Tubal ligation

Overview:

Tubal ligation is a surgical method done in females. It means to cut and tie the fallopian tubes to prevent pregnancy. It is a type of permanent birth control procedure. It is also known as tubal sterilization. This prevents the egg from getting fertilized by the sperm thus preventing pregnancy and helping in birth control. It is an effective non-hormonal method of birth control. 

Anatomy:

The female reproductive system consists of the following:

• ovaries that produce eggs that combine with sperm to make a baby 
• Fallopian tubes that collect eggs from the ovary 
• Uterus – sac where a baby grows 
• Cervix – that opens the uterus to the vagina 
• Vagina – a part that opens outside 

Principle:

Tubal ligation depends on the principle that when the fallopian tubes are cut tied up and stitched, they do not collect eggs produced by the ovary. As there are no eggs, the sperm cannot fertilize them. As there is no fertilization, pregnancy does not occur. This leads to birth control. The term tubal ligation means tying the tubes. This is also called female sterilization and is done after normal delivery or cesarean delivery. 

Indications:

It is indicated in:

• Avoiding unplanned pregnancies 
• Couples or partners want permanent birth control 
• If an individual does not want to be pregnant again 

Contraindications:

It is not indicated if individuals want to have short-term birth control or temporary birth control. 

Advantages:

It has many advantages:

• It is a safe, effective, and permanent birth control method 
• One can have safe sex without any worries  
• One need not use any other birth control methods 
• It does not involve hormones 
• It also decreases the chance of ovarian cancer

Before the procedure:

Before undergoing the procedure, one should discuss the necessity and type of procedure by discussing it with the healthcare provider (HCP). One should opt for this procedure if they are sure about not having a pregnancy. One can also opt for other birth control methods if they are planning for a temporary phase. 

History regarding previous surgeries, medications, allergies, and any medical history is collected by the HCP. Necessary tests like blood tests are done to understand the physical fitness for surgery. A pregnancy test is conducted to check if an individual is pregnant. 

During the procedure:

The type of tubal ligation depends on the condition and the preferences of the individual. 

• In the laparoscopic method, two cuts are made near the navel and the pubic area under general anesthesia. A small camera is sent through these cuts to have a proper view of the inside structures. Carbon dioxide is used for the inflation of the abdomen for a better view of the internal organs. Through the second incision near the pelvis areas, special instruments are sent to locate the fallopian tubes. They can be closed by coagulating them with an electric current or tied with a band, ring, or clip. The surgical openings are closed. This procedure can be carried out as an outpatient procedure and at any time. 
• In the laparotomy procedure, large cuts are made in the abdomen, and the fallopian tubes are cut and sealed with bands, rings, or clamps. This is a type of open abdominal surgery that is no longer preferred as it takes longer recovery time and is more invasive. This is only advantageous if it is done during the cesarean section delivery using the same cut for delivering the baby. 
• In the mini-lap procedure, small cuts are made to perform the tubal ligation. The fallopian tube is located and closed using a suture. If it is done after a vaginal birth the cut is made near the navel area under epidural anesthesia. If it is done after childbirth the cut is made near the pubic area. 

Previous scarring, growth of tissue called endometriosis, and irregular structure of the female reproductive tract are some of the factors that prevent the complete removal of the fallopian tubes. 

After the procedure:

Based on the type of tubal ligation opted the discharge and recovery depend. If laparotomy is opted one has to be in the hospital for 1-2 days and then discharged. If laparoscopic methods are opted for, then they can be discharged on the same day. Procedures done under general anesthesia take more time to get discharged as the vital have to be monitored till they stabilize. Medications will be given for pain and to ward off infections. 

Instructions:

One has to avoid lifting heavy weights except for the baby for at least 1-2 weeks and if the ligation occurs at the same time as delivery, it is better to avoid heavy weights at least 4 weeks after the surgery. 

• Avoid smoking and alcohol for at least one day as they may interfere with healing 
• Avoid driving for one day after the procedure 
• Avoid swimming in pools, sauna baths, and hot showers for at least two weeks after the surgery 
• Use a heating pad or do mild walking to avoid pain due to gas 
• Light evening meals on the day of the surgery will help prevent nausea on the day of surgery

Side effects:

Swollen abdomen for many days after the surgery, vaginal bleeding up to 1 month after surgery, shoulder pain, bloating, abdominal cramps, sore throat, and dizziness are some of the common side effects. Post-tubal ligation syndrome can develop with symptoms of pelvis pain, painful sex, headaches, period cramps, abnormal bleeding, and menopause symptoms. 

Risks and complications:

Infections at the surgical site, bad smell of the discharge from the vagina, irregular bleeding, pelvic and abdominal pain, swelling in the area of the abdomen, allergy to anesthesia, injuries to the internal organs, and rare cases of ectopic pregnancies are some of the potential risks and complications.

Conclusion:

Tubal ligation is the surgical method of cutting and tying the fallopian tubes. This is done to avoid unnecessary pregnancies and to protect from ovarian cancers. It is a safe and effective procedure for permanent birth control. 

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