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Laparoscopic sterilisation

If you are considering having a sterilisation or have an operation planned, it is important to know all you can about it. This includes:

 

  • why you need this operation

  • what it will be like

  • how it will affect you

  • what risks are involved

  • any alternatives.

 

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

 

 

What is the problem?

You wish to have a permanent form of contraception. This will prevent you becoming pregnant. We can achieve this with a sterilisation operation using keyhole instruments. We use a telescope, called a laparoscope, to see inside your abdomen. The operation is called a laparoscopic sterilisation. During the operation we also use the laparoscope to check that your uterus, Fallopian tubes, ovaries and other abdominal structures are healthy.

 

What are the uterus, Fallopian tubes and ovaries?

To explain where your uterus, Fallopian tubes and ovaries are and what they do, the best place to begin is the vagina. Your vagina is a tube about five inches long. It runs from just in front of your rectum up into your pelvis. It is just behind your bladder. You can feel your bladder in your lower abdomen when it is full of urine.

Laparoscopic sterilisation

 

At the top of your vagina is your uterus. It is about the size of your clenched fist. It is made of special thick muscle, but it is hollow inside with a special lining called the endometrium. The lowest part of your uterus, which juts into your vagina, is ‘the neck of the womb’, also called your cervix. Cervical smears are taken from the surface of your cervix.

 

The rest of your uterus is called the body. It thins out at the top to form two hollow tubes called the Fallopian tubes. You have a Fallopian tube on each side. These run sideways to end near your left or right ovary. Your ovaries are slightly smaller than a golf ball. They lie deep in your pelvis just below your waist. Your ovaries make hormones and contain tiny eggs, which are too small to see with the naked eye.

 

What do the uterus, Fallopian tubes and ovaries do?

The uterus is where a baby normally develops during pregnancy. About once a month an egg in one of the ovaries grows and breaks free from the ovary. It moves into the Fallopian tube and travels down the tube towards the uterus. At the same time, hormones make the endometrium thicker so that if the egg is fertilised by a sperm it can lodge in the uterus.

Laparoscopic sterilisation 2

 

Often, the egg is not fertilised and it dies. The hormones change and the endometrium also dies and is shed. There is some bleeding from the raw endometrium for a few days. This is a typical period. The cycle then starts again for the next month. If the egg is fertilised it starts making extra hormones. These make the uterus and endometrium grow to take the developing baby.

 

After the age of about 45 years the ovaries stop making some of the female hormones. Eggs are not released each month. The endometrium is no longer shed. The periods stop. This is called the change or the menopause. The changes in hormones often cause hot flushes and dizzy spells. Sometimes the periods become very heavy during this time.

 

What is sterilisation?

We sterilise you by blocking your Fallopian tubes. When your Fallopian tubes are completely blocked, your eggs cannot pass down and sperm cannot swim up. Therefore, fertilisation of your egg by a sperm cannot occur, so you cannot become pregnant. Your ovaries and uterus will continue to work as normal. Your ovaries will still produce eggs and hormones each month, so you will still have periods. We block your Fallopian tubes by putting a special clip across each one. The clips stay there forever. There are various types of clips. The type your surgeon uses is a matter of personal choice made through experience. One of the most common is the Filshie clip.

 

After sterilisation, your eggs will die in your pelvis a few days after being released from your ovary during each menstrual cycle. Your eggs are very small, about the size of a pinhead. You have special cells in your body that clear away the dead egg cells. This is what happens to millions of other body cells every day.

 

Is sterilisation reliable?

Sterilisation is the most reliable form of contraception for women. It is much more reliable than the pill or the coil. The risk of becoming pregnant after sterilisation is about one in 800 in any year. After sterilisation there is a very small chance of a pregnancy in the Fallopian tube between the clip and the ovary. The Filshie clip is currently considered the best clip to prevent this.

 

The aims

The aim of the operation is to block your Fallopian tubes to prevent you from becoming pregnant.

 

The benefits

The operation gives you permanent reliable contraception. You will not need to use the contraceptive pill or any other method to prevent pregnancy. Your risk of ovarian cancer is also slightly reduced after this operation.

 

Using keyhole techniques is less painful than doing open operations, recovery is quicker and you avoid having a large scar.

 

What are the disadvantages of sterilisation?

The main disadvantage of sterilisation is that it is permanent. It is fairly simple to do but an operation to reverse it is long, complicated and only successful in seven in 10 cases.

 

You should only be sterilised when both you and your partner are sure you want to go ahead and will not regret it. Generally the smaller your family, the younger your age and the less stable your relationship, the more likely you will come to regret the decision to be sterilised.

 

Make sure you have fully explored all the alternative methods of contraception. If you use the combined oral contraceptive pill, this may be keeping your periods regular and under control. When you stop the pill after sterilisation your periods may not remain as regular.

 

Are there any alternatives?

There are many effective contraception methods, such as the pill or condoms. These methods are usually easily reversible. For example, if you stop taking the pill you can become pregnant. Consider these methods carefully before sterilisation. Sterilisation reversal is difficult. It is only successful for about seven in 10 women (70%) and it may not be available on the NHS.

 

Your partner could consider male sterilisation, called a vasectomy. This is a simple operation, often carried out under local anaesthetic.

 

If you have scarring, called adhesions, in your abdomen from past operations or infection, a keyhole operation may not be safe. Consider other contraceptive methods before an open sterilisation operation with a larger wound, called a mini-laparotomy.

 

A new method, known as hysteroscopic sterilisation does not involve making any cuts. It is not yet widely available, as it is still being tested out. It cannot be reversed. The only hysteroscopic method used in the UK at present is the Essure method. The surgeon inserts a tiny titanium coil into the Fallopian tubes through the vagina and uterus. Body tissue then grows around the coil and blocks the Fallopian tube.

 

What if you do nothing?

If you are sexually active but do not wish to become pregnant you need effective contraception.

 

Author: Dr David Hutchon M.R.C.O.G, F.R.C.O.G.  Consultant Gynaecologist.

© Dumas Ltd 2006

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