LAPAROSCOPY

As with every surgical procedure the usual complications of bleeding, infection, pain, development of blood clots in the legs or lungs apply for laparoscopy, although they are uncommon. Very rarely because of serious complications arising during a laparoscopy, such as injury to your bowel, bladder or blood vessels, immediate major abdominal surgery may be needed. With respect to your life, this operation is six times safer than driving a car.  

The operation takes place in the most prestigious maternity hospitals located in Athens and in Thessaloniki and is usually a day-case procedure. 

The recommended time of staying in Greece is two days. You may fly back home the next day following the procedure. 

Prior to laparocopy 

You must not have the procedure if you are pregnant. To avoid this possibility, it is important to use contraception or avoid sex for the time between your last period and the date of the operation.  

If you are taking blood-thinning medication such as aspirin or warfarin, you should stop taking them a few days beforehand. You are advised to have a shower or a bath the night before the surgery. Nail polish, make-up, jewellery and contact lenses should be removed prior to coming in.  

On the day of the operation you need to present at the clinic in the morning, having had nothing to eat or drink from midnight the night before your procedure. 

Prior to moving to the operating theatre you will be reviewed by the cardiology and the anaesthetic team and you will be asked to sign the consent form for the surgery. You may also be offered a urine pregnancy test to exclude a current pregnancy. 

The Procedure  

Laparoscopy is performed under general anaesthesia
in an operating theatre. 

Initially a small cut of around 1 cm is usually done near your belly button. A tube is inserted at the incision site, through which a gas called carbon dioxide is introduced to distend your tummy. This gas creates a space in your tummy so that the laparoscope can be safely introduced, thereby reducing the risk of inadvertently puncturing your bowel, bladder or any blood vessels.  

The laparoscope allows us to fully assess your pelvis and if conditions that may affect your fertility such as endometriosis or fibroids are found, a second small incision at the pubic hairline and sometimes a third one to the side of the abdomen need to be done, so that other instruments required to surgically treat these conditions, can safely introduced and used under direct vision.  

Dye can also be injected through your cervix into the uterus and fallopian tubes to check whether your tubes are open.  

In the final stage of the procedure, your abdomen is deflated, the incisions are closed using stitches or glue and a dressing is applied.  

 The laparoscopy takes usually 30-45 minutes, but may take longer if extra procedures are needed such as, removal of fibroids or ovarian cysts, division of adhesions, treatment to endometriosis or surgery for blocked tubes. 

The whole procedure will be recorded on a DVD and you will be given a copy after the procedure. 

Post- laparoscopy

You should be able to go home on the same day, though occasionally you may be asked to stay in hospital overnight. Once you are fully awake and able to eat, drink and pass urine, you will be able to leave hospital. This usually takes between three and four hours. However, if you are unable to empty your bladder or have severe nausea, an overnight stay may be required.  

During the first 24 hours you may feel more sleepy than usual, therefore you are strongly advised to arrange for someone to drive you home and avoid driving and drinking any alcohol for 24 hours.  

Your cuts will be closed by stitches or glue and will initially be covered with a dressing.  You should be able to take the dressing off about 24 hours after your operation and have a shower. Glue and some stitches dissolve by themselves. Other stitches may need to be removed and this is usually done about a week after your operation.  

You may have some vaginal bleeding or discharge for 24 to 48 hours but this should not be very heavy. 

Mild pain and discomfort in your lower abdomen for the first few days after your operation is expected. You may also have some pain in your shoulder from the gas used to distend your tummy during the operation. If needed, you can take pain relief such as 400 mg of ibuprofen every 8 hours or 1 gram of paracetamol every 4 hours. 

There is a small risk of blood clots forming in your legs and lungs after any operation and this could be serious. You can reduce the risk of clots by mobilizing as early as you can after your operation and you may also be given  

heparin injections (a blood- thinning agent), which you may need to continue for up to a week. 

You can usually return to work and moderate activities by the third day. Increase your activity gradually during this time. Return to work will depend on the type of job you do. You may need 2-3 weeks to go back to heavy activities and for full recovery. It is recommended to use sanitary towels, not tampons and avoid sex for two to three days after surgery. 

Future follow-up

A free of charge, face-to-face or Skype follow up consultation will be offered by Dr Diamantopoulos to discuss in detail the findings of the laparoscopy, watch the surgery’s DVD and help you choose the most appropriate approach to treat your subfertility.

Endometriosis is a possible cause of infertility. There is good evidence to suggest that in infertile women with endometriosis, an operative laparoscopy with excision or ablation of the endometriosis lesions and division of any adhesions can improve fertility and increase spontaneous pregnancy rates. 

Following your laparoscopy and treatment to your endometriosis, we will either advise you to consider trying to conceive naturally, or recommend you a fertility treatment, such as IUI or IVF. This will depend on your age, your medical history and the co-existence of any other fertility related factors. 

When a fallopian tube is blocked and full of fluid is called a hydrosalpinx. It can be found in one or both tubes and is a common cause of infertility. 

This condition has been associated with a previous history of genital infections or abdominal surgery.  

Hydrosalpinx is suspected during an ultrasound scan, a HyCoSy or an HSG examination and confirmation is made with laparoscopy. 

Diseases of the fallopian tube, such as hydrosalpinx can severely reduce the chances of pregnancy with IVF if left untreated. Current evidence suggests that removing the fallopian tube (salpingectomy) or occluding blocked or diseased fallopian tubes with clips can increase pregnancy and live birth rates for women undergoing IVF.  

Another treatment option depending on the severity of damage to the tube is to perform restorative surgery, open the tube and drain the fluid (salpingostomy). The main drawback of restorative surgery is that the tube may later reclose and become blocked again.  

Further research is required to assess the value of less invasive techniques, such as aspiration of hydrosalpinx prior to or during IVF.