Tubal ligation
Tubal ligation is a surgical procedure designed for female sterilization, preventing pregnancy by blocking the Fallopian tubes through which eggs travel to the uterus. This method is considered permanent, although there are instances where reversal may be attempted, with varying success rates influenced by factors such as age and health. The most common technique for performing tubal ligation is laparoscopy, where a small incision is made in the abdomen, and the tubes are either cut, burned, or blocked with clips. Typically, this procedure can be completed in about thirty minutes and often involves only minor postoperative discomfort.
Tubal ligations are frequently performed immediately after childbirth, particularly during cesarean sections, but can be scheduled for a later date if necessary. The effectiveness of this procedure is high, with a failure rate of approximately 0.2%. While the procedure is generally safe, potential complications can arise, similar to those associated with any abdominal surgery, including bleeding, infection, and the rare occurrence of ectopic pregnancy. Women considering tubal ligation are encouraged to be fully informed and certain about their decision, as it is intended for individuals who do not wish to have any more children in the future.
Tubal ligation
Anatomy or system affected: Abdomen, reproductive system, uterus
Definition: A surgical procedure that closes the Fallopian tubes and causes permanent sterilization
Indications and Procedures
Tubal ligations are performed strictly for the 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 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 minilaparotomy, 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 can be between 50 to 80 percent reversible; however, the success of the reversal is influenced by several factors including age, overall health, and the health of the Fallopian tubes. Other, less permanent forms of birth control, such as pills or an intrauterine device (IUD), 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. Studies have indicated that there is no significant change in the level of hormones produced by women prior to or following tubal ligation.
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