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Tubal Ligation

by Julie J. Martin, MS

Anatomy and Physiology
A woman's reproductive system includes the organs that produce eggs, conceive a child, maintain a pregnancy, and deliver a baby. The internal components of this system form a pathway called the genital tract. This pathway includes the: vagina, which is the canal where sperm are deposited and babies emerge during delivery, uterus, which is a pear-shaped organ where a fertilized egg grows into a baby, fallopian tubes, which are ducts that transport eggs from the ovaries to the uterus and where sperm usually fertilize eggs, and ovaries, which are glands that produce and release eggs.

During sexual intercourse, sperm are introduced into the vagina. They travel through a channel called the cervix and into the uterus. The sperm then move into the fallopian tubes where they can meet and fertilize eggs that have been released from the ovaries. A fertilized egg is the first stage of pregnancy.

Reasons for Procedure
A woman can use various family planning methods to control the timing and number of her pregnancies. For many reasons, she may choose to avoid future pregnancies. The methods of controlling pregnancy fall into two categories: contraception to temporarily avoid pregnancy and sterilization to permanently avoid pregnancy.

Because contraception is temporary, it requires a woman or her partner to continually take precautions to prevent pregnancy. Sterilization is a permanent measure, and eliminates the need to take alternative precautions.

There are several methods of sterilization for women. Each method involves blocking, or closing off, the fallopian tubes. This practice ensures that eggs and sperm are unable to meet and fertilize.

Tubal ligation is a procedure used to permanently sterilize women. Surgical instruments, inserted through tiny incisions in the abdomen, are used to locate and interrupt the fallopian tubes. The most common techniques used to perform this procedure are: laparoscopy and mini-laparotomy.

A less common technique is a laparotomy, for which a 2-5 inch incision is made in the lower abdomen. A physician locates the fallopian tubes through this incision and closes them off. This major surgery requires general or spinal anesthesia and has a longer recovery than a laparoscopic or mini- laparotomy procedure.

During each of these sterilization procedures, the fallopian tubes are closed off in one of three ways: tied and cut, sealed using a cautery to create scar tissue, or blocked using a plastic band or clip.

Before your procedure, you and your doctor will thoroughly discuss your reasons for having the procedure, since your decision is not reversible once it is done. He or she will also: perform a physical exam, obtain a pregnancy test, evaluate certain factors, such as obesity and prior abdominal surgery, that may increase your risk from the operation.

In the days leading up to your procedure: Arrange for a ride to and from the hospital. If you regularly take medications, herbs, or dietary supplements, your doctor may recommend temporarily discontinuing them. Do not start taking any new medications, herbs, or dietary supplements before consulting your doctor. The night before, eat a light meal and do not eat or drink after midnight. Wear loose-fitting clothing on the day of the procedure. Before the procedure begins, an intravenous line will be started and you will be offered medication to help you relax. Most tubal ligations are done under local anesthesia, which means a medication will be applied to numb the area of the operation, and you will remain awake for its duration. In some cases, general or spinal anesthesia may be used instead.

If you are having laparoscopic tubal ligation, your doctor will begin by making one or two tiny incisions in your abdomen. Usually, one incision is placed near your belly button and the other just above your pubic bone.

Your doctor will then inject carbon dioxide, a harmless gas, through a tube inserted into the upper incision. This inflates the abdominal cavity, allowing your doctor to clearly see and work around your internal organs.

Next, your doctor will introduce a long, thin, lighted instrument, called a laparoscope, through one of the incisions. The laparoscope projects images of the structures inside your abdomen onto a monitor. Through the other incision, your doctor will pass surgical instruments to grasp the fallopian tubes and close them off.

At the end of the procedure, your doctor will allow the carbon dioxide to escape and close the incisions with dissolving stitches.

If you are having a mini-laparotomy tubal ligation, your doctor will make a small incision just above your pubic bone, grasp the fallopian tubes with forceps, and close them off. After the procedure, the incision will be closed with stitches. This method is often used just after childbirth.

In both procedures, your doctor will close off the fallopian tubes using the cutting and tying, blocking, or sealing technique.

The procedure usually takes 20-30 minutes. Immediately afterward, you will be taken to the recovery area. If you had local anesthesia, you'll rest there for 1-2 hours. The recovery time from other forms of anesthesia is longer.

Risks and Benefits
Sterilization is considered a safe and effective procedure. It may, however, be associated with a few complications, including: wound infection, excessive bleeding, adverse effects to the anesthesia, injury to the bowel, bladder, or ureter, and/or continued fertility, if the operation fails or if the fallopian tubes rejoin. In up to 60% of cases, sterilization can be reversed. If the procedure was done with clips or bands, which cause less tissue damage than cutting or sealing, the chance of reversal is greater. However, sterilization should always be considered permanent. Also, health insurance does not pay for the reversal of sterilization.

After a tubal ligation you will no longer need to use contraception to avoid pregnancy. However, tubal ligation will not protect you from sexually transmitted diseases.

In tubal ligation, or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate treatment choice for you.

After the Procedure
If you have a laparoscopic tubal ligation, you will likely go home the same day. If you have a laparotomy, or a mini-laparotomy after childbirth, your hospital stay may be extended slightly.

Following your procedure: do not drive or drink alcohol for 24 hours; do not lift heavy objects or perform hard labor for at least three days, or as specified by your doctor; avoid sexual activity for at least three days, or as specified by your doctor.

If you had a laparoscopy, the carbon dioxide gas may make you feel bloated or you may have pain in your shoulder or chest for up to three days. To decrease your discomfort, try the following: walking, using a heating pad, taking a warm shower.

Be sure to contact your doctor promptly if you experience: signs of infection, such as fever and chills, redness, swelling, increasing pain, bleeding, or discharge at the incision sites, severe and continuous abdominal pain, cough, shortness of breath, or chest pain, fainting or dizziness, persistent or severe nausea or vomiting, heavy vaginal bleeding after the first day, and/or a missed menstrual period.

Beers, Mark H., Andrew J. Fletcher, Thomas V. Jones, et al. 2003. The Merck Manual of Medical Information. Merck Research Laboratories: Whitehouse Station, NJ.
Planned Parenthood. Available at: www.plannedparenthood.com.
Accessed September 2004.

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Last Updated: Jun 3rd, 2009


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