Tubal ligation

Alternative names
Sterilization surgery - female; Tubal sterilization

Definition
Tubal ligation is the surgical procedure commonly known as “tying the tubes”. A woman’s fallopian tubes transport mature eggs from the ovary to the uterus approximately once a month. When sperm travels from the uterus through the fallopian tubes toward the ovary, it may encounter a mature egg - and fertilization may result.

Tubal ligation permanently sterilizes a woman by preventing transport of the egg (ovum) to the uterus, and by blocking the passage of sperm up the tube to the ovulating ovary where fertilization normally occurs.

Description

Tubal ligation is done in the hospital or outpatient surgical clinic while the patient is under anesthesia. One or two small incisions are made in the abdomen (usually near the navel), and a laparoscope (a device similar to a small telescope on a flexible tube) is inserted.

Using instruments that are inserted through the laparoscope, the fallopian tubes are coagulated (burned), sealed shut with cautery, or with a small clip placed on the tube. The skin incision is then stitched closed. The patient is able to return home a few hours after the procedure.

Tubal ligation can also be performed immediately after childbirth through a small incision near the navel or during a cesarean section.

Indications

Tubal ligation may be recommended for adult women who are certain that they wish to prevent future pregnancies (permanent sterilization). Keep in mind that tubal sterilization is not a trivial surgical procedure, and that it carries some risk.

While sterilization is very popular, some women who choose to have the procedure regret their decisions later. The younger the woman, the more likely it is that she will regret her decision.

Tubal ligation is not recommended as a temporary or reversible procedure - it is considered a PERMANENT form of birth control. The operation can sometimes be reversed if a woman later chooses to become pregnant. However, this requires a major surgical procedure. Following tubal ligation reversal, about 50% to 80% of women eventually become pregnant.

Risks
Risks due to anesthesia include:

     
  • Reactions to medications  
  • Problems breathing

Risks of any surgery include:

     
  • Bleeding  
  • Infection

Additional risks for tubal ligation include:

     
  • Incomplete closure of the tubes, with possible continued fertility. Approximately 1 out of 200 women who have had tubal ligation will get pregnant.  
  • Increased risk of an ectopic (tubal) pregnancy if pregnancy occurs after a tubal ligation.  
  • Injury to adjacent organs or structures caused by the laparoscopic instruments.

Expectations after surgery
Most women recover with no problems. There are no tests required to verify sterility.

Convalescence
Most women are advised to avoid strenuous exercise for several days. Oral pain medications can usually manage the pain. Most women are able to return to work within a few days. Sexual intercourse can be resumed as soon as the patient feels ready, usually within a week.

Johns Hopkins patient information

Last revised: December 3, 2012
by Gevorg A. Poghosian, Ph.D.

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