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After the operation, there may be some discomfort. This may include:
Most of these minor symptoms will disappear within a day or two after surgery. The abdomen may feel swollen for a few days. Any unusual or peculiar symptoms should be reported at once to the doctor.
To really appreciate the benefits of laparoscopy, one should remember that the alternative is major surgery (laparotomy) which involves a large abdominal incision, a four to six day hospital stay, and four to six weeks of postoperative recovery time.
While the doctors may term laparoscopy as being "minor" surgery, remember that for the patient all surgery is major! The risk of laparoscopy are minimal. But certain conditions increase the possibility of complications. If there has been previous surgery in the abdomen, especially involving the bowel, there is an increased risk. Other conditions that lead to a higher risk of complications are evidence of an infection in the abdomen, a large growth or tumor within the abdomen, and obesity.
Complications among young, healthy women under going laparoscopy are rare and occur only in about three out of 1000 cases. These complications can include injuries to structures in the abdomen such as the bowel, a blood vessel or the bladder. Most often, these injuries occur when the laparoscope is placed through the navel. If such an injury occurs during the procedure, the physician can perform major surgery and correct the damage through a longer abdominal incision. Sometimes, complications may arise after surgery. If bleeding or pain appears excessive or if high fever develops, the doctor should be informed.
Unfortunately, many gynecologists are not skilled at performing a laparoscopy properly. In order to choose the best doctor for performing your laparoscopy, you need to ask him the following questions.
In our practise, we prefer using an HSG to document tubal patency, because it is much less expensive; is non-surgical; and provides a hard copy record , which all doctors can refer to later on. Some doctors still believe that both the HSG and laparoscopy are complementary procedures, and you may even need both, especially if your tubes are blocked. HSG provides information only about the inside of the tubes and uterine cavity, whereas in laparoscopy, not only can the tubal patency be determined, but two other disorders ( endometriosis and tubal adhesions) inside the abdomen which affect tubal function and which do not show up on HSG can also be diagnosed. However, while it is true that a laparoscopy offers the doctor a chance to diagnose and treat these problems at the same time , it is still unsure whether correcting these problems actually helps to improve the patient's fertility !
A common problem which patients face in practice is that many doctors will insist on repeating the laparoscopy. One reason for this is that doctors feel that they need to do the laparoscopy for themselves, because they cannot "trust" another doctor's judgment. This is, of course a major problem for patients, who suffer repeated (and unnecessary) laparoscopies. Having a video record should help to minimize this problem.
What happens if your laparoscopy was normal and the second doctor wants to repeat it anyway? Sometimes doctors have little to offer in the way of effective treatment and since there is nothing else to do, they suggest a repeat laparoscopy to which the hapless patient is forced to agree. If your first laparoscopy did, in fact indicate you had a problem, a second look laparoscopy may be indicated (and this should have been discussed with you after the first laparoscopy) to determine if the problem has been successfully resolved. Ask the doctor what information he hopes to get by doing the repeat laparoscopy and how this will change your treatment. If you feel the doctor wants to do a laparoscopy for no very good reason, refuse. It's a surgical procedure after all - and it's your body.
One benefit of laparoscopy is that in addition to allowing the accurate diagnosis of a problem, if it exists, operative laparoscopy can also be done in the same surgery to correct the problem. However, we feel that the routine use of laparoscopy is not called for in treating infertile patients, since a HSG can provide similar information at much less risk and expense. We use the procedure very sparingly in our practise.
At the follow-up visit, discuss with the doctor what he found at the time of the laparoscopy and also how to proceed on the basis of the findings. There are three possible courses of action: