Laparoscopic sterilisation

Read our guide below about laparoscopic sterilisation.

You can also download a PDF version of this patient information by following the link on the right.

What is laparoscopic (keyhole) sterilisation?

It’s a method of female sterilisation done under general anaesthetic. A thin telescope called a laparoscope looks at the uterine (fallopian) tubes with a small clip applied to each tube. This blocks the tube, preventing either sperm or eggs from passing along the uterine tube, and stopping pregnancy.

Alternatively, both fallopian tubes may be removed.

Is this type of contraception permanent?

Yes and should be considered if you don’t want any more children. A small number of women may regret sterilisation for different reasons.

It may be possible to remove the clips and re-join the uterine tubes but this involves major surgery with limited chance of conceiving afterwards.

There’s a high chance of an ectopic pregnancy (pregnancy growing outside the uterus) after reversal of sterilisation. The success rates for reversal procedures depends on things like:

• original method of sterilisation
• presence of other gynaecological problems.

Sterilisation reversal is not usually available on the NHS.

Is the sterilisation operation always successful?

No. Every method of contraception carries a risk of failure including female sterilisation. The possibility of getting pregnant after clip sterilisation is about 1 in 200 in 10
years. This means that for every 200 women undergoing sterilisation, 1 may get pregnant. This may happen many years after the original operation.

If you’ve been sterilised and experiences any pregnancy symptoms such as a delayed period, get advice from your doctor as soon as possible. If pregnancy continues, there’s a very high risk of an ectopic pregnancy.

A specialist gynaecologist should investigate the confirmed pregnancy.

Why might the operation fail?

The most common reason for sterilisation failure is the formation a new tubal opening in spite of the clip blocking the tubes during the operation.

Failure might also happen beacuse of an incomplete blockage of the tube. The likelihood of this happening is greater if you’re sterilised just after a pregnancy.

The use of sterilising clips is a safe method of sterilisation.

When both fallopian tubes are removed for sterilisation, the risk of failure is significantly less than for clip sterilisation.

Do the clips dissolve?

No. They’re permanent. The material they’re made from doesn’t generally cause any reaction with body tissues.

They contain metal which show up on x-rays including those of the abdomen or pelvis for other purposes later in life.

They don’t cause problems with metal detectors at airports. Metal in the body can sometimes cause problems with certain types of scans carried out for medical purposes. You should always tell the x-ray department about your sterilisation operation.

The clips work by crushing the portion of tube they’re attached to. As a result, they may drop off the tube over time and x-ray pictures may show the clips sitting a distance away from your reproductive organs.

This is normal and doesn’t indicate that a failure of the operation. The clips don’t cause any pain or problems when this happens.

Are clips always used for sterilisation?

No. Sometimes it isn’t possible to apply the clips securely to the uterine tubes so we use another method called diathermy. This uses heat to cauterise and seal a section of each uterine tube. In other cases, we may remove your tubes.

Can you always do the sterilisation operation using the laparoscope?

No. Sometimes it isn’t possible to do keyhole sterilisation. We may discover before surgery that there are particular risks or difficulties and will discuss an alternative method with you.

This would involve a more conventional operation, making a small cut in the lower abdomen. In this case, the surgeon will close the tubes with a stitch or clips, divide them or remove both tubes.

Sometimes this might be necessary during a planned keyhole sterilisation because the surgeon can’t see the uterine tubes with the laparoscope. If that happens, they’ll open the abdoment to do the operation.

It’s a small possibility which you must understand and accept if you’ve requested sterilisation.

It’s fairly unusual and happens in fewer than 1 in 100 patients. It may be because of:

• a large abdomen
• previous abdominal or pelvic surgery.

Disadvantages of the open operation

You’ll need to stay overnight in hospital and takes a little longer to recover at home afterwards.

Should I stop contraception before the operation?

No. Although the operation is effective immediately, you should continue with your usual method of contraception until your first menstrual period after your sterilisation operation. This also applies to women taking the contraceptive pill.

You’ll have a pregnancy test before the procedure.

Where do the eggs go after this operation?

Nowhere really. The egg produced at ovulation can’t pass along the uterine tube. Each microscopic egg is absorbed and removed from the pelvis by normal body processes.

Does this sterilisation operation cause menstrual or other long-term problems?

No. There’s no direct link between sterilisation and the development of later menstrual problems such as heavy, painful or irregular periods. You may have taken the contraceptive pill for many years before your sterilisation. The pill tends to make the menstrual cycle very regular with lighter and less painful periods.

When you stop the pill, the pattern of menstrual loss returns to the way your periods were before taking the pill. They may become heavier again.

Your menstrual cycle will become less regular with heavier and more uncomfortable periods as you get older. There’s no evidence that sterilisation has any negative long-term effect on health. By removing the anxiety about unplanned pregnancy, it may improve quality of life and be a positive factor in your relationships.

Are there any other benefits to being sterilised?

It’s an effective form of pregnancy prevention. Sterilisation either by clips or removal of the fallopian tubes also reduces the risk of developing some types of ovarian cancer.

There’s no evidence that having your tubes removed rather than clipped affects your ovarian function.

When can I get back to normal?

You may feel a little unwell for a few days afterwards. We recommend that if you go home on the same day as the operation, you should rest.

You should avoid anything too strenuous or active for 2 to 3 days. Be guided by how you feel and use common sense in resuming normal activities. You may have to make arrangements for
some extra help at home for 2 to 3 days, particularly if you’re responsible for younger children.

You must avoid having sex for 1 to 2 weeks after surgery.

What are the alternatives to sterilisation?

A very reliable method of contraception includes the intrauterine contraceptive device containing progestogen (Mirena).

You must discuss alternatives with your GP, family planning adviser or gynaecologist before deciding on the most suitable option for you.

Vasectomy, the equivalent operation in men is a technically simpler procedure. It usually doesn’t need general anaesthesia and has a much lower long-term failure rate (approximately 1 in 2000) than female sterilisation.

Still not sure?

Don’t get sterilised. If you’re uncertain about proceeding with this permanent method of contraception, use an alternative method until you’re absolutely certain.

What if I have any side effects or questions?

Call the staff on Ward 16A on 01296 418107/8.

How can I help reduce healthcare associated infections?

Infection prevention and control is important to the wellbeing of our patients so we have procedures in place. Keeping your hands clean is an effective way of preventing the spread of infections.

You, and anyone visiting you, must use the hand sanitiser available at the entrance to every ward before coming in and after you leave. You may need to wash your hands at the sink using soap and water. Hand sanitisers are not suitable for dealing with patients who have symptoms of diarrhoea.

More help or advice

Contact our patient advice and liaison service (PALS) on 01296 316042 or bht.pals@nhs.net