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Operation: Removal of Ectopic (including Laparoscopically)

Insurance code: Q3110

Introduction: This information is written by John Fairbank and is provided for the benefit of his patients. Additional information will be given during consultation in the clinic and during the pre-operative discussion. It is not appropriate for all surgeons’ individual practice or for all patients.

Purpose of operation: To remove an ectopic pregnancy in a fallopian tube sometimes requiring the removal of the whole fallopian tube.

Description of procedure: A series of small incisions are made on the anterior abdominal wall. One incision is just below the umbilicus and a further one or two incisions are made above the bikini line for other instruments to pass through. The pelvis is assessed. If there is very heavy bleeding or a very large ectopic a laparocopic removal is not safe and the abdomen is then opened. The ectopic is removed and the abdomen is closed with stitches in the usual way. Where the ectopic is small and there is not heavy bleeding the ectopic is removed using laparoscopic techniques and sent for pathology inspection before sensitive disposal. The small incisions are closed with dissolving sutures that usually do not require removal. A D and C (scrape) of the uterine cavity is often carried out to remove the thickened lining of the uterus to prevent a heavy and tedious post-operative discharge.

Anaesthetic These operations are usually carried out under general anaesthetic.

Length of stay A four night stay is typical if the abdomen is opened whereas an overnight stay is all that is required for the laparoscopic approach.

Post-operative management If a catheter has been inserted it is normally removed the following day. The IV fluid line is left in place until oral fluids are tolerated. The painkilling pump is kept in place until it is no longer required. Stitches or skin staples are normally removed the day of discharge from hospital.

Potential complications
Complications at the time of surgery include peri-operative bleeding, and damage to structures such as bladder and bowel. These complications are rare but require corrective surgery immediately or as soon as a problem is recognised. Venous thrombosis (DVT) can follow any pelvic surgery. Stockings are therefore worn and heparin injections given each day to reduce the risk. Early mobilisation and early discharge from hospital reduce the risk of thrombosis.

Post-operative consultation
A four week post-operative consultation is usually made. Information on the state of the pelvis and the condition of the remaining fallopian tube will be discussed. If further assessment of the fallopian tube(s) are required a special X-ray can be organised to check the tube is open and healthy (hysterosalpingogram). Advice will be given that an early scan is sensible in any future pregnancy.

Other considerations
Sex and exercise are best avoided until the skin has healed and sutures have dissolved. This may take up to four weeks. Heavy lifting is best avoided but light lifting is not a problem. Driving short distances is practical once comfortable and strong sedative pain killers are no longer being taken.

Relevant web sites

Information on laparoscopy

More information on laparoscopy

Information on ectopic pregnancy