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Laparoscopic sterilisation

Patient information

Introduction

This gives information about your operation and your stay in hospital and advice for when you go home. If you have any questions, please feel free to ask a member of staff.

For pregnancy to start, a man’s sperm must join the woman’s egg cell. This actually takes place at the lower end of one of the Fallopian tubes that connect the ovaries to the womb. All methods of sterilisation for a woman are to block or remove these two tubes.

What does laparoscopic sterilisation involve?

The operation is performed under general anaesthetic and usually takes less than half an hour.
A tiny cut is made in the abdomen just below the umbilicus (belly button) and a small telescope is passed through it. The telescope is connected to a video camera and television so that the inside of the abdomen can be seen on the screen. One or two further small cuts are made in the abdomen to allow narrow instruments to be inserted. Watching the TV screen, the doctor blocks the Fallopian tubes (usually using clips). It may be that other procedures are carried out at the same time (e.g. coil removal), but your doctor will have discussed this with you in advance. At the start of the operation, gas is pumped through one of the cuts into the abdomen to inflate it, because this makes it easier to see what is happening through the camera. The gas escapes through the cuts at the end of the operation.

Permanent and irreversable

Once your tubes have been blocked this is permanent. There is no need to repeat the process after a number of years. Although operations to reverse sterilisation are occasionally done, they are difficult and may not be successful. You should, therefor think about the operations as irreversible, and so the decision is normally best taken with the support of a partner.

Advantages and disadvantages of laparoscopic sterilisation

Most women prefer laparoscopic sterilisation to other methods because:
  • It involves a shorter stay in hospital (normally one day or less)
  • It takes less time to recover from the operation (you should be able to presume all your normal activities within one week)
  • There is much less pain after the operation from the small cuts, compared to the long cut needed for open surgery.
  • The scars are very small.

It is worth noting that:

  • After laparoscopic sterilisation, you may experience some discomfort both in your abdomen and in your shoulders. This is because the gas used during the operation causes pressure on a nerve that is also connected to the shoulder area this can last for up to one week.
  • It may be due to developments during the operation doctors decide that is advisable to perform open surgery (mini – laparotomy) after all ,but this is very rare
  • As with any operation, laparoscopic sterilisation has a small chance of complications. The main complications are : haemorrhage (difficulty in controlling the major blood vessel during or after the operation) risk of 1:2000

Damage to the bowel or the tubes coming from the kidneys to the bladder (uterus) risk of 1:500
Every effort is made to reduce the chance of these occurring. If you are concerned about these complications, please discuss the matter with the consultant or a member of their staff, who will be happy to answer any questions.

In some cases, laparoscopic sterilisation is not suitable for a woman, in which case she will have open surgery, which will require a longer stay in hospital. Occasionally, the operation is unsuccessful, although failure is rare (1 in 200 cases.) If pregnancy does occur, then there is a risk of pregnancy in the tube.

Preparing for laparoscopic sterilisation

There is nothing you need to do between now and when you come into hospital, although being fit usually helps people recover faster from an operation. Do not stop taking contraceptive precautions before the operation – if you are pregnant at the time of your operation, the pregnancy may well continue. If you have any suspicion that you might be pregnant, even a few days before the operation, you should let the doctor know when you come in. If you have an IUCD in place and it is removed you are not advised to have intercourse for the previous five days. You usually come into hospital on the day of the operation. You must not eat or drink anything from SIX hours before the operation. How will I be anaesthetised?
Just before the operation you will have a general anaesthetic, which may be given in one of several ways. You will have an opportunity to discuss this with an anaesthetist some hours before your operation and it is worth asking about the effects of the type of anaesthetic you will have.

After the operation - in hospital

When you come round after the operation, you will find yourself back in the ward. You will probably feel drowsy and you may feel slightly sick. This will wear off after a few hours. Your two small wounds do not need any special dressing and the two or three self – dissolving stitches should fall out by themselves. If they are still there after two weeks, then go to your G.P.to have them removed. Sometimes non – dissolving stitches are used. These need to be removed after 4-5 days.

Leaving hospital

Your nurses will advice you when you will be ready to leave hospital. You should not go home unaccompanied and you may want to organise to have some help at home when you first return. You may feel poorly on the day after the operation, but should be back to normal after 48 hours. You should try to have rest for one to two days after the operation. You may not need to stay in bed, but you should be guided by how strong you feel as to how much you do.

Back at home

  • Sex and pregnancy: most women find their sexual response does not change following sterilisation. You may feel sore, but apart from this you can have sex when you feel ready. You should continue to take contraceptive precautions until after your next period. If you think you might be pregnant some time after the operation, you should go to your GP soon as there is a chance of pregnancy occurring in the Fallopian tubes (ectopic pregnancy)
  • Periods: Your periods may become a little heavier, especially if you are stopping taking the pill, but most women do not notice any change.
  • Pain: You will probably still be feeling some discomfort when you are back at home. Ordinary painkillers like paracetamol should help. If the pain becomes distressing, please contact your GP.
  • Driving: You can start driving again when you can stamp your feet hard without causing any pain or discomfort and believe your concentration will not be impaired.
  • State of mind after the operation: Some women are concerned that they may loose their femininity after the operation, but there is no basis for this while you are in hospital, ask a member of staff, or get them to put you in touch with a gynaecology liaison sister.

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