Tubal Reversal Surgery Checklist

Chapel Hill Tubal Reversal Center

This checklist will help ensure your successful preparation for and recovery after your tubal reversal by Dr. Berger. Use the Printer page to print it, and mark off each item on the timeline as you complete this checklist.

When surgery date is scheduled:

___	Complete and submit the Medical and Anesthesia Form within 24 hours of scheduling your surgery.
___	Within 24 hours of scheduling, return a signed and dated copy of the New Patient Confirmation letter, the Patient Requirements and Responsibilities Statement, and the completed Registration Packet to our office by fax (# 919-869-1976) or by scanning and emailing documents back to the person who emailed you the paperwork.
___	Pre-op lab results are due in our office no later than 3 weeks prior to the surgery date. Testing should be performed within a day or two of scheduling surgery, but not more than 90 days prior to the surgery date.
___	CBC
___	HIV-1 antibody
___	Hepatitis B Surface Antigen
___	Hepatitis C Antibody
___	(Additional pre-operative testing will be required for patients with history of medical problems.) If you have questions about your pre-op lab test results, contact us at (919) 968-4656.
___	Make reservations at the Sheraton Chapel Hill (make sure you are quoted the special rate for Dr. Berger's patients).
3 weeks prior to surgery:
___	Avoid anti-inflammatory medications such as aspirin, ibuprofen (Advil, Nuprin, Motrin), and naproxen (Naprosyn, Aleve). Acetaminophen (Tylenol) is an acceptable over-the-counter pain medication during the 3 weeks preceding your surgery.
___	Avoid herbal supplements, green tea, and diet pills.
___	If you have not been contacted for your pre-anesthesia telephone consultation, call (919) 968-0611 between 12 noon and 2 pm Eastern Time and ask for the anesthesia staff.
3 days prior to surgery:
___	Start daily washing of abdomen with HIBICLENS® soap.
When you leave for Chapel Hill:
___	Bring (or pick up when in Chapel Hill) the following - Loose clothing, warm socks, bottle of Ibuprofen (Advil, Nuprin, Motrin), thermometer, and non-carbonated clear liquids for after surgery (such as tea, water, apple juice, white grape juice, lemonade without pulp) and jello.
Day prior to surgery:
___	Come to Chapel Hill Tubal Reversal Center for your pre-op consultation (includes vaginal ultrasound exam).
___	Eat a light dinner such as soup and ½ sandwich. Avoid fried or fatty foods.
___	Take Zantac 150 mg at bedtime.
___	Do not eat anything after 10:00 pm. Small amounts of clear liquids are acceptable until 2 hours before arrival time for surgery.
Day of surgery:
___	Shower using soap.
___	Take Zantac 150 mg with sip of water 1 hour before arriving at the surgical center.
___	Do not eat breakfast.
___	Do not wear make-up, perfume, jewelry (including body piercings), or contact lenses.
___	Arrive at Chapel Hill Surgical Center at designated time with 1 responsible adult and no children.
Day after surgery:
___	Remove dressing and shower using soap.
___	Check temperature morning and evening for 1 week - call us if above 100.0 F.
5 days after surgery:
___	Remove steri-strips.
10 days after surgery:
___	Clip suture knots at skin level.
When you have a positive pregnancy test:
___	Read the I'm Pregnant page on our website.
___	Complete the on-line Pregnancy Report Form, or call a tubal reversal nurse at (919) 968-4656.
___	Have quantitative serum HCG assays twice a week through your ob/gyn doctor.
___	Schedule vaginal ultrasound exam when HCG is between 1500-2500 for gestation sac location.
___	Keep us informed of your results!