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Operations: Laparoscopy including the puncture and drainage of ovarian cysts and treatment of minor areas of endometriosis and laparoscopic sterilisation

Insurance code: Q3900

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: Laparoscopic procedures for diagnostic purposes such as fertility investigations and simple surgical procedures requiring one additional incision and surgical port. More complex procedures are coded differently and require more operating time.

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. Any necessary simple surgery can then be carried out. For example deposits of endometriosis can be removed surgically, or treated with bi-polar or mono-polar diathermy or with application of Helica energy. When sterilisation is required two small clips are placed across each fallopian tube. The exact procedure depends on the condition being treated and the operative findings. 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 single night stay may be required although most patients return home the same day.

Post-operative management 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. Sterilisation has its own recognised complications including the long term failure of the operation (1/500 cases), difficult clip application requiring a larger abdominal incision (1/100 cases). It is important for patients to realise that sterilisation reversal is not currently allowed by the NHS and reversal in the private sector is not covered on medical insurance.

Post-operative consultation
A post-operative consultation is usually made for one week for discussion of findings and wound inspection with Mr Fairbank, Mr Fairbank’s staff or the General practitioner depending on the complexity of the case. Laparoscopic sterilisation cases do not usually require a hospital follow up appointment. Most patients will require seven to ten days recovery before returning to work.

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.

Other web sites

Information on laparoscopy

More information on laparoscopy

Information on sterilisation