What is tubal ligation?

Indications and Procedures

Tubal ligations are performed strictly

for sterilization
of a female patient. While there has been some success with reversing the procedure, it must be considered permanent. The woman must be well informed and certain that she does not want additional children under any circumstances.

The most common technique for tubal ligation is laparoscopy
. As an outpatient, the woman receives local anesthetic and a light sedative. A small incision is made in the navel, and gas is used to inflate the abdomen, allowing easy visibility of the patient’s Fallopian tubes. An instrument called an intrauterine cannula is inserted through the vagina, and a clamp called a tenaculum is positioned on the cervix. Both are used to manipulate the tubes into position. A laparoscope, a thin tube containing a camera and light, is inserted through the incision in order to view the tubes. An instrument to block the tubes is inserted through the laparoscope. The tubes may be blocked by burning, cutting, or applying rings or clips. The incision is sewn closed.

In a minilaparatomy, a small incision is made above the woman’s pubic bone. The tubes are brought through the incision and are tied and cut. Tubal ligations can also be performed through a woman’s vagina (culdoscopy or colpotomy).

Many tubal ligations are done immediately, or within a day, following the delivery of a baby. If a patient has a cesarean section, then tubal ligation is often done as part of the same surgical procedure. Following a vaginal delivery, a woman desiring a tubal ligation is usually brought to the operating room the next day. In cases in which there is a problem with the baby (including extreme prematurity, anomalies, or sepsis), the sterilization procedure is often delayed, pending a good outcome for the infant.

Uses and Complications

The only purpose of tubal ligation is sterilization. It is highly effective (with a 0.2 percent failure rate) and largely irreversible. Depending on the type of blockage used, it is about 30 percent reversible; however, only 10 percent of women become pregnant after undergoing tubal reconstruction. Other forms of birth control are recommended for any patient who is not absolutely certain about the procedure.

Tubal ligations take only thirty minutes to perform, and there is only minor postsurgical pain. A rare complication may be an ectopic pregnancy within the Fallopian tube, which could rupture. Other potential problems are those associated with any abdominal surgery, including unintentional damage to other internal organs, bleeding, and infection. One recent study indicated that there is no change in the level of hormones produced by women prior to or following tubal ligation.

Bibliography

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