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Tubal Ligation

Tubal ligation

Introduction

Tubal ligation is a method of female sterilization. It is a form of permanent birth control. In this procedure, the fallopian tubes (tubes through which the egg travels from the ovary to the uterus) are blocked or cut. This prevents the egg and the sperm for meeting and therefore prevents pregnancy.

Many women choose to get their “tubes tied” because unlike other contraceptive methods such as birth control pills, IUDs etc. once the procedure is performed, nothing else needs to be done and the effect is permanent.

Tubal ligation may be done at any time, but it is common to schedule it after a c-section pregnancy or with any abdominal surgery. This removes the need to have additional spinal anesthesia.

Tubal ligations are 99% effective, however there is a slight chance of pregnancy. This may happen due to mistakes or errors made during the ligation procedure, such as misidentification of the fallopian tubes. This can happen due to the presence of scar tissue as a result of previous abdominal surgery. At times, the ends of the fallopian tubes may re-attach and re-establish the connection between the ovary and the uterus (recanalization). Some procedures used for tubal ligation are more prone to failure than others. Studies have also shown that in some women, tubal ligation has an increased chance of failure in the long term.

Tubal ligation procedure

A tubal ligation can be done in multiple ways:

  1. Laparoscopic bilateral tubal ligation: This involves making an incision below the navel for insertion of the laparoscope (for visualization). A second cut is made above the pubic hairline to insert the instrument that will ligate the tubes.
  2. Mini-laparotomy: involves just a single cut above the pubic hairline. The surgeon then pulls the fallopian tubes out and closes them off by cutting them or sealing them. The tubes are then put back into place and the incision is stitched close.
  3. Laparotomy or open tubal ligation: This is considered major surgery and needs to be done under general anesthesia. A large incision is made in the abdomen and the fallopian tubes are pulled out and cut, sealed or tied. A laparotomy is usually done along with a C-section.
  4. Hysteroscopic sterilization: is a form of tubal sterilization wherein the body’s natural orifices are used for insertion of small implants into the fallopian tubes. It involves placing implants with a device, along with a hysteroscope (for visualization) that reaches the fallopian tubes via the cervix and uterus, after insertion into vagina.

The actual ligation methods also differ. Some common types include:

Bipolar tubal coagulation: This method uses the heat produced by electrical current to cauterize and ligate the fallopian tubes. It is primarily used with laparoscopic tubal ligation.

Pomeroy method for tubal ligation: involves creating a loop with sutures around the fallopian tube. The tied off section is then surgically removed and cauterized.

Tubal ring: is also called the Falope ring or Lay loop. The ring is a small silastic (polymeric silicone substance) band placed around a loop of the fallopian tube. As the ring contracts due to its elastic nature, it constricts the base of the loop. Lack of blood supply to the region then causes the formation of scar tissue.

Hulka or Filshie Clip Tubal Ligation: In this method, the fallopian tubes are clamped and fastened with a tubal clip (Hulka or Filshie). Constriction of the tubes cuts off blood supply and scar tissue is formed.

Fimbriectomy: involves removal of the fimbriated end of the fallopian tubes. Fimbriae are fringe like tissues in fallopian tube. The cilia of the fimbriae transfer the egg from the ovary to the uterus.

 

While considering whether tubal ligation is the appropriate birth control method, women should keep in the mind the following benefits and risks.

Benefits:

  1. It is permanent in most cases.
  2. Tubal ligation can be cost effective in the long run because it does not require frequent check ups after the initial post surgery period.
  3. Unlike birth control pills, tubal ligation does not require women to do anything daily to make sure they are protected against unplanned pregnancies.

Risks:

  1. The surgical procedure necessary for tubal ligation may involve certain risks, such as adverse reaction to anesthesia, infection after surgery and/or improper healing of the wound. Some women may also experience pelvic or abdominal pain.
  2. Diabetic or obese women are at a higher risk of complications associated with the surgery.
  3. This method does not protect against sexually transmitted infections (STIs).
  4. Younger women who undergo tubal ligation have a higher risk of failure. In the event they do get pregnant, it is likely to be an ectopic pregnancy (fertilized egg is implanted in the fallopian tubes).

Reversal of tubal ligation

Some women may change their minds and decide to get pregnant after having a tubal ligation done. Tubal reversal surgery is an option. It is considered major surgery and requires a laparotomy. Many factors such as length of the remaining tubal stumps, age of the female and existing pelvic conditions need to be considered before going ahead with the procedure. Therefore, not all tubal ligation procedures may be reversible.