Tubal ligation
What is tubal ligation?
Tubal ligation is a surgical procedure during which the fallopian tubes are blocked, bandaged, or cut. According to many experts, this is a reliable method of contraception, but there is still no 100% guarantee, and within a year after such an operation, 5 women out of 1000 may become pregnant, and after another 10 years - in 18 women out of 1000.
Ineffective dressing occurs in the case of fusion of the tubes, when there is a passage into which sperm penetrate, as well as in case of improperly performed sterilization.
To understand the essence of the operation, it is necessary to recall that the reproductive system in women includes two ovaries, two fallopian tubes, the uterus and the vagina. Normally, both ovaries are able to expel an egg ready for fertilization (this process is called ovulation). This phenomenon occurs on days 12-17 of the menstrual cycle every month. The ovum exits the ovary into the fallopian tube and moves through it into the uterus due to muscle contractions and movements of small, hair-like cilia.
Types of surgical intervention
Laparoscopy
Fallopian tube closure or tubal sterilization can be performed laparoscopically with a microscopic camera and surgical instrument inserted through a small incision made in the abdomen. The operation is done under anesthesia in two ways.
Laparoscopic dressing begins with the injection of gas into the abdomen to make the procedure easier. Then the fallopian tubes are sealed with a ring, clip or electric current.
The upper cut, as seen in the figure, is for the indicated device, and the lower one is for the clamp. The dotted line marks the locations of the cuts.
Mini laparotomy
Mini-laparotomy ("mini-paws") involves removing a portion of the tube and sealing the remainder with sutures, tapes, clips, or electric shock. Any woman after 35 years old who does not want to give birth anymore can use this method of protection against unwanted pregnancy. This method of contraception is irreversible, it does not allow you to conceive a child naturally, so this decision should be well thought out. Both fallopian tubes are crossed for a woman.
A mini-laparotomy is performed through an incision that is less than five cm long. As part of the operation, the surgeon makes two minor incisions. One of them is in the pubic area. This type of intervention can permanently prevent pregnancy.
An open type of laparotomy is performed through a significant incision in the abdomen.
It is recommended in a situation where:
- An abdominal operation is required for the purpose of a cesarean section;
- You have pelvic inflammatory disease, endometriosis, or need pelvic surgery for another reason.
In some cases, postpartum tubal ligation is used. Since in this case the fallopian tubes are placed higher in the abdominal region, the incision is performed below the level of the navel. It is best to carry out the operation in the first one and a half days after the birth of the child. Because after 48 hours, the uterus shrinks and postpartum tubal ligation will be much more painful and problematic.
It should be noted that laparoscopy is usually performed under general anesthesia. But all forms of this operation can be performed not only under general, but also under local (epidural) anesthesia.
Tubal implant method
Implants are inserted into the fallopian tube area without surgery and without anesthesia. It takes no more than half an hour; before starting the operation, a woman should sit in a chair, as usual at a gynecologist's appointment. First of all, the cervix should open - this will help to avoid its damage.
Next, the specialist inserts a catheter through the vagina into the cervix, then into the organ cavity, and then into the fallopian tube: first into the first, and then into the second. A catheter is used to place implants in the tubes. In some cases, cramps similar to menstrual cramps occur during the procedure.
Over time, scar tissue forms, which grows near the implants and overlaps the fallopian tubes. The presented type of operation makes it possible to prevent the removal of an egg from the ovaries into the fallopian tubes. As you know, it is in them that fertilization becomes possible.
X-rays should be taken to make sure the pipes are securely closed. In the first three months after the implantation, it is recommended to change the method of contraception. At the end of this period, a dye is introduced into the uterus and an X-ray examination, or hysterosalpingography, is performed again. This will make sure that the implants have not moved and the tubes are 100% blocked by scar tissue.
Surgery with incision of the suprapubic zone
Conventional surgery involving an incision in the suprapubic abdomen requires a lengthy hospital stay. After the operation, a scar is formed. During culdoscopic surgery, which is a puncture of the posterior wall of the vagina, there are no scars, no complications, and rapid tissue healing occurs. It is known that such sterilization does not cause hormonal disorders, libido and a normal menstrual cycle are preserved.
Ripe eggs are absorbed in the abdominal cavity, and women have no fear of a possible unwanted pregnancy. As a rule, the majority of patients prefer postpartum sterilization, it is performed immediately after delivery. The operation usually takes less than 30 minutes and does not require a long hospital stay. After such a procedure, women may experience minor painful sensations and abdominal cramps, bloating, decreased physical activity, dizziness, and nausea.
Is it worth using this method of contraception?
Tubal ligation is a radical type of contraception that is almost impossible to reverse in the future.
Voluntary sterilization is allowed for women of reproductive age who already have at least one child and do not want to have children in the future. Tubal ligation is indicated for a number of diseases that can pose a threat to life and health during pregnancy.
Many women have contraindications to the use of hormonal contraceptives and the use of intrauterine devices, then sterilization becomes the only reliable means of protection. Tubal ligation is extremely effective and is the most popular method of contraception among mature married couples with children. However, an increased risk of ectopic pregnancy is a serious complication of sterilization.
Although doctors warn that tubal ligation is irreversible, and ask to think carefully about everything before doing it, if necessary, you can try to restore the functions of the tubes, after which 60-80% of women become pregnant. These are microsurgical operations that take place under general anesthesia, the difficulty arises with the reunification of the dissected ends of the fallopian tubes.
Before making a decision, you should remember the statistics that show that many women who have had a tube ligation surgery regret it. Science does not stand still, and today a new, simpler and safer method has been developed, which does not require intervention in the abdominal cavity. Its essence is the introduction into the uterus of various drugs or devices that cause local damage and an inflammatory reaction, as a result of which the connective tissue grows, and the fallopian tubes become impassable.
The effectiveness of this method is more than 99%, but it is not yet used in clinics in the CIS countries.
The most reliable method is a simple dissection of the pipe with a scalpel or an electric knife, after which a puncture is made with a nylon ligature needle in two places of the pipe in its middle part. The ends of the threads are tied and cut. Also, sterilization by resection of a part of the tube with immersion of its ends under the peritoneum is no less reliable.
What to expect after surgery?
After tubal ligation
After successful ligation of the fallopian tubes, the patient returns to normal life within 24 hours. However, minor vaginal bleeding may occur. After laparoscopy is completed, the abdomen is bloated due to the gas used to lift the skin and muscles above the peritoneal organs for surgery. This effect usually goes away within a few days.
Back or shoulder soreness is likely due to gas in the abdomen, which will also go away after the gas is fully absorbed. It is permissible to take a shower a day after the operation, but without rubbing and other influences for a week.
Full recovery of the body after tubal ligation occurs in about 7 days.
Besides:
- You can have sex if there is no pain;
- A rest from cleaning, laundry and household chores is recommended;
- There is no need for an additional method of birth control.
After implantation
After implantation, women return to their daily activities within 24 hours. Precautions include using another method of contraception for three months and until the X-ray confirms that the fallopian tubes are completely blocked.
How effective is such an operation?
Tubal ligation at the entrance to the uterus, as well as the introduction of implants, cannot be considered 100% effective methods of preventing unwanted pregnancy.
There is a relatively low chance of getting pregnant after the tubes have been tied in this way. Five out of 1000 women experience this 12 months after surgery. 10 years after the intervention, at least 18 out of 1000 may be in a position.
This can happen if:
- The tubes have grown together or a new passage has formed through which the egg will be fertilized by the sperm;
- The dressing was done incorrectly;
- The woman was already pregnant at the time of the operation.
What if tubal implants were used? This method does not have long-term statistics, since it is relatively new. Studies show that less than one in 100 women with implants become pregnant in two years.
Reasons for visiting a specialist
You should see your doctor immediately if you have symptoms of pregnancy. This can be a disruption in the menstrual cycle, increased breast tenderness, and nausea. Painful sensations on either side of the lower abdomen, loss of consciousness and dizziness should be considered as reasons for concern.
Risks and complications after dressing
For tubal ligation, it is characteristic that after it there are no serious complications. Less severe consequences involve infection and dehiscence. It occurs in 11% of women after mini-laparotomy and in 6% at the end of laparoscopy. More serious complications include tangible and dangerous blood loss, problems that are triggered by general anesthesia, as well as organ damage during the operation and the need for even more significant dissection.
Although fewer complications are formed with laparoscopy than with other types of tubal ligation, such complications can be more threatening. For example, when a laparoscope is inserted, damage to the bladder or intestines is likely. The risk of surgery increases if the woman has diabetes, is overweight, nicotine addiction or cardiovascular disease.
Risks and complications after the introduction of tubular implants
After implantation, painful sensations in the pelvic area may not go away. In such situations, the implants are removed six weeks after being inserted into the fallopian tubes. This increases the risk of developing diseases of the pelvic organs. It is recommended to undergo an examination before the intervention. This will make it possible to make sure that the patient does not have infectious diseases of the reproductive system.
The risk of developing an ectopic pregnancy
If the process of resection of the fallopian tubes or implantation was unsuccessful, and the woman nevertheless became pregnant, then her likelihood of an ectopic pregnancy increases many times. This can happen several years after the surgery, and most likely - after three years or more.
What should you think about?
Consider the following points related to tubal ligation and implantation:
- The menstrual cycle and menopause will remain unchanged because the egg will be produced monthly;
- Sexual attraction will not change, and even greater looseness is likely, because the woman stops worrying about unwanted pregnancy.
Benefits
The main advantage is the ability to have sex and not be afraid of getting pregnant. Despite the fact that this is a rather expensive procedure, it is a one-time expense. In addition, sterilization does not require rehabilitation costs.
disadvantages
Ligation of the fallopian tubes, like the introduction of tubal implants, does not provide protection against those sexually transmitted diseases. Including from the human immunodeficiency virus (HIV). For full protection, it is necessary to use condoms from the very beginning of sexual intercourse.
Other considerations
Restoration of the fallopian tubes to their original state implies the return of their previous connection. The likelihood of a positive result with such a recovery is extremely low. It should be remembered that with tubal ligation, a woman should be 100% sure that in the future she will never want to have a child of her own.
Those of the fair sex who are most likely not recommended to carry out resection of the fallopian tubes include those who:
- Has not reached the age of 30. This is especially true for those who have never given birth. According to statistics, women who underwent tube resection at the age of 20 to 30 have a desire to restore fertility in the future;
- Faced problems during pregnancy. Those women who decided to resect the fallopian tubes due to stress due to a complicated pregnancy almost always regret their decision in the future;
- Do not have a stable and serious relationship that may yet appear;
- They expect that they will be able to restore reproductive function in the future if they change their own decision;
- Does this because they are coerced by spouses, family members, etc.;
- Give up looking for an alternative method of contraception and don't trust any of them.
Therefore, tubal ligation is a major surgical procedure that requires a compelling case. This operation is absolutely safe, but irreversible, therefore, female representatives are advised to think carefully before resorting to it.
The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist
Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.
