Having a laparoscopic sterilisation
This booklet has been written to provide information about your operation, and the benefits and risks. The medical and nursing staff will be happy to answer any questions you may have. What is laparoscopic sterilisation? Laparoscopic sterilisation is the term used to describe the blocking of your fallopian tubes (occasionally during this operation the fallopian tubes are removed). This operation then prevents sperm from reaching the egg at the end of the tubes where fertilisation usually occurs. You should therefore think of this operation as irreversible, i.e. permanent. You should be aware that there are other long-acting reversible forms of contraception available which are as effective at preventing pregnancy as sterilisation. These include the intrauterine contraceptive device, the Mirena intrauterine system and the contraceptive implant. Other therapy such as vasectomy of your partner also offers permanent contraception, does not involve a major operation with a general anaesthetic and is more reliable. Do I need to prepare for this operation? Being fit usually helps people recover more quickly from an operation. It is advisable for you to continue with your usual contraception until the onset of your period after sterilisation. Sterilisation can be performed at any time of the menstrual cycle. However, it is quite possible that pregnancy can go unrecognised if sterilisation is carried out in the second half of your cycle. It is important to realise that you could be pregnant at the time of sterilisation. If you have any suspicion that you might be pregnant - even a few days before the operation - you must tell the doctor when you come into hospital.
You will be asked to attend the pre-operative assessment clinic. A nurse will discuss the operation with you. You may need to undergo some routine tests before your operation eg. heart trace (ECG), x-ray, blood test. You will be asked some routine questions about your general health, the medicines you take at the moment and any allergies you have. Smoking cessation Smoking greatly increases the risk of complications during and after surgery, so the sooner you can stop the better. Even a few days before your operation can help to improve healing and recovery afterwards. For free help and advice contact your GP or Fresh Start Stop Smoking Service. It is advised that you do not start smoking immediately after the surgery as this can make you dizzy and possibly faint but also make you feel sick and actually vomit. What are the risks and consequences of having a laparoscopic sterilisation? Most operations are straightforward; however as with any surgical procedure there is a small chance of side-effects or complications. Risks are divided into those which occur frequently and those which are less frequent but more serious. Common risks Bruising and discomfort around the scars on your abdomen. Shoulder-tip pain which should be short-lived and not require more than simple painkilling tablets to relieve.
Rare but more serious risks Failure, resulting in unplanned pregnancy: the lifetime failure rate is 1 in 200. Pregnancy can occur several years after the procedure. The possibility of a future pregnancy occurring in the fallopian tube (called an ectopic pregnancy) if failure occurs. Pregnancy following a failed sterilisation is more likely to be an ectopic pregnancy than under normal circumstances. Uterine perforation (i.e. accidentally making a small hole in the womb). Damage to internal structures including bowel, bladder or internal blood vessels are serious but infrequent risks (3 in every 1000 procedures). Approximately 5 women in every 100,000 undergoing laparoscopy die as a result of complications. It is possible that the doctor may be unable to gain entry to the abdomen. If the above complications do occur, the doctor may decide to perform open surgery - a laparotomy. This involves having a larger cut to your tummy (abdomen). If necessary, repair of any damage to bowel, bladder or blood vessels would then be carried out. Please be reassured that every effort is made to reduce the chances of this happening. If you are concerned about any of these risks, or have any further queries, please speak to your consultant.
Will the sterilisation affect my periods? It is not likely to. Your period will reflect the fact that you may no longer be using the pill or coil. It may also depend on normal changes expected for your age. IF YOU THINK YOU MAY BE PREGNANT FOLLOWING STERILISATION IT IS IMPORTANT THAT YOU SEEK MEDICAL ADVICE TO EXCLUDE AN ECTOPIC PREGNANCY. Getting ready for the operation For a time before certain types of anaesthetic you will need to stop eating, drinking and chewing gum. This will be explained to you and you may also be given a booklet about this. If you have any questions please contact the hospital - telephone number on your admission letter. You will be asked to sign a consent form to say that you understand what you have come into hospital for and what the operation involves. You will be asked to have a bath or shower before coming into hospital (if possible). You will be given a theatre gown to wear. A porter will walk you to the anaesthetic room. What sort of anaesthetic will I have? Your operation will be carried out under general anaesthetic, which means you will be asleep throughout. The anaesthetist will visit you before your operation and discuss the anaesthetic with you.
What happens during a laparoscopic sterilisation? Sterilisation usually takes less than half an hour. It is carried out using an instrument called a laparoscope, which is a type of small telescope. Two small cuts (each about 1cm long) are made in your abdomen (tummy). One cut is made just below your tummy button and the other is made lower down. The laparoscope is inserted through the cut just below your tummy button. It is connected to a video camera and television, so that the inside of your abdomen can be seen on the screen. The doctor is then able to get a good view of your fallopian tubes. At the start of the operation, gas is introduced through one of the cuts in the abdomen to make it swell. This makes it easier to see what is happening through the camera. The gas is released out through the cuts at the end of the operation. Watching on the television screen, the surgeon puts small rings or clips onto the fallopian tubes. The lower cut is used to put the ring or clip into the abdomen. Other procedures may be carried out at the same time, eg. coil removed, and if so your doctor will have discussed this with you beforehand. The 2 small cuts are closed with a clip or stitch, you will be told which. The stitches may be dissolvable. The cuts will then be covered with a small dressing.
What should I expect after the operation? When the operation is over, you will have your pulse, blood pressure, breathing and wounds checked regularly by a nurse. Your wounds will be covered with elastoplast or dressings. It is usual to feel drowsy for several hours. You will be given oxygen through a facemask until you are more awake. Anaesthetics can sometimes make people feel sick. The nurse may offer you an injection if the sick feeling does not go away, this will help to settle it. The general anaesthetic may make you feel lethargic for a few days and you may have some general muscular aching. Your throat may feel dry and sore, but this will improve after a couple of days. Pain You may suffer from mild to severe pain in the abdomen and around the shoulders this is caused by gas collecting under the diaphragm (lower chest) and stimulating a nerve arising in the shoulder area - this is quite normal. You will experience some discomfort around the small cuts in the tummy and a feeling of bloatedness. The discomfort around the shoulders is due to the gas used during the operation, creating pressure on an abdominal nerve that is also connected to the shoulder area. The discomfort should not last more than a day. If severe or the pain persists, you will need to see your GP. You may take painkillers such as Paracetamol (do not exceed the stated dose), or peppermint water which will help to relieve it. Please make sure you have an adequate supply at home.
Going home The operation is usually performed as a day case, which means there will be no overnight stay. You must not drive or go home by public transport. Therefore, you must make arrangements for someone to collect you. It is not appropriate to go home unaccompanied in a taxi. Please note hospital transport and ambulances are not normally available for day patients. You will need a responsible adult at home with you for 24 hours. You should rest quietly at home for the rest of the day and be aware that it could take 2-3 days before the weariness wears off.
DISCHARGE INFORMATION AND AT HOME ADVICE For 24 hours after your general anaesthetic, you must not: Drive a car or any other vehicle or cycle. Operate any machinery/domestic appliance or go back to work. Do any strenuous exercise. Drink alcohol. Please drink plenty of fluids, but not too much tea or coffee. A light diet is advised. Lock yourself in the bathroom or toilet or make yourself inaccessible to the person looking after you. Make any important decisions or sign any important documents. Be responsible for looking after small children. Watch too much television, read too much or use a computer. Dressings The elastoplasts or dressings may be removed the morning after your sterilisation. Plasters may be needed if oozing is present. The following day, you may have a bath or shower.
Stitches Nurse to delete as necessary Your wound has dissolvable stitches, these do not need to be removed. If however, they have not dissolved and feel uncomfortable, your GP will remove them for you. Please make an appointment to have this done at your GP s surgery. Your wound has non-dissolvable stitches, these need to be removed by the Practice Nurse at your GP s surgery in 2-3 days time. You will need to take the yellow Sutures Out card to the surgery to make an appointment for this. The next few days You should take it easy for about a week after your operation and you should avoid lifting heavy items. Be guided by how strong you feel. You will probably still be feeling some discomfort when you are back at home. Ordinary painkillers such as Paracetamol should help, do not exceed the stated dose. Please make sure you have an adequate supply at home. Driving Do not drive until you can wear a seat belt comfortably and feel able to perform an emergency stop. Your insurance company may refuse to meet a claim if they feel you have driven too soon. It is also advisable to contact your insurance company with regards to cover following a general anaesthetic. Returning to work You can return to work as soon as you feel able. This is often in about a week s time. Follow up appointment You will be given a letter to give to your GP as soon as possible after returning home.
If an outpatient clinic appointment is needed, an appointment will be sent to you through the post. (If an outpatient clinic appointment is not needed, you should see your GP in 6 weeks time for a check-up). Points to note If you are on the pill, finish the pack you have started. Sexual intercourse/penetration can resume as soon as you feel ready. You must use another form of contraception until your next period. You may experience some vaginal bleeding - this is normal and may last a few days. Contact your GP if your wound becomes increasingly painful, red or swollen in the days after you go home or if you develop severe abdominal pain or pain in the shoulder 24 hours after the operation. Eat and drink as normal as soon as you feel like it. Please show this booklet to your GP if you need to see him/her. References RCOG Consent Advice No. 3. Laparoscopic tubal occlusion. Royal College of Obstetricians and Gynaecologists, London. October 2004 If you have any queries, or require further information please contact Ward 209 on 01332 787209. NHS Direct is a 24 hour nurse led, confidential service providing general health care advice and information. Telephone 0845 4647 or visit the website at www.nhsdirect.nhs.uk
www.derbyhospitals.nhs.uk Trust Minicom 01332 254944 Any external organisations and websites included here do not necessarily reflect the views of the Derby Hospitals NHS Foundation Trust, nor does their inclusion constitute a recommendation. Reference Code: P1012/0646/01.2012/VERSION7 Copyright 2012. All rights reserved. No part of this publication may be reproduced in any form or by any means without prior permission in writing from the Patient Information Service, Derby Hospitals NHS Foundation Trust. (P0652/04.2010/V6) Smoking is not permitted anywhere in the buildings and grounds of Derby s Hospitals. For advice and support about giving up smoking please call Free Phone 0800 707 6870.