecological problems such as fibroids, ovarian cysts and heavy menstrual periods.
Mr. Khazali usually refers patients with urinary incontinence and gynaecological cancers to his colleagues with particular expertise in the field of urogynaecology or gynaecological oncology. He believes that complex subspecialist surgery must be done by those who do a large volume of those particular procedures. He does not perform colposcopies (to assess abnormal cervical smear for example) and refers those to his colleagues.
Mr. Khazali accepts patient with fertility problems and performs procedures to investigate and treat infertility but when patients require assisted conception or IVF, he refers the patients to a fertility subspecialist.
Getting Ready for Your Surgery
Mr. Khazali does his private procedures at one of these three hospitals: HCA The Lister hospital in Chelsea, Central London, The Woking Nuffield Hospital in Woking Surrey and BMI The Runnymede in Chertsey, Surrey. Where you have your procedure depends on the complexity of your procedure, availability of theatre space and of course your preference. It also may depend on your insurance company as some insurance companies and certain policies do not cover The Lister hospital.
You will be given information about the proposed procedure, its potential risks and the details of what will be done during the procedure. This will be done during your consultations, through the leaflets and letters you will receive, and also when signing the “Consent form”.
You will be informed of the cost of surgery if self funding. If you are insured, you will be given the codes for the proposed operation so that you can get authorisation from your insurance company. If your procedure is expected to be complex, you may need to cover a “shortfall”. This depends on your insurance company, your policy and our agreements with each insurance company, as well as the level of complexity of your procedure. You will be fully informed of potential costs that you may be responsible for and will never receive an unexpected invoice from us.
You need to have stopped eating 6 hours prior to the time of your operation, this includes no chewing of gum or sucking on hard boiled sweets. You also need to stop drinking water 2 hours prior to the time of your operation. Please note: If you are completing bowel preparation, you will need to follow the instructions that are given to you at your pre-operative assessment appointment.
Yes. If you are on the combined pill, we recommend that you stop taking them 4 weeks before your surgery. This is to reduce the risk of clot formation in your legs and your lungs (thromboembolism). You can continue with progesterone only pills. Please note: it is very important that you make sure you do not have unprotected sex from your last periods before surgery until the day of your surgery. If you fall pregnant shortly before your surgery, pregnancy tests may still be negative and surgery may cause a miscarriage.
It depends. Mr. Khazali usually recommends a bowel preparation to clean your bowel if he expects significant disease on your bowel. For example when a segmental bowel resection is a possibility.
Yes. That shouldn’t be a problem.
The pre-admissions team from the hospital that you are booked to you have operation at will contact you to arrange your appointment.
The reservations team from the hospital that you are booked to you have operation at will contact you with the details of your admission.
You will be contacted by the pre-assessment team to arrange an appointment with the pre-assessment team. The aim of the appointment is to prepare you for your surgery. This will include taking a full medical history, blood tests, MRSA swabs, medication advice and taking of vital signs, including a weight and height. Diagnostic test beyond this scope will be done on a case-to-case bases and will be authorised by Mr Khazali or the Anaesthetist. The team will also provide you with any other specific requirements linked to your individual surgery. Arrival and fasting times will be communicated to you as soon as these have been finalised. Pain management after the procedure, wound dressing advice and mobilisation instructions will be given to you during your assessment, and will be communicated to you again prior to discharge.
All diagnostic tests are promptly followed by the pre-assessment team, and actioned accordingly. As the saying goes: No news is good news! The team will only contact you should further action be required. You are welcome to call the team on the number provided later in this document should you wish to know your results.
Surgery and Your Time at the Hospital
Woking Nuffield and Runnymede hospitals have parking facilities. Just make sure you register your car at the reception.
Being located in central London, There is no parking for patients and visitors at The Lister hospital. They are within walking distance or a short taxi drive from Victoria and Sloane Square tube stations though.
When patients are being collected from the hospital after their discharge, the small parking area next to the hospital main entrance can be used. There is an intercom located at the gated entrance that is used to identify the reason for your parking.
The reception area is located immediately after the main entrance. The Reception Team will be able to assist you from there. Providing your name will be sufficient for us to escort you to your private room.
Your private room is complete with an en suite shower room. You will have access to our free WiFi and television with a large variety of channels for your viewing pleasure. There is a safe located in the closet where valuables can be kept, and a hairdryer can be found in the dresser. Toiletries and towels and supplied and replenished after every use. The temperature of your room is controlled by you, and a telephone can be found next to your bed. The nurse call bell will be placed within your reach so we are never far from you.
Having an operation and being put to sleep, particularly if it is your first time, can be daunting. The team, from the porter to the Consultants know this very well and will do everything they can to make you feel as comfortable as possible. You will be kept fully informed at every stage.
You will be seen by the nurses on the ward and everything will be explained to you. You will be given a hospital gown to change into and will be asked to do a pregnancy test. You will then be seen by Mr. Khazali and his team to go through the procedure again and to make sure all your questions are answered. If you have been sent a Consent form in the post, make sure you bring that with you. You will need to sign it before your operation. If you haven’t received a Consent form, one will be filled on the day.
You will also be seen by the anaesthetist, who is the doctor putting you to sleep and looking after you whilst your surgery is taking place.
When its time for your procedure, you will be taken to the operating theatres and are greeted by the theatres team. You will go in the anaesthetic room where a series of checks will take place to ensure everything is in order. You will then be put to sleep by the anaesthetist and will be taken to the operating room.
Yes. The only exception is if to remove the disease you need a procedure that has not been discussed and agreed beforehand. For example if none of the investigations showed that the disease has gone into your bowel but at the time of surgery Mr. Khazali finds that the bowel is invaded and you need a segmental bowel resection to remove all the disease. This is unlikely to happen but in this scenario, the segmental bowel resection will need to be done with proper preparations and discussions.
Complications do happen, even in best of hands but fortunately they are uncommon. In most cases, an unintended injury to surrounding structures, when identified during the operation, can be repaired laparoscopically with no significant negative impact on your recovery.
Usually you will not wake up with a catheter. If Mr. Khazali feels during the operation that your bladder needs to rest for 24 hours or so, then he will leave a catheter which will usually be removed the next morning.
If you have had a bladder endometriotic nodule removed, you may need to have a catheter for 10-14 days and will go home with a catheter.
Usually 4. One in your belly button, one in the middle on the bikini line and one on either side of your abdomen. The one in your belly button is usually around 1 cm (half an inch) and the other are usually only 5-6 mm (a quarter of an inch). Sometimes, one of the incisions will be bigger. For example, if you are having a segmental bowel resection, you will have a 4-5 cm incision in your belly button.
You may notice 6 or 7 plasters/dressings on your abdomen. Two of these are to cover the ovarian suspension sutures and are not incisions.
Normally, these incisions heal nicely and you may not even notice these scars after a while.
Endometriosis affects fertility in many different ways. For example, an ovarian endometrioma can affect the egg quality and ovarian reserve. We can tell if the fallopian tubes are blocked or not, as a result of endometriosis by performing a Dye test. That is pushing a blue dye into the uterine cavity and seeing if the dye comes through the fallopian tubes.
Yes. He will see you either in the afternoon of your surgery (if your procedure was in the morning) or the day after. That is to explain what he found and what he did.
If you were the last patient on the list, you will still be drowsy when he comes to see you and may not remember the conversation. In that situation, he usually talks to your family with your permission so that when you wake up, they can explain to you what the findings were. He will see you or talk to you on the phone the next day.
Yes. You will get a very detailed report that explains the findings and the procedure. A copy will be sent to your GP too.
Most patients will be able to empty their bladders normally and with no problems. The nurses on the ward will make sure that you are passing good amount of urine and are emptying your bladder fully, before they discharge you home. Some patients, however, may have difficulty emptying their bladder. This will usually respond to simple measure. If you are still not emptying your bladder fully, a catheter needs to be inserted to empty your bladder. This is uncommon.
We do not have set visiting hours at The Lister. We simply ask that patients and visitors are respectful towards our other inpatients. Children are welcome but remain the responsibility of the accompanying adult.
We offer a bespoke discharge planning service that you can discuss with the nursing team on the ward. We appreciate that the majority of our patient do not live in central London and rely on friends or family to collect them. Timings can therefore be discussed and adjusted accordingly. Traffic in London should be included in your decision making process.
Sick notes will be provided to you prior to your discharge by the nursing team on the ward. This is usually for 2 weeks. If you need time off work after that, you will need to see your GP.
You will be given pain killer if required. Most patients will be given an injection that reduces the risk of clot formation in your legs and lungs (Heparin or Clexane). You may need to inject these into your abdomen at home for 2 weeks or sometimes longer. It sounds scary but it’s not really. It is very easy to do, the needle is very thin and the injections are normally not painful.
Explaining Some Medical Jargon
This is a term Mr. Khazali coined and a technique he uses often when endometriosis is whidespread on both sides of the pelvis. When both pelvic sidewalls, both uterosacral ligaments and the back of the cervix and the peritoneum over the pouch of Douglas is all cut away as one butterfly-shaped specimen, we call it Butterfly excision.
Pelvis is full of very important nerves. Some of these nerves are responsible for bladder function, bowel function and sexual function (hypogastric nerve, inferior hypogastric plexus, autonomic nerves etc) and others are sensory or motor nerves in charge of muscle movements and sensation (such as sciatic nerve, femoral nerve, lumbosacral trunk etc)
Some of these nerves are closer to the surface and are very easily injured if the surgeon isn’t aware of them and isn’t specially trained in “neuropelveology”.
Mr. Khazali is specially interested and experiences in working around these nerves, identifying and preserving them. He is one of very few surgeons worldwide with the highest level of formal training available in the field of Neuropelveology.
When the area under the ovaries is excised (which is very often), there is a possibility that the ovaries may stick to this raw area, causing adhesions. To reduce the chance of this happening, Mr. Khazali usually uses a technique to hold the ovaries up (suspend them) for a few days using a special suture. These sutures will be removed after 5-7 days, when the peritoneum (lining covering the inside of the pelvis) is healed.
A total hysterectomy does NOT mean that the ovaries are removed and does not mean you will go into menopause. Whether or not ovaries should be removed will be decided and discussed in full with you.
The difference between a total and a subtotal hysterectomy is whether or not the cervix (neck of the womb) is removed or left behind. Mr. Khazali does subtotal hysterectomies only in very selected cases (almost never for endometriosis) where the reason for a hysterectomy is merely heavy menstrual bleeding and fibroids and where the patient prefers the cervix to be left behind.
This means removal of fallopian tubes and ovaries. If you are having a hysterectomy, your fallopian tubes are always removed. Whether or not your ovaries should be removed depends on many factors and will be discussed in full with you before surgery. Mr. Khazali’s default position is always to leave the ovaries behind unless there is a good reason to remove them (an example is recurrent endometriomas in someone close to the natural age of menopause)
Removal of fallopian tubes. This is always done at the time of a hysterectomy. Sometimes, when the tubes are damaged by endometriosis or when they are filled with fluid (hydrosalpinx) or blood (haematosalpinx) they need to be removed.
Recovering from Surgery
It depends on the complexity of your surgery and varies from person to person. Most patient can go home either the same day or next day. You should be able to get out of bed and walk around a few hours after your surgery. Most of our patients will be able to do most of their normal activities within days of surgery.
The important trick is to listen to your body. It will tell you when you are doing too much. Try to take it slowly and give your body the chance to rest and recover.
You may feel the effects of anaesthetics for a few weeks. You may feel a bit more tired than usual and may notice that your sleep pattern is different. These are all normal and should go away with time.
When you can return to work will depend on the type of work you so as well as the complexity of you procedure. Some women will find that they are ready to go back to work within a few days, others may need 6 weeks and sometimes even longer.
You will be given a sick note for 2 weeks before you leave the hospital. If you feel you need more time to recover, see your GP to get further time off.
Most patients tell us that the pain after surgery was less than they expected but in some, the pain may be more intense.
It is normal to have shoulder tip pain for a day or two. This is because of the CO2 used at laparoscopy.
Some healing pain is to be expected and your abdomen may feel sore for a few days. You will be given painkillers to take home with you. For most patients, simple pain killers will do the trick to get them through the pain after surgery.
If you have had ovarian suspension, it is normal to feel a pulling sensation, particularly when walking. This may even be a bit painful. This pulling sensation will go away as soon as the ovarian suspension sutures are removed. If the pain from the ovarian suspension sutures is bothering you too much, it is ok to have these sutures removed earlier than planned, after 3 or 4 days..
Mr. Khazali usually uses dissolvable sutures for closure of the skin. This means you don’t need it have these removed. You may, however, have ovarian suspension sutures in addition to skin sutures. These are permanent and have a blue colour. They need to be removed after 5 to 7 days.
The nurses on the ward will confirm this with you before your discharge and will give you instructions for how to look after your incisions and how to keep them clean.
Yes, you can have a shower as soon as you are comfortably standing up and walking around and as soon as you feel you are safe to do so.
You can remove the plasters if you want to.
It is best not to have a bath or go swimming until the incisions have healed.
Your GP or community nurse are probably unfamiliar with ovarian suspension and may feel uncomfortable removing these sutures.
Your operation report explains how the nurse or the GP should remove these sutures after 5-7 days (just cut on one side of the knot and gently slide the suture out. It shouldn’t be painful but it may feel strange and uncomfortable. Just show them that part of your operation notes when you go to see them and hopefully they should be reassured.
If for whatever reason your GP surgery is not able to help, get in touch with our specialist nurse and she will be happy to help.
Your first couple of periods may be very different to your usual. They may come earlier or later than expected. They may be less or more heavy than normal and they may be even more painful than before. It is just impossible to predict but it is important to know that it is normal for some patients to have unusual and abnormal periods for a couple of months.
Some patients wake up from surgery and immediately notice a significant improvement in their pain and in how they feel. This usually happens in those with very severe disease and in many patients who undergo a segmental bowel resection. They often say immediately after surgery that they feel something has been lifted, they feel lighter and the pain they had for many years has suddenly gone.
For most patients, however, that is not the case. The first couple of periods can be even more painful than before.
We normally don’t judge the effects of the operation until at least 6 months has passed.
Serious complications after surgery are fortunately rare. But it is important to know the warning signs and to report them and seek help if you are worried.
You should feel better with every day that passes after your operation. If you don’t see continuous improvement in how you feel, please seek help.
Look out for these red flags in particular and report to us directly, your GP or A&E if any of these happen, especially during the first 10 days after your operation:
Getting progressively worse or feeling generally unwell
Fever or any other signs of infection
Abdominal pain that gets progressively worse and doesn’t get better with simple painkillers
Severe nausea and vomiting
Unexplained or unusual bleeding
If you are not sure or are worried, just get in touch with us and ask.
You can get some blood stained fluid coming out of your incisions for a couple of days. That is more likely to be the sterile fluid that is used for cleaning the operating filed left inside you from the from the operation. This is normal and will stop.
A little bit of bleeding from the incision sites is also normal but if this is not stopping after a day or so, get in touch.
After a hysterectomy, you may have some vaginal bleeding. This is usually only a little bit of blood, normally less than a period. At around day 7-10 after a hysterectomy, some women may get a gush of fresh blood vaginally. If it stops after a few hours, there is nothing to worry about. Sometimes, this is caused when the sutures used to repair the top of the vagina start to dissolve.
After a segmental bowel resection, a little bit of blood in your stools is normal and will stop.
For any issues after your operation, please follow the following steps:
If it is not an urgent matter, please email the office on PA@gynaecology.me we will get back to you usually within a couple of hours.
Or, during working hours, phone Mr. Khazali’s PA, on 0800 270 7 270
Out of office hours (or if you can’t get hold of the team), please go to GP out of hours service or attend A&E, depending on the problem. Either way, please email the office to keep us updated. Mr. Khazali will endeavor to get in touch with you directly, if required.
Yes, you will be seen for a post-operative consultation, usually between 6 to 8 weeks after your operation when Mr. Khazali will discuss the operation and the findings, any histology that was taken and further management is required. He will examine your incisions and makes sure everything has healed. Sometimes, for example if you have had a hysterectomy or had a Mirena coil inserted, you will need an internal examination.
For patients who live abroad or those who live far, this can usually be done using video or phone consultation. Please ask our office to organise that for you.
Our office will contact you to arrange an appointment. If you haven’t heard within a few days after your procedure, please phone or email the office to arrange your appointment.
Discuss this in your follow-up consultation but usually, you can start trying for a baby after your first normal period.
This depends on how far you have to fly, the complexity of your surgery and availability of suitable medical care in your home country. Most patients can safely travel back home after two weeks but some may need to stay longer.
Check this with your car insurance company. Normally, as soon as you can sit comfortably in the driver’s seat and turn back to reverse without feeling uncomfortable and as soon as you are able to make an emergency stop without it being painful, you are able to drive. For most patients, this will mean 2 weeks but it may be sooner or later than 2 weeks.
This is a difficult question to answer because it depends on many different factors. Different studies have shown very different recurrence rates, ranging from 20% to 80% over the course of 5 years. One study showed that 50% of women with endometriosis will go on to have repeat surgery and the younger you are, the more likely it is that you would require further procedures. It depends on many factors, including the quality of surgery.
In Mr. Khazali’s experience, the outlook is much more positive than many of these numbers. With good surgery and complete excision, the chances of recurrence to the degree that more surgery is needed, are relatively low.
The risk of recurrence also depends on the severity and extensiveness of the disease. For example, if you have endometriosis that is only affecting one or two areas of your pelvis, it is unlikely that it comes back after it has completely been removed, even if it is very advanced and deep. If, however, you have a very extensive disease that is widespread over the whole of the pelvis and is on multiple areas, you will be comparatively more likely to have a recurrence, even with very good surgery.
Another factor is whether or not there is Adenomyosis present. That is when the uterus and its muscle is affected by abnormal endometrial type tissue. In these cases, if medical treatments fail, a hysterectomy may be required to remove the disease completely.
Also, when endometriosis affects the ovaries (chocolate cysts or endometriomas), the risk of recurrence is significant. Excision of endometrioma reduces this chance significantly and that is what Mr. Khazali does but still, the cyst may come back.
Good quality and thorough excision minimises the chances of recurrence and even when and if the disease comes back, you may not necessarily need surgery.