Author Archives: Dr. Thomas J. Waliser

About Dr. Thomas J. Waliser

Dr. Waliser is a gynecology specialist, performs minimally invasive surgery, and has been practicing medicine for over 22 years, primarily in the Scottsdale and Tucson areas. He graduated from the University of North Dakota School of Medicine & Health Sciences and completed his residency at St. Francis Hospital. Dr. Waliser is fellowship trained in Advanced Laparoscopy/Hysteroscopy and is board certified.

Laparoscopy for Endometriosis

Common Questions About Laparoscopy for Endometriosis

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By Dr. Tom Waliser

Endometriosis is a difficult disease. Many patients who are diagnosed with endometriosis experience significant amounts of pain and discomfort on a regular basis. Though modern medicine is beginning to develop solutions to endometriosis, science has a long way to go.

Fortunately, there are options for patients who live with endometriosis. Laparoscopies are one such option. Though surgery of any kind can be intimidating, laparoscopies provide an immense amount of relief. What’s more, they provide patients with much-needed answers about their condition.

What Is a Laparoscopy?

A laparoscopy is a minimally invasive surgery that allows a surgeon to look inside a patient’s abdomen to determine the cause of their pain. Though they can be used as a solution for endometriosis pain, laparoscopy procedures primarily provide diagnostic information about a patient’s condition.

What Are the Reasons to Get a Laparoscopy?

There are many scenarios in which a laparoscopy may be necessary. Though doctors may try other methods first, there are situations in which a laparoscopy is the best way to obtain a diagnosis. These situations include:

  • Pain
  • Ovarian cysts
  • Endometriosis
  • Fibroids

Medical professionals will be able to assess whether a patient is a good candidate for a laparoscopy, and if the procedure may be able to help their condition.

How Is a Laparoscopy Done?

How Is a Laparoscopy Done?

In an operating room, an anesthesia care provider will give the patient general anesthesia. After the patient is asleep, the surgeon will make 2–4 very small “incisions” (cuts in the skin) about ¼ of an inch long in the abdomen. The first incision is placed just inside the belly button.

After the first incision, the surgeon will put carbon dioxide gas into the patient’s abdomen through this incision. The gas makes room inside the abdomen so that the internal organs can be seen.

When the carbon dioxide is inserted, the surgeon will put a surgical telescope into the first incision. This is a long instrument that looks like a thick straw and at the tip of the telescope is a small lens. The lens projects an image of the inside of the patient’s abdomen through a fiber optic cable on a small screen (like a television).

The other incisions (1–3) are made just above the patient’s pubic bone. Special laparoscopic instruments are placed into the lower incision sites. The surgery is done through the small incisions in the lower belly.

What Can the Surgeon See?

During the procedure, the surgeon will be able to see the outside of the pelvic area organs. This includes the uterus, ovaries, fallopian tubes, bowel, bladder, appendix, and the area behind the uterus.

This view allows the surgeon to see problems such as appendicitis, ovarian, or tubal cysts, as well as signs of endometriosis and fibroids. The surgeon can also tell if the patient is severely constipated or has any tumors or growths.

It may be possible for the surgeon to remove or destroy the endometriosis that is found. Additionally, they may drain, remove, or destroy any ovarian or tubal cysts.

How Is Endometriosis Destroyed?

Surgical treatment using different methods is aimed at removing and/or destroying any visible endometriosis lesions. Superficial lesions (lesions that are just on the surface and don’t go deep into the tissues) are treated at the time of laparoscopy by surgical excision (cutting them out) or burning them off. This is also known as “fulguration.”

Surgical excision is the most common and effective treatment for endometriosis of the ovary (endometrioma cyst). Surgical removal at the time of laparoscopy has been shown to improve pain without damaging the ovaries.

How Long Does the Surgery Take?

Laparoscopy usually takes one to two hours, but it depends on the extent and severity of what the surgeon finds. Patients under anesthesia will not notice that time has passed when they wake up.

What Type of Scar or Stitches Result From the Surgery?

Modern surgeries, including laparoscopies, often use stitches that dissolve into the body. This means that the patient does not need to have them removed.

This can occasionally be alarming. These stitches sometimes come out of the skin, which causes concern in many patients. However, this is normal. Most incisions look red or dark pink after the stitches dissolve, but they fade over time. The scars will be hardly visible since the incisions themselves are small.

How Common Is Endometriosis?

Depending on which clinical study is referenced, women with chronic pelvic pain (pain that has been going on for longer than three months), who did not respond to hormonal suppression or birth control pills, have about a 70-80% chance of having endometriosis. Depending on the patient, the doctor may need to eliminate other diagnoses before settling on endometriosis.

How Long Is the Recovery After a Laparoscopy?

Recovery time is different for every patient. However, the median recovery for a laparoscopy is 3-4 days. If the patient has significant endometriosis or adhesions (pelvic scar tissue) then the recovery can be up to two weeks.

What If the Patient Is Menstruating?

Patients who are experiencing a period on surgery day can still go through with the procedure. However, tampons cannot be worn in the operating room. The patient will be given a pad instead.

What Do Patients Feel Directly After the Surgery?

Most patients do not stay overnight after a laparoscopy procedure, because it is minimally invasive. However, abdominal tenderness and bloating are common.

To make themselves more comfortable, patients are encouraged to wear or bring stretchy, comfortable clothes to wear home after the procedure. This can help to minimize pain and tenderness in the abdomen. Patients are also encouraged to bring a book or other form of entertainment for the pre-op waiting area, as surgeries often require some wait time.

Pain Management After a Laparoscopy

Pain Management After a Laparoscopy

Everyone’s experience following laparoscopies is different. The recovery room nurse will discuss which medications to take and how often once the patient returns home. In some situations, prescription pain medications are required, while other individuals can take over-the-counter NSAIDs, such as ibuprofen and acetaminophen. Since most prescription pain medications cause constipation, it’s important that the patient drinks plenty of water, eats foods that contain fiber, such as fruits and vegetables, and stays active. Some patients may also opt to take 1 capful of MiraLAX® (over the counter) in 8 ounces of fluid twice a day to relieve constipation.

For more information about laparoscopies, endometriosis, or other gynecological topics, contact AZGYN. We can answer any additional questions or concerns you have. 

 

What is female sterilization?

What You Need to Know About Female Sterilization

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Since the early days of birth control, science has come a long way in giving individuals valid choices surrounding reproductive health. Whether a woman would like to have a child or avoid pregnancy, we have many ways to help her achieve her goals. One such method of avoiding pregnancy is female sterilization. Though it is not often discussed as a starting point, female sterilization is a viable option for preventing pregnancy. In fact, it is one of the most reliable forms of birth control on the market today.

What Is Female Sterilization?

Female sterilization is the process of blocking the fallopian tubes to keep sperm from meeting with an egg and implanting inside the uterine lining. Normally, when an egg does travel out of the ovaries and into the fallopian tubes, it can be fertilized by any incoming sperm. With the fallopian tubes blocked by a sterilization procedure, sperm cannot find their way to an egg, and fertilization cannot occur. In this way, sterilization prevents pregnancy. This procedure is permanent.

Types of Sterilization

There are several types of female sterilization. Each of them has different benefits and may be right depending on the patient’s unique needs.

Tubal Ligation

Tubal ligation is most similar to the process described above. In this procedure, a doctor will cut or close a fallopian tube laparoscopically, meaning that the process is minimally invasive. In some situations, the doctor may even remove a part of the fallopian tube during a tubal ligation.

Bilateral Salpingectomy

In this process, a doctor entirely removes the fallopian tube. Bilateral Salpingectomy poses no risk of ectopic pregnancy or fallopian tube regrowth.

Female Sterilization Following Pregnancy

Because sterilization is an effective family planning method, many individuals opt to undergo the procedure following the birth of a child. Many families know when they are finished having more children, and immediately post-birth is a simple time to undergo the procedure. Rather than being done laparoscopically, a doctor can perform sterilization through the vagina while the birth canal is still dilated. Cesarean births also present a convenient time for the procedure.

Is Female Sterilization Painful?

It is not considered a painful procedure. A patient may have mild pain at the incision site, as well as cramping in the abdominal area as the body adjusts. This is usually very minor pain, and it passes quickly.

How Long Does It Take to Recover From Female Sterilization?

Recovering From Female SterilizationFemale sterilization is usually an outpatient procedure. After the doctor is finished, the patient will be monitored regularly for a few hours. This is simply to verify that nothing major has gone wrong and that the body is recovering well. After that, it is normal for the patient to be discharged. Rest is recommended for the first week, and the doctor will likely schedule a follow-up around 7 days later. The doctor can also give specific instructions on care and recovery time based on the individual patient’s situation.

What Are the Side Effects of Female Sterilization?

The primary and most obvious purpose of female sterilization is to prevent pregnancy. However, as with any medical procedure, there may be unintended side effects of the procedure. Bleeding is possible, both internally and vaginally.

It is possible for an infection to occur as well. However, this is rare. Patients should always speak with their doctor about any procedures and be sure to know about side effects or risks associated with them before making any decisions.

Sex After Sterilization

After the sterilization procedure, patients can return to their normal sex lives when it feels comfortable to do so. When a patient sees their doctor for the procedure follow-up, they can ask for details about what the doctor does and does not recommend in the way of sexual activity. Once a patient is healed, sex drive and sexual activity often return to normal.

It is important to use alternative contraception for three months following sterilization. This is to ensure that the internal wound is healed and able to effectively prevent pregnancy. Pregnancy, especially ectopic pregnancy, can occur in the three months following the procedure.

Pregnancy After Sterilization

Sterilization is nearly 100% effective at preventing pregnancy. However, there is a very slim chance that a pregnancy will occur following sterilization.

Because the fallopian tubes are cut, blocked, or otherwise compromised, pregnancies that occur after sterilization are ectopic. Ectopic pregnancies are pregnancies that occur outside of the uterus. The uterus is the only area in which a fertilized egg can develop. Ectopic pregnancies, therefore, do not make it to term. However, they can be extremely painful and can damage surrounding organs if not properly addressed.

Does Sterilization Protect Against STDs?

Many people use birth control such as condoms and dental dams to protect against sexually transmitted infections or diseases. Sterilization does not replace these methods in this effort. If a patient has multiple partners, has not been recently tested, or has a partner with a known STD, it is important to continue to use physical barriers such as condoms to prevent STD transmission. Sterilization will only protect against pregnancy, not STDs.

Sterilization and Menstrual Cycles

It is essential to note that sterilization is not intended to alter the menstrual cycle. In fact, your cycle will likely remain the same after the procedure. Many people use birth control options such as the pill and an IUD to manage painful, heavy, or irregular periods. These options are often effective because they contain hormones that alter the menstrual process. Sterilization is not this way. It will only prevent pregnancy — it will not alter menstruation.

Is Sterilization Right for Me?

Is Sterilization Right for Me?As mentioned, sterilization is a permanent procedure that prevents pregnancy at a nearly 100% rate. Though the procedure can technically be reversed, it is not always successful. Reversals are not guaranteed, and not even recommended in many cases. If a patient is considering sterilization, it should be assumed that the effects will be permanent.

These are some key questions a patient should ask themselves if sterilization is a possible option:

Is There Any Chance I’ll Want to Get Pregnant in the Future?

Remaining childless is a very valid option for many people, and many know from a young age that they do not want to have children. However, sometimes patients have only recently come to the conclusion. In these situations, alternatives might be better until the decision feels like a permanent one.

Is My Decision to Sterilize a Response to a Temporary Situation?

Sometimes, patients believe that sterilization is the right choice because they are battling a difficult situation. For example, a difficult patch in a marriage, sexual issues, economic hardship, or illness can prompt an individual to want to avoid pregnancy. However, no matter how bleak a situation may seem, none of the above will necessarily last forever. It is very possible that the situation prompting the decision will end and the individual may want to have a child.

Though, of course, this is not always the case, it is a strong possibility. If a patient is exploring sterilization in response to hardship, another birth control option may better suit their needs.

Do I Feel Pressured to Get Sterilized?

No patient should feel pressured to undergo a procedure unless it is medically necessary to keep them alive. If friends, family, a partner or partners, or anyone else is pressuring the patient to undergo sterilization, it is not wise to do so. If this is the case, it is important for the patient to have an open and honest conversation with their doctor about the circumstances. Often, there are other options that would be more appropriate.

What Are the Benefits of Sterilization Over Other Options?

It is essential to be sure that sterilization has unique advantages over other options. It is important to understand all of the options and ensure that sterilization has benefits that other reproductive health choices do not. Some patients find that less permanent options deliver similar results and offer them enhanced freedom.

Alternative Options

A large part of the sterilization process is exploring options to make sure that sterilization is right for the patient. Many doctors will not agree to the procedure until a basic understanding of reproductive options has been established. Sterilization is permanent, and most doctors want to ensure that their patients do not regret getting a life-changing procedure.

IUD

An IUD, or intrauterine device, is a small plastic or metal t-shaped object inserted into the uterus through the vagina. A doctor can do this in an outpatient procedure at a clinic, and recovery is fairly minimal. Most people experience minor pain or cramping for the first few days after the device is inserted.

There are two types of IUDs, copper and hormonal. The hormonal option releases hormones similar to the birth control pill that further aid in contraception. The copper IUD does not contain hormones but keeps an embryo from implanting in the uterine wall.

An IUD is a major alternative for those interested in the efficacy of sterilization, but who are not sure about the permanence. IUDs remain in the uterus for 3-12 years or until removed, depending on the brand and type. Once it is removed, your fertility returns.

Though sterilization is slightly more effective than an IUD, IUDs are a less permanent option for those who are going through a temporary situation, or who may want to get pregnant in the future.

Vasectomy

For those in monogamous partnerships concerned with getting pregnant, vasectomies are a viable alternative to female sterilization. Vasectomies are for male partners and are much easier to reverse, meaning that you can change your mind later on and expect to successfully conceive. Vasectomies are less invasive as well and often have a shorter recovery period.

Talking to a Doctor About Female Sterilization

Talking to a Doctor About Female SterilizationHere at Arizona Gynecology Consultants, we believe that the power is in the hands of the patient. Our job is to inform patients of their options, any side effects, any dangers, and empower them to make the decision that is right for them. Though many ‘professionals’ will assume that a patient will change their mind about childlessness, we stay away from swaying our patients in any particular direction, and simply supply them with facts. Ultimately, the power is always in the patient’s hands.

For more information on female sterilization, or to talk to a medical professional about options, contact us today.