laparoscopy

Laparoscopy and laparoscopic sterilisation

Laparoscopy

The Operation

You will have a general anaesthetic and be completely asleep. A small cut is made in the skin just below your tummy button. A narrow telescope called a laparoscope is passed through the tummy wall, and your tummy is inflated with carbon dioxide gas. This gives the surgeon a good view of the inside of your pelvis. He may also pass other instruments into the tummy through one or two other cuts. These will help him to get a better view. He may pass a fine instrument through the vagina and into the womb to help him move the pelvic parts around as he looks for the problem. Finally, a stitch is put into each skin wound. The operation usually takes about 20 minutes. It can usually be done as a day case. This means you come into hospital on the day of the operation and go home the same day providing that everything is fine with you and you recover from the anaesthetic, which usually takes three to four hours. Usually a laparoscopy tells the surgeon if there is anything wrong.

Sometimes the surgeon can operate using special instruments passed down the laparoscope tubing. This may be just taking a snippet of unhealthy tissue - a biopsy. Sometimes he can take out all the diseased part. If not a bigger operation will need to be planned at a later date. Quite often a laparoscopy will reveal that the womb, ovaries, and tubes are in good order.

Any Alternatives

Usually by the time a laparoscopy is performed, it is because there is a high chance of finding an abnormality. You will probably have already had scans.

Before the operation

Stop smoking and get your weight down if you are overweight. Check you have a relative or friend who can come with you to hospital, take you home, and look after you for the first week after the operation.

After the operation - In Hospital

When you wake up, you will have a sanitary pad in place. You may have some discomfort in the tummy and shoulders caused by the gas inside the tummy. Tell the nurse if this is troubling you. You can be given an injection to help. After this, mild painkillers should be all you need. After three or four hours on the ward, you should feel fit enough to go home. You should be prepared to stay overnight, in case you are still not comfortable. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours.

After - At Home

Make sure you are going home by car with your relative or friend. At home, go to bed and rest for at least six hours. Sometimes there may be some bruising in the tummy, but this will settle after a week or so. You can shower and bath but try to keep the area of the wound(s) dry for a week. You can take the dressing off the wound after three days. The hospital will arrange for the stitch to be taken out, if this is a non-absorbable suture. There may be slight bleeding from the vagina, like the end of a period. It will last for a few days. Only use external pads for any loss. Do not use tampons. You can usually go back to normal activity and work after a week. Avoid heavy exercise for a week. You can have sex after your next natural period if you feel comfortable enough.

Possible Complications

As with any operations there is a risk from the anaesthetic. However, laparoscopy is a very common and safe operation. Very rarely bleeding can happen during the operation. Even more rarely, the bowel or other organs inside the abdomen can be damaged by the instruments. In either case, the surgeon can deal with the problem straight away but it will require a big cut in your tummy.

Sometimes, there is some infection in the tummy button area after the operation. This settles down with antibiotics. For simple laparoscopies when the surgeon is just having a look in the abdomen, complications occur in less than 1% of cases. In more complicated procedures (such as when the surgeon takes small samples of unhealthy tissue-biopsies for tests) complications will be higher.

General Advice

We hope these notes will help you through your operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.

You should remove any plasters from the wounds after 24 hours you may then bath or shower.

There may be some stitches in the wound these will dissolve spontaneously or need to be removed. You will be told if the stitches need to be removed before you are discharged; your practice nurse can usually does this for you.

Laparoscopic Sterilisation

Laparoscopic sterilisation involves blocking the Fallopian tubes so that the egg cannot travel down them to meet the sperm.

There is a small failure rate that may result in pregnancy; this is estimated at 2 in 100.

A laparoscopic sterilisation should be seen as a PERMANENT and IRREVERSIBLE form of contraception. However, in some exceptional circumstances a doctor may agree to reverse this operation, this involves major surgery and is not provided on the NHS, and it cannot guarantee to restore your fertility.

General Advice

It is very important to continue using your current contraception till you get your first period after the operation.

Your periods should continue as normal, however some women find their periods are heavier after a laparoscopic sterilisation, especially if they were previously on the oral contraceptive pill which usually gives lighter periods.

If you are worried see your GP.No heavy lifting for at least a week.

You should see your GP if:

You ever suspect that you are pregnant after Laparoscopic sterilisation as there is an increased risk of an ectopic pregnancy.

You have smelly discharge or inflammation from the wounds.

Hysteroscopic sterilisation

This is when the tubes are blocked with a device put into the tubes from the inside.

The success and failure are similar to the laparoscopic approach except that the procedure has less risk, especially if you have had a number of operations on your tummy before, or are overweight or have medical conditions.

We are trying to introduce this to Kent in the next few months, either at Maidstone in the day case unit, or at Pembury. It is possible we may need to organise it through private hospitals through “choose and book”.

This web site will keep you informed of progress.

Operations (full list)