Laparoscopic sterilisation

Laparoscopic sterilisation

It has been recommended that you have laparoscopic sterilisation.

This procedure involves blocking, cutting or removing both of your fallopian tubes. This
prevents the sperm from reaching the end of the tubes where fertilisation occurs.
Occasionally operations to reverse sterilisation are performed but are difficult and may
not be successful. You should, therefore think of the operation as irreversible.

This leaflet explains some of the benefits, risks and alternatives to the operation. We
want you to have all the information you need to make the right decision. Please ask
your surgical team about anything you do not fully understand or want to be explained
in more detail.

We recommend that you read this leaflet carefully. You and your doctor (or other
appropriate health professional) will also need to record that you agree to have the
procedure by signing a consent form, which they will give you.

Why laparoscopic sterilisation?

Laparoscopy is a surgical procedure, which allows your gynaecologist to inspect the
organs inside the pelvis and abdomen (tummy). It is often referred to as minimal
access surgery, minimally invasive surgery, keyhole surgery, or “endoscopy”, which
means, “to look inside”.

Compared to a laparotomy (surgery through a
larger incision in the abdomen), laparoscopy has significant benefits such as:

• Less pain and discomfort during recovery;
• Shorter hospital stay;
• Faster recovery times for the patient and an earlier return to normal daily activities;
• Smaller and less visible scars.

The laparoscopic sterilisation procedure
In attendance at your surgery will be the doctor, the surgical assistant, the anaesthetist,
the scrub nurse, the scout nurse, and the anaesthetic nurse. When you are asleep, your
doctor will insert a thin, hollow needle into the abdomen (most often through a small cut
in the navel) where carbon dioxide gas is passed into the abdominal cavity. The gas
gently inflates the abdomen, raising the abdominal wall above the uterus, bowel and
other organs, so that visibility is increased and all areas of the pelvis can be easily
inspected.
The laparoscope is then inserted. There will usually be a second incision just above the
bikini line in the lower part of your abdomen in the midline.

Laparoscopic sterilisation involves putting a clip or tight ring on each of your fallopian
tubes, to stop you getting pregnant.

When the instruments are removed the gas is released from the abdominal cavity, and
a stitch may be used to close each of the small cuts. Usually, if stitches are used they
will dissolve. We will tell you if they need to be removed. The laparoscopic procedure
will take approximately 15 minutes.

In some cases, it may be unsafe to continue the laparoscopy due to unexpected or life-threatening problems, and become necessary to convert to laparotomy (open surgery
through a much larger incision in the abdomen). This is only done in the interests of the
well-being and safety of the patient.

You should be aware that laparoscopic sterilisation:

• Is not reversible;
• Has a failure rate of 1 in 200;
• Will not be effective until the menstrual period after your procedure (so use other
  contraception before your surgery and until you have had your next period after the
  surgery);
• May rarely require larger incision in your abdomen if it cannot be completed by
  keyhole surgery;
• Can fail and result in an ectopic pregnancy (where the pregnancy is caught in the
  fallopian tube);
• If you are taking the contraceptive pill you should continue this until the first period
  after your sterilisation to avoid unwanted pregnancy.
  Some women experience heavier periods after sterilisation. This is usually because of
  stopping the oral contraceptive pill rather than anything to do with the operation.
  Normal first incision
  (½ – 1cm)
  Normal second incision
  (½ – 1cm)
  The decision to undergo a laparoscopic sterilisation is always yours and should not be
  made in a rush. Make a decision only when you are completely satisfied with the
  information you have received and believe that you have been well informed.

Benefits of the procedure
The aim of your surgery is to stop you from becoming pregnant.

Complications of surgery
Every attempt is made to reduce the risk of complications, but minor adverse events
occur in less than 3 out of 100 of cases.
Serious complications are rare (about 1 in 500 to 1 in 1000), but no surgery is without
risk.

Serious or frequent risks
Everything we do in life has risks. Laparoscopic surgery has some risks associated with
it.

Those specifically related to laparoscopic sterilisation include:

• Chance of failure of procedure (1 in 200)
• Failure to gain entry to abdominal cavity, so the procedure cannot be completed.
• Failure could lead to ectopic pregnancy (where pregnancy is caught in the fallopian tube).
• Shoulder pain following surgery due to some gas left behind (this settles with time).
• Uterine perforation during surgery (which will usually repair itself without any further treatment).
• Because laparoscopy requires the insertion of sharp instruments into the abdomen injury to major blood vessels, bladder, ureters, stomach and bowel is possible. This type of injury is rare. Patients who are very thin or obese, or who have had previous surgery to the abdomen, may have an increased risk for this type of injury.
• Laparotomy (open surgery) to repair damage to internal organs caused by the laparoscopic instruments. In the event of serious damage the surgical repairs may be extensive (1 in 1,000).
• Peritonitis is an extremely rate complication. This is an infection of the inside of the abdomen. It may not be immediately obvious and can be life threatening. In some cases, a colostomy (where the bowel empties into a bag) is created. Once again, this is an extremely unlikely complication but women undergoing laparoscopy should be aware of this.

The general risks of surgery include problems with:

• The wound (for example, bruising, infection);
• Breathing (for example, a chest infection);
• Bladder infection;
• The heart (for example, abnormal rhythm or, occasionally, a heart attack);
• Blood clots (for example, in the legs or occasionally in the lung);
• Excessive bleeding (that may require blood transfusion);
• Keloid – a surgical scar that becomes inflamed, raised and itchy. Keloid can be annoying but is not a threat to your health.

Most people will not experience any serious complications from their surgery. The risks
increase for older people, those who are overweight and people who already have heart,
chest or other medical conditions such as diabetes or kidney failure. As with all surgery,
there is a very small risk that you may die although this is extremely rare.

You will be cared for by a skilled team of doctors, nurses and other health-care workers
who are involved in this type of surgery every day. If problems arise, we will be able to
assess them and deal with them appropriately.

Other procedures that are available
Other contraceptive methods are available and some of these are, as or more effective,
than female sterilisation (for example, a vasectomy only has a failure rate of less than
1 in 1000. Hormonal methods like Mirena coil and Implanon are as effective as
sterilisation but easily reversed when the coil or implant is removed).

A member of the gynaecology team will discuss these options with you. Patients in the
young age group often have a high regret rate after choosing permanent birth control
and might be encouraged to choose effective but non-permanent options.

Your pre-surgery assessment visit
You may be asked to attend a pre-surgery assessment clinic before admission. This
allows you, the nurse and doctor to go through all the paperwork and discuss any
queries. The nurse will explain the ward routine and what to expect before and after the
operation. For example, when you will be allowed to eat and drink before and after the
operation, when you can expect to be out of bed and what observations the nurses need
to do.

At this appointment, we will also record your current symptoms and past medical history,
including any medication you are taking. Your heart and lungs will be examined to check
that you are well enough for surgery. Blood tests and x-rays will usually be taken or
arranged during this clinic.
The members of the gynaecology team will check that you agree to have the planned
surgery. If you have been given a consent form please bring it with you, alternatively
you may be given a consent form in clinic. Make sure that you have read and
understood this information before your clinic visit. If you have not understood any part
of the information, you will be able to ask any questions you may have about your
planned surgery.

Before you come into hospital
There are some things you can do to prepare yourself for your operation and reduce the
chance of difficulties with the anaesthetic.

▪ If you smoke, consider giving up for several weeks before the operation. Smoking
reduces the amount of oxygen in your blood and increases the risks of breathing
problems during and after an operation.
▪ If you are overweight, many of the risks of anaesthesia are increased. Reducing your
weight will help.
▪ If you have loose or broken teeth or crowns that are not secure, you may want to visit
your dentist for treatment. The anaesthetist will usually want to put a tube in your
throat to help you breathe. If your teeth are not secure, they may be damaged.
▪ If you have long-standing medical problems, such as diabetes, hypertension (high
blood pressure), asthma or epilepsy, you should consider asking your GP to give you
a check-up.

There is a risk that your procedure will be cancelled if there is a chance of very early
pregnancy. In order to be sure you are not pregnant at the time of the procedure you
must not have sex or you must use reliable contraception between the first day of the
last NORMAL period to the date of procedure.

Pre-laparoscopy preparation
Before your laparoscopic sterilisation, you will be asked to provide a urine sample to
perform a routine pregnancy test. It is very important you continue to use a reliable
method of contraception until advised by your doctor to avoid unwanted pregnancy. If
you are expecting removal of an intrauterine device please use additional contraception
1 week prior to surgery.

A week before surgery try to avoid heavy meals, such as pizza, pies, steak, chips or
roast dinner and preferably stick to easily digestible food like porridge, soups, eggs, fish,
chicken etc. The gynaecology team can discuss this with you in more detail.

Being admitted to the ward
You will usually be admitted on the day of your surgery. We will welcome you to the
operating theatre admission area and check your details. We will fasten an armband
containing your hospital information to your wrist. You will see the team performing your
procedure and get chance to ask further questions.

If you are at high risk of blood clots in your legs after surgery, we may give you anticlotting injections and ask you to wear support stockings before and after your surgery.
We will usually ask you to continue with your normal medication during your stay in
hospital, so please bring it with you.

Your pre-surgery visit by the anaesthetist
After you are admitted into hospital, the anaesthetist will come to see you and ask you
questions about:

• your general health and fitness;
• any serious illnesses you have had;
• any problems with previous anaesthetics;
• medicines you are taking;
• allergies you have;
• chest pain;
• shortness of breath;
• heartburn;
• problems with moving your neck or opening your mouth; and
• any loose teeth, caps, crowns or bridges.

Your anaesthetist will discuss with you the anaesthetic they will use.

On the day of your operation
Nothing to eat and drink (nil by mouth)
It is important that you follow the instructions we give you about eating and drinking. We
will ask you not to eat or drink anything (including chewing gum or sucking sweets) for
six hours before your operation. This is because any food or liquid in your stomach
could come up into the back of your throat and go into your lungs while you are being
anaesthetised. You may take a few sips of plain water up to two hours before your
operation so you can take any medication tablets.

Your normal medicines

• You may be asked to stop Aspirin and other non-steroidal anti-inflammatory
  medications 7 days prior to surgery.

• Hormonal medications such as the oral contraceptive pill may be continued –
  if you are on the pill you should continue this until the first period after your
  sterilisation to avoid unwanted pregnancy.
• Medications for diabetes and heart conditions may also be continued.

It is important to let us know, before you are admitted, if you are taking anticoagulant
drugs (for example, warfarin, aspirin or clopidogrel).
Also provide us, and the anaesthetist, with a list of all the medications you are taking or
have recently taken, including medicines prescribed by your family doctor and those
bought “over the counter” without prescription, and also any herbal medications.
Keeping an up-to-date list of medications with you is highly recommended.

Please contact us if you are unsure which medications you must stop. If we do not want
you to take your normal medication, your surgeon or anaesthetist will explain what you
should do.

We will need to know if you do not feel well and have a cough, a cold or any other illness
when you are due to come into hospital for your operation. Depending on your illness
and how urgent your surgery is, we may need to delay your operation as it may be better
for you to recover from this illness before your surgery.

Your anaesthetic
We will carry out your surgery under a general anaesthetic. This means that you will be
asleep during your operation and you will feel nothing.
When it is time for your operation, a member of staff will take you from the ward to the
operating theatre. They will take you into the anaesthetic room and the anaesthetist will
make you ready for your anaesthetic.

To monitor you during your operation, your anaesthetist will attach you to a machine to
watch your heart, your blood pressure and the oxygen level in your blood. General
anaesthesia usually starts with an injection of medicine into a vein. A fine tube (venflon)
will be placed in a vein in your arm or hand and the medicines will be injected through
the tube. Sometimes you will be asked to breathe a mixture of gases and oxygen
through a mask to give the same effect.

Once you are anaesthetised, the anaesthetist will place a tube down your airway and
use a machine to ‘breathe’ for you. You will be unconscious for the whole of the
operation and we will continuously monitor you. Your anaesthetist will give you
painkilling drugs and fluids during your operation. At the end of the operation, the
anaesthetist will stop giving you the anaesthetic drugs. Once you are waking up
normally, they will take you to the recovery room.

Pain relief after surgery
Pain relief is important as it stops suffering and helps you recover more quickly. We
may give you tablets or injections to make sure you have enough pain relief. Once you
are comfortable and have recovered safely from your anaesthetic, we will take you back
to the ward. The ward staff will continue to monitor you and assess your pain relief.
You would be discharged home with some pain relief tablets to keep you comfortable at
home.

What are the risks of anaesthetic?
Your anaesthetist will care for all aspects of your health and safety over the period of
your operation and immediately afterwards. Risks depend on your overall health, and if
you have any other health issues. Anaesthesia is safer than it has ever been. If you
are normally fit and well, your risk of dying from any cause while under anaesthetic is
less than one in 250,000. This is 25 times less likely than dying in a car accident. Side
effects of having an anaesthetic include drowsiness, nausea (feeling sick), muscle pain,
sore throat and headache. We will discuss with you the risks of your anaesthetic.

After your surgery
Recovering from laparoscopy
After your laparoscopy, while you are still under the effects of the anaesthetic, you will
be taken to the recovery room where you will be monitored by the recovery staff until
you are transferred back to the ward. Back on the ward, the nursing staff will monitor
your condition and take routine observations. Our medical team will explain how the
surgery went and what the findings were.

Following laparoscopy, you may experience the following:

• Tiredness;
• Muscle pain;
• Mild nausea;
• Pain or discomfort at the site of the incisions;
• Pain in one or both shoulders that may extend to the neck and rib cage (this is
  thought to be caused by some of the gas used during the procedure being left inside
  your body and may last for a number of days but will gradually wear off – often lying
  down can help relieve the symptoms).
• Cramps (similar to period pain);
• Vaginal discharge or bleeding for a few days;
• A sensation of bloating in the abdomen.

Leaving hospital
Length of stay
How long you will be in hospital varies from patient to patient and depends on how
quickly you recover from the operation and the anaesthetic. Most patients having this
type of surgery will be in hospital for a few hours but you may have to stay in overnight.

Medication when you leave hospital
Before you leave hospital, the pharmacy will give you any extra medication that you
need to take when you are at home.

Convalescence
How long it takes you to recover from your surgery varies from person to person. It can
take up to one to two weeks. After you return home, you will need to take it easy and
should expect to get tired to begin with.

Stitches
We usually use dissolvable stitches. If these have not disappeared after seven days,
they can be removed by the nurse at your GP practice.

Personal hygiene
You may bathe or shower normally after you leave hospital.
We recommend that you do not use tampons immediately after your procedure.
Sanitary pads may be used and should be changed regularly.

Diet
You do not usually need to follow a special diet. If you need to change what you eat,
we will give you advice before you go home. You should avoid constipation and straining
for bowel motions and ensure that you get plenty of rest while you are recovering.

Exercise
You should do light exercise, such as walking and light housework, as soon as you feel
well enough.
Normal physical activity may be resumed when any discomfort has disappeared, and
when you are feeling well enough. This may take anywhere from three days to a few
weeks, depending on the nature of your procedure and your general health.

Sex
You can continue your usual sexual activity when any bleeding and discomfort have
disappeared, and when you are feeling well enough.
We advise you to continue using a form of contraceptive until your first period following
surgery, as there may be a small risk of falling pregnant if your egg has reached the
womb before sterilisation. Unprotected intercourse will lead to fertilisation and
pregnancy from this egg if precautions are not taken until your next period.

Driving
You should not drive until you feel confident that you could perform an emergency stop
without discomfort – probably a few days after your operation. It is your responsibility
to check with your insurance company.

Work
How long you will need to be away from work varies depending on:

• how serious the surgery is;
• how quickly you recover;
• whether or not your work is physical; and
• whether you need any extra treatment after surgery.

You can usually return to work after one to three days. Please ask us if you need a
medical sick note for the time you are in hospital and for the first three to four weeks
after you leave.

Outpatient appointment
You do not usually need a follow-up appointment for this type of surgery.

Once you leave hospital
If you experience fever-like symptoms, or excessive pain, redness and discharge at the
incision sites you should contact us.

You should report to your GP or us if you experience any of the following:

• Persistent bleeding from the vagina that is smelly or becomes heavier than a normal
  period and is bright red;
• Persistent redness, pain, pus or swelling around the wounds, of a fever or more than
  38 degrees centigrade, or chills, which may indicate infection;
• Pain or burning on passing urine or the need to pass urine frequently, as this may
  indicate a urinary tract infection;
• Increasing nausea;
• Increasing abdominal pain with vomiting.

Contact details
If you have any specific concerns that you feel have not been answered and need
explaining, please contact the following:
Worcester Royal Hospital

• Gynaecology Nursing Staff, Lavender Ward (phone 01905 760586)
• Hospital Switchboard (phone 01905 763333)
  Alexandra Hospital
• Gynaecology Nursing Staff, Ward 14 (phone 01527 512100)
• Hospital Switchboard (phone 01527 503030)
  Kidderminster Treatment Centre
• Gynaecology Nursing Staff (phone 01905 760586)
• Hospital Switchboard (phone 01562 823424)

Other information
The following internet websites contain information that you may find useful.

• www.patient.co.uk
  Information fact sheets on health and disease
• www.rcoa.ac.uk
  Information leaflets by the Royal College of Anaesthetists about ‘Having an
  anaesthetic’
• www.nhsdirect.nhs.uk
  On-line health encyclopaedia
• www.worcestershirehealth.nhs.uk/acute_trust
  Worcestershire Acute Hospitals NHS Trust

If your symptoms or condition worsens, or if you are concerned about anything,
please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you
and your loved ones. If you have any questions or concerns, please do speak with a
member of staff on the ward or in the relevant department who will do their best to
answer your questions and reassure you.

Feedback
Feedback is really important and useful to us – it can tell us where we are working well
and where improvements can be made. There are lots of ways you can share your
experience with us including completing our Friends and Family Test – cards are
available and can be posted on all wards, departments and clinics at our hospitals. We
value your comments and feedback and thank you for taking the time to share this with
us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the
nurse in charge or the department manager in the first instance as they are best placed
to answer any questions or resolve concerns quickly. If the relevant member of staff is
unable to help resolve your concern, you can contact the PALS Team. We offer informal
help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf,
if you feel unable to do so, to resolve your problems and where appropriate refer to
outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate
your concerns. You can make a complaint orally, electronically or in writing and we can
advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please
be aware that you may need to leave a voicemail message, but we aim to return your
call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.

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