STERILIZATION

                          

                         


                                 BANDING OF THE FALLOPIAN TUBES

             Eggs from the ovaries travel to the fallopian tubes and on to the uterus
       where they can be fertilized. Sterilization is done by blocking the Fallopian
       tubes by putting a special plastic band across each one, or by taking out a
       short piece of each tube and closing off the ends with a stitch. The ovaries
       and uterus still work normally so that the periods come just as before. The
       eggs, the size of a pinhead, will die in the pelvis after a few days and are
       cleared away by special cells. Sterilization is the most reliable form of
        contraception for women. There is a very small chance of a pregnancy in
       the tube between the band and its ovary end. It is very difficult, expensive
       and unreliable to try to join the clipped ends of the tubes up again. DO
        NOT MAKE A QUICK AND RUSHED DECISION ABOUT STERILIZATION.
       You will be sterile as soon as the operation is done. You must make sure
       you are not already pregnant before the operation. There is no way of the
       surgeon telling if you are pregnant by looking at the uterus during the operation. 

                                          
                                                 
               If you are taking the oral contraceptive pill, carry on and finish the packet you
        are using right past the time of your operation. If you have an IUD, this is best
        kept in until after the period following your sterilization. It will stop any fertilized
        egg already in the tube, settling in the womb. Your coil can be taken out when
        the sterilization is done if you use condoms. You must use them from the
        period before, to the period after the operation. This will stop fertilization of
        any egg during this time. If you think your contraception may have failed, tell
        the doctor when you are in hospital. In itself, sterilization is free from side effects.
        However, stopping using the pill, or having a coil taken out, may upset the periods
        for a month or two. Also long-term use of the Pill may have made the periods lighter.
        Sterilization does not prevent you having the period problems that can crop up as
        you get older. At the time of your operation, the surgeon may see fibroids or other
        things that can lead to period problems after the sterilization.

      The Operation

           You will have a general anesthetic and be completely asleep. The keyhole
        method is the most common. A small cut is made in the skin just below your 
        tummy button. A narrow telescope called a laparoscope is passed through
        the tummy wall, and your tummy is inflated with some carbon dioxide gas.
        The two clips are put on the Fallopian tubes using a fine instrument which
         is passed in the tummy through a second keyhole which is close to the one
         used for the telescope. Finally, a stitch may be put into each skin wound. 
         It usually takes about 15 minutes. It is dangerous to use the keyhole
         method if there are many scars inside from other operations. Also the
         laparoscopy is not safe if you have been pregnant very recently. The womb
         is in the way, and all the tissues bleed. If this is the case, small cut is made 
         in the lower part of your tummy. The Fallopian tubes are blocked by taking
         out a short length of each one and closing off the ends with a stitch. The
         operation can usually be done as a day case.

        Any Alternatives

      By this stage, you will surely have tried and ruled out the Pill, the coil, condoms, and
      injection treatment. Waiting until the youngest child is over one year old is often a
      sensible plan. Sterilization of the male partner - vasectomy is worth thinking about.
      It is more reliable than female sterilization. It can be done with just local anesthetic
      to numb the skin. It takes about three months to work. It is very difficult and expensive
      to join the ends up again, with about 1 in 3 chance of success. Some men do just not
      like the idea of a vasectomy. You need to decide with your partner on the best way for
      you to go ahead.

      Before the operation

        Stop smoking and get your weight down if you are overweight.  If you know that
        you have problems with your blood pressure, your heart, or your lungs, ask your
        family doctor to check that these are under control. Check you have a relative or
        friend who can come with you to the hospital, take you home, and look after you
        for the first week after the operation. Sort out any tablets, medicines, inhalers
        that you are using. Keep them in their original boxes and packets. Bring them
        to hospital with you. On the ward, you may be checked for past illnesses and
        may have special tests to make sure that you are well prepared and you can
        have the operation as safely as possible. . Please tell the doctors and nurses
        of any allergies to tablets, medicines or dressings. You will have the operation
        explained to you and will be asked to fill in an operation consent form. Many
        hospitals now run special preadmission clinics, where you visit for an hour or
        two, a few weeks or so before the operation for these checks.

        After - In Hospital

               If you have had the keyhole operation you may have a sanitary pad in place.
        You may have some discomfort in the tummy and shoulders caused by the gas
        inside the tummy. After three or four hours on the ward, you should feel fit enough
        to go home. A general anesthetic will make you slow, clumsy and forgetful for
        about 24 hours. The nurses will help you with everything you need until you can
        do things for yourself. Do not make important decisions, drive a car, use machinery,
        or even boil a kettle during that time. The nurses will advise about sick notes,
        certificates etc.

    After - At Home

              Make sure you are going home by car with your relative or friend. At home,
      rest for at least six hours. Take the dressing off the wound while in the bath or
      shower after three days and although you can shower or bath try to keep the
      wound(s) dry for a week. You will be advised about the stitches. There may be
      slight bleeding from the vagina, like the end of a period. It will last for a few days.
      Only use external pads for any loss. Do not use tampons. You can usually go
      back to normal activity and work after a week. Avoid heavy exercise for a week.
      You can have sex after your next natural period if you feel comfortable enough.

     Possible Complications

             As with any operation under general anesthetic there is a very small risk of
       complications related to your heart or you lungs. The tests that you will have
       before the operation will make sure that you can have the operation in the
       safest possible way and will bring the risk for such complications very close to zero.

        All operations have some risks. Laparoscopy is a very common and safe
       operation. However, complications can occur in 1-2% of cases. Very rarely
       bleeding can occur during the operation. Even more rarely, the bowel can
       be damaged by the instruments. In either case, the problem can be dealt 
       with straight away through a bigger wound. Sometimes, there is some infection
       in the tummy button area after the operation. This settles down with antibiotics.

      General Advice

            We hope these notes will help you through your operation. They are a
       general guide. They do not cover everything. Also, all hospitals and surgeons
       vary a little. If you have any queries or problems, please ask the doctors or nurses.

                                                                  

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    _______________________________________________________________________________________________________________________                     

                               KENNETH GOODRICH, M.D.  -  OBSTETRICIAN- GYNECOLOGIST  
     
                                           Certified by the American Board of Obstetrics and Gynecology

           Specializing in General Obstetrics and Gynecology, Minimally Invasive Gynecological Surgery- Hysterectomies
              and Uterine Fibroids, HPV treatment for Women and Men, Surgery on Obese Women,  Chronic Vaginal
              Discharges, Sexually Transmiited Diseases, Menopause, Abnormal Bleeding ,Cellulite Reduction and
                                                                                 Aesthetic Services