Tubal Ligation (Surgical Sterilization, TL)

The night before, eat a light meal and do not eat or drink anything after midnight.Wear loose-fitting clothing. During ProcedureIV fluids, sedation, and anesthesia will be administered. AnesthesiaGeneral or local anesthesia will be use for this surgery. Description of the ProcedureThere are two main methods of tubal ligation, and one less common method. Laparoscopic Tubal Ligation The doctor injects a harmless gas (carbon dioxide) into the abdomen, which inflates the abdominal cavity, making it easier to see the internal organs. The doctor then makes a tiny incision near the navel and inserts a long, thin instrument (called a laparoscope) that contains a small lens and lighting system to magnify and illuminate the structures inside the lower abdomen. The physician may make a second incision just above the pubic hair to insert an instrument for grasping the fallopian tubes. The tubes are closed by one of the following means: Tying and cutting (ligation)Sealing by creating scar tissueRemoving a small piece of the tubeApplying plastic bands or spring-loaded clipsThe tools are then removed and the openings closed with stitches. The procedure can be performed in outpatient surgical clinics. It takes 20 to 30 minutes. Very little scarring occurs. Women often go home the same day. They may have sexual intercourse as soon as they feel comfortable about it. Injury to the bowel or bleeding inside the abdomen occurs in five out of 1,000 cases. Major surgery may be required to resolve such complications.

Mini-Laparotomy Tubal LigationFor this procedure, there is no gas or laparoscope. It is typically performed soon after childbirth. The doctor makes a small incision just above the pubic hair, or if done within 48 hours of childbirth, below the navel. The tubes are located, and the doctor uses a small tool to tie, clip, or seal off the tubes. Women usually recover in a few days. Doctors will advise when sexual intercourse can be resumedOther surgical therapies: LaparotomyThis procedure is major surgery. It is less commonly used than mini-laparotomy and laparoscopy. The surgeon makes a two-to-five-inch incision in the abdomen. The surgeon locates and closes off the tubes. The operation requires general or spinal anesthesia. A woman may need to be hospitalized for two to four days. It may take several weeks at home to completely recover. If the procedure is done after delivery, the woman's hospital stay may be extended by one or two days. When to resume sexual intercourse depends on the rate of recovery. Open Tubal Ligation 2008 Nucleus Medical Art, Inc. After ProcedureRest in the recovery room for about an hour with local anesthesia, perhaps longer if a general anesthetic was given. How Long Will It Take?The procedure lasts about 20 to 30 minutes.

Will It Hurt?Anesthesia prevents pain during surgery. Depending on which type of surgery you have, you may have some pain during recovery, but you will be given pain medication to help relieve this discomfort.You may feel bloated or have pain in the shoulder or chest, due to abdominal gas, which may last for up to three days. Try walking, a heating pad, or a warm shower to decrease the discomfort. Possible Complications Complications may develop in 1% to 4% of sterilizations performed through the abdomen, and in 2% to 13% of sterilizations performed through the vagina. Deaths resulting from tubal sterilization are extremely rarethe rate is about four per 100,000. Possible complications include: InfectionBleedingAnesthesia-related problemsInjury to the bowel or bladder Pregnancy related to operative failure, or rejoining of the fallopian tubes (occurs in about one out of 400 women)If pregnancy occurs, there is an increased risk of ectopic pregnancy . Average Hospital StayNone Postoperative CareYou can remove the operative dressings the morning after surgery and the small paper strips after 2-3 days.Do not drive or drink alcohol for 24 hours.Do not lift anything heavy or perform hard labor for at least a week.If you are nauseous, try eating tea, toast, or crackers.Avoid sexual activity for at least one week, or as long as your doctor recommends. OutcomeYou should be able to return to work in about a week, and your menstrual cycle will resume in 4 to 6 weeks. Sterilization success rates are greater than 99% during the first year. Tubes may later grow together, increasing pregnancy risk. If pregnancy occurs, a chance exists that the fetus may develop in the fallopian tube, an emergency condition called an ectopic pregnancy.

Call Your Doctor If Any of the Following OccursSigns of infection, including fever and chillsRedness, swelling, increasing pain, excessive bleeding, or discharge from the incision siteSevere and continuous abdominal painCough, shortness of breath, chest pain, or severe nausea or vomitingFainting or dizzinessNausea and vomiting lasting more than a dayHeavy vaginal bleeding after the first dayMissed menstrual period RESOURCES: National Women's Health Information Centerhttp://www.4woman.gov Planned Parenthoodhttp://www.plannedparenthood.org CANADIAN RESOURCES: The Canadian Women's Health Networkhttp://www.cwhn.ca/indexeng.html The Society of Obstetricians and Gynaecologists of Canadahttp://www.sogc.org References: Engender Health website. Available at: http://www.engenderhealth.org/ . Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/002138.htm . Peterson HB. Sterilization [abstract]. Obstetrics and Gynecology. 2008;111:189-203. Planned Parenthood website. Available at: http://www.plannedparenthood.org/BIRTH-CONTROL/allabouttubal.htm . Last reviewed January 2008 by Jeff Andrews, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.