Tubal Ligation

Overview 

Tubal ligation, commonly known as “getting your tubes tied,” is a highly effective surgical procedure used to prevent pregnancy. The process involves cutting, blocking, or sealing the fallopian tubes to stop eggs from being fertilized by sperm. The term “tubal” refers to the fallopian tubes, and “ligation” means to tie. During the procedure, the fallopian tubes are either cut and tied with a suture or blocked using a clamp, clip, or band. 

The fallopian tubes are a part of the female reproductive system, situated on either side of the uterus, and extend toward the ovaries. They play a crucial role in receiving eggs from the ovaries and transporting them to the uterus. By closing off the fallopian tubes, sperm can no longer reach the egg, and the egg cannot travel to meet sperm, thus preventing pregnancy. 

Tubal ligation, also known as tubal sterilization or female sterilization, can be performed after childbirth (vaginal or Cesarean) or during another abdominal surgery. It can also be done as a standalone procedure. While effective, it is difficult and expensive to reverse and does not offer protection against sexually transmitted infections (STIs). 

Reasons for undergoing the procedure  

Tubal ligation is regarded as a permanent form of birth control, boasting an effectiveness rate of approximately 99% in preventing pregnancy. If you are confident that you do not wish to become pregnant or have more children in the future, this procedure provides a safe and reliable contraceptive option, allowing you to engage in sexual activity without the worry of unintended pregnancy.

In certain circumstances, your healthcare provider may recommend the removal of the fallopian tubes to address specific medical conditions. This may be advised if you have a heightened risk of carrying a genetic mutation, such as the BRCA gene, which is associated with an increased risk of ovarian cancer.  

Risks 

Following the surgery, you may experience some abdominal pain and feel fatigued. Your symptoms may also be influenced by the kind of anesthetic used and the technique of the surgery. The following are the most typical tubal ligation adverse effects:  

• Bloating.  
• Nausea.  
• Dizziness.  
• Shoulder pain.  
• Abdominal cramps.   
• Sore throat brought on by the breathing tube.

Get in touch with your doctor straight away if you have fever or pelvic pain that doesn’t go away after a few days.  

The process of tubal ligation is risk-free and rarely causes problems. Nonetheless, the following complications are linked to the procedure:  

• High temperature.  
• Odorous vaginal discharge.  
• Blood or pus from the wound.  
• Any irregular vaginal bleeding.  
• Pain in the abdomen or pelvis.  
• Rashes or swelling near the incision.  
• Reaction to anesthetic that is allergic.  
• Having the sensation that you will pass out.  
• Damage to other organs (such as your uterus or bladder) sustained during surgery.

Rarely, the clamp may malfunction, or your fallopian tubes may rejoin following tubal ligation. Ectopic pregnancy, a potentially fatal disorder in which a pregnancy grows inside your fallopian tube, may result from this.

You run a higher risk of complications if you have a history of abdominal surgery, are obese, have diabetes, or endometriosis.  

Post-Tubal Ligation Syndrome (PTLS) symptoms are not present in all people. Among the typical signs of PTLS are:  

• Back or pelvic discomfort.  
• Sex that hurts.  
• Headaches.  
• Having cramps when on your menstruation.  
• No menstruation or unusual bleeding.  
• Menopause or PMS symptoms.

If, months or years after your tubal ligation, you continue to have painful or uncomfortable symptoms, speak with your healthcare physician. In addition to helping you cure your symptoms, they can rule out any major consequences.  

Before the procedure  

It’s crucial to thoughtfully evaluate your decision before opting for sterilization, as tubal ligation is designed to be a permanent solution, even though reversal is sometimes possible. If you’re unsure about wanting children in the future, you might consider exploring reversible contraceptive options, such as birth control pills, an intrauterine device (IUD), or barrier methods like a diaphragm.  

Another option to think about is having your partner undergo a vasectomy, which is a sterilization procedure that involves cutting and sealing the vas deferens, the tube responsible for carrying sperm.

Before proceeding with tubal ligation, it’s essential to discuss your decision with your doctor. Ensure you understand the risks associated with sterilization, the procedure itself, and any specific instructions you may need to follow.  

During the procedure  

During tubal ligation, your fallopian tubes are either cut and tied with specialized thread, sealed with an electric current, or fastened shut with bands or clips. Three methods can be used to carry it out:  

Laparoscopic tubal ligation  

Your doctor can finish the tubal ligation with a laparoscopy by making two tiny incisions: one at your navel and the other slightly above your pubic bone.  

• First, an intravenous (IV) line will be placed in a vein in your hand or arm. You’ll receive a general anesthetic through the IV to relax your muscles and eliminate any pain during the procedure.    
• Next, a small incision will be made near your navel, and a laparoscope—a thin, pencil-sized tube with a camera—will be inserted through the incision. Carbon dioxide gas is used to inflate your abdomen, providing a clearer view of your internal organs.    
• A second small incision is made at your pubic hairline for inserting a surgical instrument. Your fallopian tubes are then located and sealed using a band, ring, or clip. In some cases, an electric current (electrocoagulation) is applied to seal the tubes.    
• Once the fallopian tubes are sealed, the laparoscope is removed, and the incisions are closed with dissolvable stitches.

Laparoscopic sterilization can be done whenever it’s convenient for the patient and is usually done as an outpatient treatment. Less incisions mean a shorter recovery period following surgery and a lower chance of complications. After a laparoscopy, you can often leave the surgical center four hours later.  

Laparotomy  

A laparotomy is a more invasive surgery involving a larger abdominal incision and may require a hospital stay of one or two days for recovery. During the procedure, your healthcare provider makes an incision of two to five inches in your abdomen and brings the fallopian tubes up through the opening. The tubes are then cut and sealed using bands, rings, or clamps, and the incision is closed with stitches.

Since this is an open abdominal surgery, recovery can take several weeks. This method of tubal ligation is generally considered outdated and more invasive compared to modern techniques, except when performed immediately after a C-section delivery. In such cases, the same incision used for delivering the baby is also used for the tubal ligation.  

Mini-laparotomy tubal ligation (mini-lap)  

Unlike a laparotomy, a mini-laparotomy involves a smaller incision, which is why it’s referred to as “mini.” This type of tubal ligation is usually performed within 24 hours after vaginal childbirth, while you are already under epidural anesthesia. If you did not receive an epidural during labor, it can also be done using spinal anesthesia.

Following childbirth, your provider will locate your fallopian tubes and uterus just below your navel. If the mini-laparotomy is performed outside of childbirth, the incision is made just above the pubic bone.

During the procedure, your healthcare provider will find your fallopian tubes, bring them to the incision site, and seal them with a special suture. For non-childbirth procedures, bands, rings, or clamps may be used instead. The incision is then closed with dissolvable stitches.  

After the procedure  

You are brought to a monitoring area after your tubal ligation. After a laparoscopic tubal ligation, you might be discharged in a few hours. Should you have undergone a laparotomy or mini-laparotomy, an overnight hospital stay may be required. You will already have made arrangements for a hospital stay if you have your tubes closed after delivering birth.

Following a tubal ligation, some typical limits you can anticipate are:  

• Refrain from lifting heavy objects for at least one or two weeks. If you recently gave birth and had a tubal ligation, it’s generally advised to wait at least four weeks before lifting anything heavier than your baby.  
• Avoid consuming alcohol and driving for at least 24 hours.  
• You can resume showering as usual, but wait at least two weeks before swimming or taking baths to ensure the incision site heals properly.  
• You may experience discomfort from gas in your abdomen, which can affect your neck, shoulders, and chest for 24 to 72 hours after the surgery. To alleviate this, consider taking a warm shower, using a heating pad, or walking.  
• Mild nausea is possible. Eating a light evening meal on the day of the surgery, such as tea, soup, toast, or crackers, may help ease this feeling.  
• Swelling in your abdomen for several days post-surgery is normal. Over-the-counter pain relievers or prescription medications, as advised by your healthcare provider, can help manage the discomfort.  
• It’s normal to experience vaginal bleeding for up to a month after surgery. Your next menstrual cycle might be delayed by four to six weeks, and when it does return, you may experience heavier bleeding and increased discomfort.  

Outcome 

Your recovery time after tubal ligation can vary based on your overall health and the specific type of surgery performed. If you had a laparoscopic tubal ligation, you can usually return to normal activities within a few days. However, if the procedure was conducted after childbirth, expect a recovery period of a few weeks as you also heal from the delivery. For those who underwent tubal ligation alongside another abdominal surgery or a C-section, recovery may take up to eight weeks.

It is essential to follow all post-operative instructions provided by your doctor. They will schedule a follow-up appointment to monitor your healing and check for any potential complications.  

A tubal ligation does not impact your menstrual cycle; you will continue to have periods, and it will not induce menopause. If you experienced irregular periods prior to the procedure, you are likely to have them again afterward.

The chances of becoming pregnant after a tubal ligation are very low. Depending on how the fallopian tubes are sealed, the pregnancy rates within ten years of the procedure range from 0.4% to 1%.