Bilateral Tubal Ligation

WHAT IS BILATERAL TUBAL LIGATION?

Bilateral Tubal Ligation is a procedure wherein a woman’s fallopian tubes are blocked. It is a permanent form of birth control in which the eggs cannot move from the ovary through the tubes (a woman has two fallopian tubes), and eventually to the uterus. Also, sperm cannot reach the egg in the fallopian tube after it is released by the ovary. Pregnancy is prevented.

A tubal ligation typically is performed via a small incision in your abdomen. It can either be performed after delivery or at a latter time. When a tubal ligation is performed after delivery it is called a post-partum tubal ligation and does not require laparoscopy. If you have a tubal ligation and you are not pregnant, it is usually performed by laparoscopic surgery. All forms of tubal ligation require either burning, cutting, clamping or tying the mid section of your fallopian tubes.

EFFECTS OF BILATERAL TUBAL LIGATION

Bilateral Tubal Ligation is performed to prevent the egg and sperm from meeting and you from becoming pregnant.

CANDIDATES FOR BILATERAL TUBAL LIGATION

Bilateral Tubal Ligation is a procedure intended for women who are considering permanent sterilization after having their desired number of children and who never will desire for more or for any.

YOUR CONSULTATION

A tubal ligation sterilization procedure means that you and your partner will not be able to have children at any point in the future, thus it requires a great deal of thought and consideration prior to the procedure.

Tubal ligation is considered a permanent procedure and not performed if you have any doubts about further child bearing capabilities. Reversing the surgery is possible, but requires major surgical intervention, and is not always successful.

Tubal ligation is usually performed within the first 24 hours after delivery. The greater the delay between the procedure and delivery, increase the difficulty of the surgery and the risk of infection. If you are not pregnant, a tubal ligation can safely be performed during your period or shortly afterwards to avoid the risk of being pregnant at the time of the procedure. 

THE PROCEDURE

While you are under general anesthesia, an instrument is inserted through the vagina to move the uterus into position during the operation. One or two small incisions (cuts) are made in the abdomen (usually near the navel), gas is introduced to distend your abdomen, and a device similar to a small telescope on a flexible tube (laparoscope) is inserted.

Using instruments that are inserted through the laparoscope, the tubes (fallopian tubes) are coagulated (burned), sealed shut with cautery, or a small clip is placed on the tube. The skin incision is then closed with a few stitches. You are usually feeling well enough to go home in a few hours.

RECOVERY

After surgery you may go home within a few hours. There will be minimal discomfort and cramping which may be relieved by pain medications. Some shoulder pain may be expected and should not be a cause of worry. You should return to normal activities within a few days.

Most women return to normal activities, including work, in a few days, although you may be advised not to exercise during the first 7 days. You may resume sexual intercourse around one week after the procedure or when you feel ready. You are advised to use contraception until your next menstrual period.

In the 24 hours after anesthesia has been administered, please do not:

·         Drive any motor vehicle

·         Drink alcohol

·         Ingest sedatives or tranquilizers

·         Operate machinery

·         Handle any sharp or potentially harmful instruments e.g. knife, scissors

·         Make important decisions

Arrange for someone to accompany you home and keep you company overnight after the surgery.

RISKS AND COMPLICATIONS

The risks of complications due to bilateral tubal ligation are minimal, but may include infection, bleeding or blood clots. Some patients may experience mild sore throat or body aches after the anesthesia. It is common to have slight abdominal discomfort and shoulder ache after the operation, which will usually decrease in less than 48 hours. There may be some vaginal discharge or bleeding for up to 2 weeks after the surgery.

Some women who undergo the ligation will have more menstrual pain and have more cramping during menstruation. Some may also complain of more irregular cycles than non-sterilized women. 

Other rare complications include perforation of the womb, injury to other organs during surgery which require repair, and unusual reactions to anesthetic drugs and other medications.

There is still a chance you may become pregnant after tubal sterilization. About 1 in 200 women become pregnant who have their tubes tied. This may be caused by an incomplete closure of the tubes. If pregnancy occurs after the procedure, you are at increased risk for an ectopic pregnancy in which the pregnancy develops in the fallopian tubes. This is a dangerous situation.

Tubal ligation is permanent. When reversal is attempted, the operation becomes major surgery and is only successful about 50-80% of the time (meaning the woman is able to become pregnant after reversal).

FOLLOW UP

Most women recover from the laparoscopic procedure with no problems. There are no tests required to confirm that you are now sterile (unable to become pregnant) after a laparoscopic procedure.

Consult your doctor for any of the following:

·         increased pain or swelling from the wound

·         bleeding or purulent discharge from the wound

·         heavy or persistent vaginal bleeding or foul-smelling vaginal discharge

·         fever of more than 38 C persisting for more than 6 hours

FAQ 

Is a tubal ligation reversible?
It may be possible to have your tubal ligation reversed, but only 50 to 80 percent of women are able to conceive after the procedure. If you do conceive you are at a higher risk for an ectopic pregnancy (tubal pregnancy).

How effective is a tubal ligation at preventing pregnancy?
The chance of you becoming pregnant in the first year following a tubal ligation is less than 1 percent. The failure rate increases with the length of time from the procedure. The failure rate is as high as 5 percent after 10 years.

Does a tubal ligation help prevent sexually transmitted diseases?
No, a tubal ligation does not protect you against sexually transmitted diseases (STDS).

Does tubal ligation reduce the risk of ovarian cancer?
Yes, tubal ligation has reduced the risk of ovarian cancer in several case control studies.

Will my menstruation change with tubal ligation?

As a general rule, no it will not. Changes may still occur, but for secondary reasons such as if you used to be on birth control pills but ceased with that after the operation. Other changes in birth control, also following the operation, can also have an impact on the menstrual pattern. After female patients stop using birth control pills, there are reports on both lighter and heavier periods so there is no clear pattern. 

Will ligation delay breakout of menopause?

No it will not. The menopause will occur as it would have, with the same pattern and intensity as if you did not have the tuba ligation operation. There may be need for hormone treatment for handling menopause symptoms, but that is just as without the sterilization. Hormones will in this case be handled in the same way as if there were no prior sterilization.

Is ligation the same as hysterectomy?

No it is not. As a hysterectomy removes the entire uterus, it is a major surgery and this is usually performed where there is a uterus problem, where there is a need for removing the ovaries, etc - often to remove cancers. After a hysterectomy, menopause will be entered with immediate effect and all future possibilities of getting pregnant are zero. A hysterectomy cannot be reversed.