Introduction

This leaflet gives you information about Wide Local Excision (WLE) of a vulval lesion. This is a treatment for pre-cancerous, recurrent and early cancer of the vulva.

 

What is WLE of a vulval lesion?

This is removal of the area containing pre-cancerous cells or cancer, along with a small border of healthy tissue around it. The border of healthy tissue is called the margin.

Before the operation

You should carry on taking your usual medications, unless told otherwise. We strongly advise that you stop smoking before your operation. If you develop an illness before your surgery date or have any questions, please contact your specialist nurse or the gynaecology secretary on 01228814217.

Pre-operative assessment

Everyone coming in for an operation will be invited for a pre-operative assessment. Much of this is now completed on-line if you are able, before attending for an assessment. This will include recording a full medical history, your current medication and arranging any investigations needed. Please tell the nurse practitioner or doctor if you have had problems with any previous operations, anaesthetic or if you have any allergies – this is very important.

Will I have to sign a consent form?

You will be asked to sign a form giving your consent to the surgery. The consent form gives your gynaecologist the right to do only what is written on this form.

During surgery

A WLE is normally carried out under a general anaesthetic (while you are asleep). A narrow plastic tube called a cannula is inserted into a vein in your arm or hand using a needle. This is used to give you fluids and medications. After you have been given a general anaesthetic and you are asleep, a catheter (a tube for urine drainage) may be inserted into your bladder.

The wound will be closed with dissolvable stitches. The procedure takes about an hour, but you can expect to be in theatre and recovery for 3 to 4 hours.

After the operation, you will normally wake up in the operating theatres recovery area, but you may not remember much until you are back on the day unit or the ward in your own bed. You will be given medication during your surgery to relieve the pain when you wake up. You may have some discomfort following your surgery but we will try to control this in the best way possible using a variety of pain relief.

Risks

There are risks associated with all surgical procedures. These risks must be considered in the context of the risks of not undertaking surgery for your vulval lesion. The risks of surgery and the alternative options will have been discussed with you but if you have questions or concerns please contact the gynaecology secretaries on 01228814217 and a further appointment will be made to discuss with you.

The main risks of surgery are
  • Bleeding
  • Infections
  • Breakdown of wound/delay to wound healing
  • Deep Vein Thrombosis (DVT), blood clots in your legs. Pulmonary Embolism (PE), blood clots in your lungs
  • Injuries to local structures (nerves, blood vessels, anal sphincter, urethra)
  • Further surgeries and other treatments
  • Risk of general anaesthetic
How long will I be in hospital?

Please bring an overnight bag with you when you come for your surgery. You may be discharged on the same day or the next day depending on the surgery you have had and how you have recovered. Occasionally patients have to stay in a little longer and sometimes depending upon the location of the excision you may go home with a urinary catheter for a short period of time. If this is the case a plan will be made as to when and where the catheter will be removed prior to you discharge home.

At home

You may still have some discomfort when you leave hospital but you will be given a supply of pain relief medication which you should take regularly for the best effect. You may feel weak or tired when you go home, this may last for a few days.

Shower the area with lukewarm water and dry with a non-shedding cloth or cool hair dryer for a minimum of 2 times a day or every time after going to the toilet. It is normal to feel tingling and pulling around the area of the surgery as your wound goes through stages of healing and it may take some time for the wound to heal completely.

The vulval stitches are dissolvable, however, they may become tight and can be removed by the district nurse after 7 days depending on how well the wound has healed. If you are experiencing discomfort and stinging when passing urine, normally due to the acidity of urine coming into contact with the wound, pouring a warm jug of water over the wound while sitting on the toilet might ease your discomfort.

Pain relief medication, reduced activity, having an operation and changes in your appetite can all affect your bowel function. If you are constipated following your discharge from hospital it is important that you try to address it as soon as possible. Try to increase your fluid intake and eat a well-balanced diet with foods rich in fibre. If you have not moved your bowels for 3 days, please contact your GP who may give you some medication to help.

Due to the location of the wound, it is common that the wound may show signs of infection despite frequent washing and your best efforts to keep it clean. If you experience any redness, heat or offensive discharge from your wound when you are at home, please ask GP for advice. They may take a swab of the wound to test for infection. It is likely that they will prescribe you a course of antibiotics.

At first you may have a brownish discharge, this is normal. If the discharge gets heavier, foul smelling or if you have bright red bleeding, contact your GP or women’s outpatients for advice.

If you are still having periods your next period may be early or late as surgery can upset your normal cycle. It can take a while for your cycle to settle back into a normal pattern.

Gradually increase your activity each day. Some exercise is important because sitting for long periods can cause ankle and foot swelling and can increase your risk of deep vein thrombosis. Walking is an excellent way to exercise. Gradually increase the length of your walks but only walk a distance you are comfortable with. Running and cycling can be recommenced once your wound is fully healed usually at around 6 weeks.

Do not swim until your vaginal bleeding has stopped and your wound has healed completely.

Sexual intercourse is not advised until the wound is fully healed usually at around six weeks. You may find using a lubricant during intercourse makes the area more comfortable.

When to seek urgent medical advice

Seek medical attention for any of the following:

  • Severe pain not controlled by pain relief medication
  • Fever, shaking, chills or other signs of a fever
  • Signs of wound infection such as increased redness, swelling, tenderness, warmth or drainage from the wound
  • Offensive smelling discharge
  • Excess bleeding
  • Persistent vomiting with the inability to tolerate food and fluids
  • Constipation for more than 3 days
  • Severe pain in either calf or leg, sudden shortness of breath or chest pain
  • Problems passing urine and/or other urinary problems.
Returning to work

You may return to work 2 to 6 weeks after the surgery depending on the depth and size of your wound, your general state of health before the operation, wound healing and your job.

When can I drive?

You will be able to travel as a passenger, but if you are travelling long distances, please make sure that you stretch your legs regularly.

You should not drive until you feel able to perform an emergency stop comfortably and are not taking regular pain relief medication. This usually means about 4- 6 weeks before starting to drive again, but it is advisable to discuss this with your insurance company.

Results and follow up

Results usually take 3 to 4 weeks to come back. Your results and treatment plan may be discussed at our weekly multi-disciplinary team meeting (MDT). These will then be discussed with you and the appropriate follow up actions arranged.

Useful contacts

We hope you have found this information useful. If there is something you do not understand or if you have any questions, please ask the clinic nurse or telephone our gynaecology/ colposcopy specialist nurse.

Gynaecology secretaries contact numbers

Cumberland Infirmary
Tel: 01228 814217

West Cumberland hospital
Tel: 01946 523217

 

Confidentiality

‘The Trust’s vision is to keep your information safe in our hands.’ We promise to use your information fairly and legally, and in-line with local and national policies. You have a right to understand how your information is used and you can request a copy of the information we hold about you at any time.

For further information on confidentiality contact the Information Governance Team:

Information.Governance@ncic.nhs.uk | 01228 603961

Feedback

We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:

pals@ncic.nhs.uk | 01228 814008 or 01946 523818

If you would like to raise a complaint regarding your care, please contact the Complaints Department:

complaints@ncic.nhs.uk | 01228 936302