• Tubal Ligation—Laparoscopic Surgery

    (Surgical Sterilization; TL; Tubal Sterilization; Sterilization, Tubal; Sterilization, Surgical)

    Definition

    Fallopian tubes are ducts that lead from the ovaries (where the eggs develop) to the uterus (womb). A tubal ligation involves closing the tubes, which prevents pregnancy.
    Options to Close Tubes
    Tubal ligation
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    Tubal ligation is done if you do not want to become pregnant. If you have this surgery, you will still ovulate and menstruate. The cut or blocked tubes keep the egg and sperm from meeting. When the egg and sperm cannot meet, fertilization does not happen and pregnancy cannot occur.
    This surgery is not recommended as a temporary or reversible procedure. Make sure you consider all the birth control options for you and your partner.

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have tubal ligation, your doctor will review a list of possible complications, which may include:
    • Infection
    • Bleeding
    • Anesthesia-related problems
    • Damage to other organs
    • Pregnancy—If pregnancy occurs, there is an increased risk that the egg will implant outside of the womb (ectopic pregnancy).
    Some factors that may increase the risk of complications include:
    Be sure to discuss these risks with your doctor before the procedure.

    What to Expect

    Prior to Procedure

    Your doctor may do the following:
    • Physical exam
    • Discuss your reason for this procedure
    • Pregnancy test
    Leading up to your procedure:
      You may need to stop taking certain medicines one week before. Talk to your doctor about your regular medicine, especially:
      • Aspirin and other nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen
      • Blood-thinning drugs, such as warfarin (Coumadin)
      • Anti-platelet drugs, such as clopidogrel (Plavix)
    • The night before, eat a light meal. Do not eat or drink anything after midnight.

    Anesthesia

    You may receive one of the following:
    • General anesthesia—blocks pain and keeps you asleep through the surgery
    • Spinal anesthesia—numbs the area from the chest down to the legs; given as an injection in the back

    Description of the Procedure

    The doctor will make a small cut in the area of the navel. Through this cut, she will inject a harmless gas into your abdomen. The gas will inflate the abdominal cavity. This will make it easier for the doctor to see the internal organs. The doctor will then insert a long, thin tool (called a laparoscope). This tool will contain a small camera and lighting system, which will let the doctor see inside the abdomen. The doctor may make a second cut just above the pubic hair to insert a tool for grasping the fallopian tubes. The tubes will be closed in one of the following ways:
    • Tying and cutting (ligation)
    • Sealing by creating scar tissue
    • Removing a small piece of the tube
    • Applying plastic bands or clips
    The tools will then be removed and the openings will be closed with stitches.
    In some cases, the doctor may switch to an open surgery. This involves making a larger incision.

    Immediately After Procedure

    You will be brought into the recovery room. You will rest there until the anesthesia wears off.

    How Long Will It Take?

    20-30 minutes

    How Much Will It Hurt?

    You may have some pain during recovery. Ask your doctor about pain medicine. Also, since your abdomen will be injected with gas, you may feel bloated and have pain in your shoulder or chest.

    Average Hospital Stay

    You can usually go home the same day. You may need to stay longer if you have complications.

    Post-procedure Care

    When you return home, do the following to help ensure a smooth recovery:
    • Remove the bandage the morning after surgery. Let the small paper strips fall off on their own.
    • Take pain medicine as directed by your doctor.
    • To relieve pain in your abdomen, try walking, using a heating pad, or taking a warm shower.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Do not drive or drink alcohol for at least 24 hours after surgery.
    • Do not lift anything heavy or do hard labor for at least a week.
    • Avoid sexual activity for one week, or as directed by your doctor.
    • Be sure to follow your doctor's instructions.
    You should be able to return to work in 1-7 days. Your menstrual cycle will resume in 4-6 weeks.
    This surgery has a high success rate in preventing pregnancy.

    Call Your Doctor

    After arriving home, contact your doctor if any of the following occur:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision sites
    • Severe and continuous abdominal pain
    • Cough, shortness of breath, chest pain, or severe nausea or vomiting
    • Fainting or dizziness
    • Pain and or swelling in one or both legs
    • Nausea and vomiting lasting more than a day
    • Heavy vaginal bleeding after the first day
    • Missed menstrual period
    In case of an emergency, call for medical help right away.

    RESOURCES

    Planned Parenthood http://www.plannedparenthood.org

    Women's Health.gov http://www.womenshealth.gov

    CANADIAN RESOURCES

    Canadian Women's Health Network http://www.cwhn.ca

    The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

    References

    Peterson HB. Sterilization. Obstet Gynecol. 2008;111:189-203.

    Sterilization for women (tubal sterilization). Planned Parenthood website. Available at: http://www.plannedparenthood.org/health-topics/birth-control/sterilization-women-4248.htm. Accessed August 13, 2012.

    Tubal sterilization. Family Doctor.org website. Available at: http://familydoctor.org/online/famdocen/home/women/contraceptive/792.html. Updated July 2010. Accessed August 13, 2012.

    6/3/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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