A B C D E F G H I J K L M N O P R S T U V W

LAPAROSCOPY

Why is a Laparoscopy performed ?

A laparoscopy is performed either to make a diagnosis or to provide a treatment.

DIAGNOSTIC LAPAROSCOPY Laparoscopy is one of the most important tests in women with infertility problems. A blue dye is injected through the womb and tubes. This tells the surgeon if the tubes are open or where any blockages may be. It is also possible to tell if ovulation has occurred. Endometriosis can be assessed, and the ovaries and the general health and anatomy of the pelvic organs checked. Women who have chronic lower abdominal pain will often be recommended a laparoscopy. It will help to distinguish between endometriosis, pelvic inflammatory disease and ovarian cysts. Laparoscopy is very helpful in diagnosing ectopic pregnancy. It is also used to assess the results of tubal surgery for infertility.

TREATMENT LAPAROSCOPY More operations are now being done through the laparoscope, the commonest is still sterilization. Areas of endometriosis can be successfully treated. Ovarian cysts can be collapsed or removed. An ectopic pregnancy can be removed. If a woman has adhesions round the tubes making her less fertile, these can be separated and removed. A laparoscopy may be used to take a small sample of tissue (biopsy) for the pathologist to examine. A laparoscopy is only sometimes a suitable approach for the problems listed above.

Preparations needed for a Laparoscopy

Many women only need to spend the day in hospital, occasionally a stay overnight. It is usually possible to return to work after 2 or 3 days. The doctor should always be told of any drugs being taken or any allergies. If trying to become pregnant, the doctor must be told when the last period was. If the operation is done in the second half of the cycle there could be a fertilized egg. This could be in the tube or the womb. Some doctors feel it is better to do the laparoscopy in the first half of the cycle because of this. Some prefer the second half of the cycle because more information is obtained. One should always try to avoid pregnancy in the cycle in which the operation is planned.

What Happens during a Laparoscopy

A general anaesthetic is preferred, although a local anaesthetic is possible. Once you are asleep, the surgeon introduces about 2-3 litres of carbon dioxide through a needle into the abdomen. This blows the abdomen up and makes it easier to introduce the laparoscope (telescope) through a small cut below the navel. This is usually made at the lower edge of the navel. It is so small that a stitch is may not be needed. The organs can now be carefully examined through the laparoscope. If an operation is to be done then one or more equally small cuts will be made lower down the abdomen. This allows instruments to be introduced to do a sterilization or other surgery. If fertility is a problem blue dye will be injected through the cervix (neck of the womb) by an assistant. The surgeon watches down the laparoscope to see the dye flow through the tubes. A dilation and curettage (D & C) may also be done.

Possible Complications during a Laparoscopy

This is a very safe operation indeed. It carries the risk of a general anaesthetic but this risk is very small, the operation only lasting fifteen minutes. There is a risk of disturbing a fertilized egg, either in the tube or the womb. The risk is avoided if the problem is discussed with the surgeon beforehand. If there is an infection in the vagina, it is possible to spread it into the tubes. This is very rare. It is possible that the needle used to introduce the carbon dioxide or the telescope might penetrate an internal organ or cause internal bleeding. Fortunately this is also rare but it might mean the surgeon would have to open the abdomen. This might mean staying in hospital for about a week and being off work longer than anticipated.

After a Laparoscopy

Most people have a little pain in the navel and a period-like pain for a day or two. This is controlled by simple painkillers . Some pain in the shoulder may occur for a few hours after laparoscopy. This is not serious and does not mean something has gone wrong. If a dye has been used for fertility tests there will be a blue-stained discharge for a short time. There may also be very slight bleeding which may last a few days if a D & C has been done. A bath or shower can be taken as soon as desired but the navel should be kept dry. If any stitches have been used to close the little cuts on the abdomen these can usually be removed after 5 days. A waterproof dressing helps for the first few days. If it does get wet, it should be dabbed gently with a towel and talcum powder used to help keep it dry. Return to work and normal social and sexual activity is possible as soon as desired.

If a Laparoscopy is not performed

Laparoscopy has become an invaluable investigation of gynaecological problems. It often avoids a much bigger operation which would mean longer in hospital and more risk of complications.