tubal ligation


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Tubal Ligation

 

Definition

Tubal ligation is a permanent voluntary form of birth control (contraception) in which a woman's Fallopian tubes are surgically cut or blocked off to prevent pregnancy.

Purpose

Tubal ligation is performed in women who definitely want to prevent future pregnancies. It is frequently chosen by women who do not want more children, but who are still sexually active and potentially fertile, and want to be free of the limitations of other types of birth control. Women who should not become pregnant for health concerns or other reasons may also choose this birth control method. Tubal ligation is one of the leading methods of contraception, having been chosen by over 10 million women in the United States—about 15% of women of reproductive age. The typical tubal ligation patient is over age 30, is married, and has had two or three children.

Precautions

Tubal ligation should be postponed if the woman is unsure about her decision. While it is sometimes reversible, the procedure should be considered permanent and irreversible. Up to 10% of sterilized women regret having had the surgery, and about 1% seek treatment in attempts to restore fertility.

Description

Tubal ligation, or getting one's "tubes tied," refers to female sterilization, the surgery that ends a woman's ability to conceive. The operation is performed on the patient's Fallopian tubes. These tubes, which are about 10 cm long and 0.5 cm in diameter, are found on the upper outer sides of the uterus, and open into the uterus through small channels. It is within the Fallopian tube that fertilization, the joining of the egg and the sperm, takes place. During tubal ligation, the tubes are cut or blocked in order to close off the sperm's access to the egg.
Normally, tubal ligation takes about 20-30 minutes, and is performed under general anesthesia, spinal anesthesia, or local anesthesia with sedation. The surgery can be performed on either hospitalized patients within 24 hours after childbirth or on outpatients. The woman can usually leave the hospital the same day.
The most common surgical approaches to tubal ligation include laparoscopy and mini-laparotomy. In a laparoscopic tubal ligation, a long, thin telescopelike surgical instrument called a laparoscope is inserted into the pelvis through a small cut about 1 cm long near the navel. Carbon dioxide gas is pumped in to help move the abdominal wall to give the surgeon easier access to the tubes. Often the surgical instruments are inserted through a second incision near the pubic-hair line. An instrument may be placed through the vagina to hold the uterus in place.
In a mini-laparotomy, a 3-4 cm incision is made just above the pubic bone or under the navel. A larger incision, or laparotomy, is rarely used today. Tubal ligation canalsobeperformed at thetime of a cesarean section.
Tubal ligation costs about $2,000 when performed by a private physician, but is less expensive when performed at a family planning clinic. Most insurance plans cover treatment costs.
Tubal ligation is performed in several ways:
  • Electrocoagulation. A heated needle connected to an electrical device is used to cauterize or burn the tubes. Electrocoagulation is the most common method of tubal ligation.
  • Falope ring. In this technique, an applicator is inserted through an incision above the bladder and a plastic ring is placed around a loop of the tube.
  • Hulka clip. The surgeon places a plastic clip across a tube held in place by a steel spring.
  • Silicone rubber bands. A band placed over a tube forms a mechanical block to sperm.

Preparation

Preparation for tubal ligation includes patient education and counseling. Before surgery, it is important that the woman understand the permanent nature of tubal ligation, and the risks of anesthesia and surgery. Her medical history is reviewed, and a physical examination and laboratory testing are performed. The patient is not allowed to eat or drink for several hours before surgery.

Aftercare

After surgery, the patient is monitored for several hours before she is allowed to go home. She is instructed on care of the surgical wound, and what signs to watch for, such as fever, nausea, vomiting, faintness, or pain. These signs could indicate that complications have occurred.

Risks

While major complications are uncommon after tubal ligation, there are risks with any surgical procedure. Possible side effects include infection and bleeding. Rarely, death may occur as a complication of general anesthesia if a major blood vessel is cut. The
Tubal ligation is a permanent form of contraception in which a woman's Fallopian tubes are surgically cut, cauterized, tied, or blocked to prevent pregnancy. This procedure blocks the pathway sperm takes to fertilize an egg.
Tubal ligation is a permanent form of contraception in which a woman's Fallopian tubes are surgically cut, cauterized, tied, or blocked to prevent pregnancy. This procedure blocks the pathway sperm takes to fertilize an egg.
(Illustration by Electronic Illustrators Group.)
death rate following tubal ligation is about four per 100,000 sterilizations.
After laparoscopy, the patient may experience pain in the shoulder area from the carbon dioxide used during surgery, but the technique is associated with less pain than mini-laparotomy, as well as a faster recovery period. Mini-laparotomy results in a higher incidence of pain, bleeding, bladder injury, and infection compared with laparoscopy. Patients normally feel better after three or four days of rest, and are able to resume sexual activity at that time.

Key terms

Contraception — The prevention of the union of the male's sperm with the female's egg.
Ectopic pregnancy — The implantation of a fertilized egg in a Fallopian tube instead of the uterus.
Electrocoagulation — The coagulation or destruction of tissue through the application of a high-frequency electrical current.
Female sterilization — The process of permanently ending a woman's ability to conceive by tying off or cutting apart the Fallopian tubes.
Laparoscopy — Abdominal surgery performed through a laparoscope, which is a thin telescopic instrument inserted through an incision near the navel.
Following tubal ligation, there is a low risk (less than 1%) of ectopic pregnancy. Ectopic pregnancy is a condition in which the fertilized egg implants in a place other than the uterus, usually in one of the Fallopian tubes. Ectopic pregnancies are more likely to happen in younger women, and in women whose tubes were ligated by electrocoagulation.

Normal results

After having her tubes ligated, a woman does not need to use any form of birth control to avoid pregnancy. Tubal ligation is almost 100% effective for the prevention of conception. The possibility for treatment failure is very low—fewer than one in 200 women (0.4%) will become pregnant during the first year after sterilization. Failure can happen if the cut ends of the tubes grow back together; if the tube was not completely cut or blocked off; if a plastic clip or rubber band is loose or comes off; or if the woman was already pregnant at the time of surgery.

Resources

Organizations

American College of Obstetricians and Gynecologists. 409 12th Street, S.W., P.O. Box 96920.
Planned Parenthood Federation of America, Inc. 810 Seventh Ave., New York, NY,10019. (800) 669-0156. http://www.plannedparenthood.org.

ligation

 [li-ga´shun]
application of a ligature.
Barron ligation (rubber band ligation) surgical treatment of hemorrhoids by binding them with rubber bands so that the ligated portion sloughs away after several days.
tubal ligation sterilization of the female by constricting, severing, or crushing the fallopian tubes; constriction may be with an encircling ring or other ligature.

tu·bal li·ga·tion

interruption of the continuity of the oviducts by cutting, cautery, or by a plastic or metal device to prevent future conception.

tubal ligation

n.
A method of female sterilization in which the fallopian tubes are surgically tied.

tubal ligation

one of several sterilization procedures in which both fallopian tubes are blocked to prevent conception from occurring. Through a small abdominal incision, the fallopian tubes are ligated in two places with laser; and the intervening segment is burnt, crushed, or excised. The procedure is less commonly performed vaginally. Complications of the procedure, which are rare but serious, include pulmonary embolism, hemorrhage, infection, and tubal pregnancy. The requirements for informed consent for sterilization procedures vary among states and institutions.
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Tubal ligation

tubal ligation

Tubal interruption Gynecology Any sterilization procedure in which the lumen of the fallopian tube is intentionally sealed to prevent future pregnancy. See Ectopic pregnancy.

tu·bal li·ga·tion

(tū'băl lī-gā'shŭn)
Interruption of the continuity of the uterine tubes by cutting, cautery, or a plastic or metal device, to prevent conception.

tubal ligation

Tying of the Fallopian (uterine) tubes as a method of female sterilization.

Patient discussion about tubal ligation

Q. if you think you are pregnant and you have had a tubal ligation what should i do? should i wait to be sure?

A. i agree with doctoradhi, first of all get checked. the pregnancy tests are cheap and you can get them anywhere.
A tubal ligation is approximately 99% effective in the first year following the procedure. In the following years the effectiveness may be reduced slightly since the fallopian tubes can, in some cases, reform or reconnect which can cause unwanted pregnancy. so it can happen.

More discussions about tubal ligation
References in periodicals archive ?
Safety and acceptability of tubal ligation procedures performed by trained clinical officers in rural Uganda, International Journal of Gynecology and Obstetrics, 2014, 124(1):34-37.
Women undergoing incisional tubal ligation typically return to normal physical activities in four to six days.
According to the United States Centers for Disease Control and Prevention, incisional tubal ligation continues to be the most prevalent form of birth control in the U.
About 650,000 women undergo tubal ligation each year, and up to 15% regret the decision, studies suggest.
Food & Drug Administration in 2002 as the first alternative to tubal ligation for women seeking permanent birth control.
Offering tubal ligation as soon as childbearing is complete is a reasonable alternative and should be followed by an oophorectomy at a later date, said Dr.
No method of contraception, including surgical tubal ligation, has been or can be expected to be 100 percent effective," said Steve Bacich, CEO of Conceptus, Inc.
Here are some pearls that just might keep your next postpartum tubal ligation from turning into tubal litigation.
The method requires a woman to check for the strings once a month, offering the same day-to-day convenience of tubal ligation without surgery, but is reversible at any time.
As a result, many women, particularly those who give birth in rural places, lack access to tubal ligation at the time of birth.
Unlike surgical tubal ligation, which involves cutting, clipping or burning the Fallopian tubes, the Essure procedure does not require any incisions and can be done in a physician's office under local anesthesia.
The Essure procedure, approved by the FDA in 2002, is a sterilization procedure that replaces tubal ligation for women.