Tubal Ligation

Introduction

Introduction- Tubal ligation is a form of permanent contraception or birth control in which a woman’s Fallopian tubes are cut surgically or are blocked off to prevent future pregnancy. Tubal ligation is a procedure for female sterilization i.e. this surgery ends a woman’s capability to conceive. Fallopian tubes, which are ligated or tied, are about 10 cm long and 0.5 cm in diameter. These are found one on each side on the upper outer aspects of the uterus and open into the uterus through small channels called tubal ostia. The fallopian tubes are a seat of fertilization i.e. the fusion of female egg with the male gamete or sperm. In this surgery, the tubes are cut or blocked in to close off the sperm’s access to the egg, thus preventing fertilization and conception.

Candidates

This procedure is performed in women who:

1. Definitely want to prevent future pregnancies.

2. Are sexually active

3. Are in fertile age group

4. Want to get rid of the limitations of other methods of contraception.

5. Should not become pregnant due to health concerns, for example women with heart disease.

Precautions- The procedure of tubal ligation is considered permanent and irreversible, although it can be reversed sometimes. Therefore, before performing the procedure, it should be made sure that the woman is absolutely ready for it. It saves the burden of trying to restore the tubal patency out of regret of such unprepared woman.

Description

1. The medical history of the patient with physical examination and lab tests are done for accessing general health of the patient. Thorough history of previous child births or abortions as well as other procedures is also taken. Proper counseling regarding permanent nature of the procedure, surgical and anesthetic risks involved should be done.

2. This procedure is usually performed under general anesthesia, spinal anesthesia or local anesthesia with intravenous sedation. It takes about 20 to 30 minutes to complete. Tubal ligation can be done on hospitalized patient after childbirth also called as puerperal tubal ligation or as an elective procedure known as interval ligation. The woman can leave the hospital on same day or the next day. Tubal ligation can be done along with a cesarean section.

3. The common approaches include

• Laparoscopy- A long, narrow telescope like surgical equipment is inserted into the pelvis via a small incision of 1cm near the umbilicus. Carbon dioxide gas is pumped inside the abdomen for easy access to the fallopian tubes. Other small surgical instruments are inserted through another incision near the pubic hair line and the ligation is done by using both these ports.

• Mini-laparotomy- it is the type of tubal ligation done through a 3 to 4 cm incision below the umbilicus. A larger incision opening the abdomen is not used nowadays also called as laparotomy.

Tubal ligation is performed in various ways

1. Electrocoagulation- The ends of the tubes are burned or cauterized with the help of a heated needle connected to an electrical device called cautery. It is the most common method of tubal ligation.

2. Falope ring- In this method, a plastic ring is placed around the loop of the tube by an applicator passed in the abdomen.

3. Hulka clip- a plastic clip with a spring is applied to the tube.

4. Silicone rubber bands.

Aftercare

After surgery, the patient is monitored for at least half an hour in recovery room and watched for complications.

Risks

1. Infection

2. Bleeding

3. Pain in shoulder due to gas insufflation

4. Bladder injury

5. Sudden death due to cutting of major vessel or general anesthesia complication

6. Failure of the procedure causing conception. This is rare nowadays.