Tubal ligation
Encyclopedia
Tubal ligation or tubectomy (also known as having one's "tubes tied" (ligation)) is a surgical procedure for sterilization in which a woman's fallopian tube
s are clamped and blocked, or severed and sealed, either method of which prevents eggs from reaching the uterus for fertilization. Tubal ligation is considered a permanent method of sterilization
and birth control
.
) them off thereby preventing the travel of eggs to the uterus. Tubal ligation is usually done in a hospital operating-room setting.
or IUD
.
Of those failures, 15-20% are likely to be ectopic
. 84% of those failures occurred a year or more after sterilization.
According to one study, Approximately 5% of women who have had tubal ligation will have a failure due to ectopic
pregnancy. Time seems to be a factor as the risk of failure increases after 1 or more years post-surgery.
The risk of ectopic
pregnancy is 12.5% for women having tubal ligation but less than those women who have not had the surgery. Recanalization or formation of tuboperitoneal fistuals occur, the openings of which are small enough for passage of sperm but too small to allow an ovum to push through, resulting in fertilization/implantation in the distal tubal segment.
Two economic studies suggest that laparoscopic bilateral tubal ligation could be less cost-effective than the Essure
procedure, which uses a special type of fiber to induce a benign fibrotic reaction.
is microsurgery to repair the fallopian tube after a tubal ligation procedure.
Usually there are two remaining fallopian tube segments—the proximal tubal segment that emerges from the uterus and the distal tubal segment that ends with the fimbria next to the ovary. The procedure that connects these separated parts of the fallopian tube is called tubal reversal or microsurgical tubotubal anastomosis.
In a small percentage of cases, a tubal ligation procedure leaves only the distal portion of the fallopian tube and no proximal tubal opening into the uterus. This may occur when monopolar tubal coagulation has been applied to the isthmic segment of the fallopian tube as it emerges from the uterus. In this situation, a new opening can be created through the uterine muscle and the remaining tubal segment inserted into the uterine cavity. This microsurgical procedure is called tubal implantation, tubouterine implantation, or uterotubal implantation.
Tubal reversal, if done by a specialist microsurgeon, has a high success rate and few complications. Successful repair of the fallopian tubes is now possible in 98% of women who have had a tubal ligation, regardless of the type of sterilization procedure.
In vitro fertilization may overcome fertility problems in patients not suited to a tubal reversal.
. One study found that postoperative complications from tubal ligation are more likely than with vasectomy
and more costly. However, this study did not consider post-vasectomy pain syndrome
. In industrialized nations, mortality is 4 per 100,000 tubal ligations, versus 0.1 per 100,000 vasectomies.
Tubal ligation has a larger initial cost than other contraceptive methods. It may take more than a decade of use for tubal ligation to become as cost-effective as other highly effective, long term methods like IUD or implant. Continued method costs or costs from unintended pregnancies make many other methods as or more costly than tubal ligation if used for several years. The cost of tubal ligation is reduced if it is performed during a cesarean section since the tubes are already exposed during the laparotomy
.
Tubal ligation may reduce the risk of ovarian cancer
, with some studies estimating the relative risk
at 0.66 for epithelial types, 0.40 for endometrioid types and 0.73 for serous types.
Fallopian tube
The Fallopian tubes, also known as oviducts, uterine tubes, and salpinges are two very fine tubes lined with ciliated epithelia, leading from the ovaries of female mammals into the uterus, via the utero-tubal junction...
s are clamped and blocked, or severed and sealed, either method of which prevents eggs from reaching the uterus for fertilization. Tubal ligation is considered a permanent method of sterilization
Sterilization (surgical procedure)
Sterilization refers to any of a number of medical techniques that intentionally leave a person unable to reproduce. It is a method of birth control. For other causes of sterility, see infertility....
and birth control
Birth control
Birth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...
.
Procedure
Tubal Ligation is considered major surgery requiring the patient to undergo general anesthesia. After the anesthesia takes effect, a surgeon will make a small incision at each side of, but just below the navel in order to gain access to each of the 2 fallopian tubes. With traditional tubal ligation, the surgeon severs the tubes, and then ties (ligatesLigation
Ligation may refer to:* In molecular biology, the covalent linking of two ends of DNA molecules using DNA ligase* In medicine, the making of a ligature * Chemical ligation, the production of peptides from amino acids...
) them off thereby preventing the travel of eggs to the uterus. Tubal ligation is usually done in a hospital operating-room setting.
Effectiveness
A tubal ligation is approximately 99% effective in the first year following the procedure. In the following years the effectiveness may be reduced slightly since the fallopian tubes can, in some cases, reform or reconnect which can cause unwanted pregnancy. Method failure is difficult to detect, except by subsequent pregnancy, unlike with vasectomyVasectomy
Vasectomy is a surgical procedure for male sterilization and/or permanent birth control. During the procedure, the vasa deferentia of a man are severed, and then tied/sealed in a manner such to prevent sperm from entering into the seminal stream...
or IUD
Intrauterine device
A copper IUD is a type of intrauterine device. Most IUDs have a plastic T- or U-shaped frame which is wrapped in copper wire, with the exception of Gynefix, which is a plastic string with several copper beads, affixed to the fundus of the uterus...
.
Of those failures, 15-20% are likely to be ectopic
Ectopic pregnancy
An ectopic pregnancy, or eccysis , is a complication of pregnancy in which the embryo implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the parent, since internal haemorrhage is a life threatening complication...
. 84% of those failures occurred a year or more after sterilization.
According to one study, Approximately 5% of women who have had tubal ligation will have a failure due to ectopic
Ectopic pregnancy
An ectopic pregnancy, or eccysis , is a complication of pregnancy in which the embryo implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the parent, since internal haemorrhage is a life threatening complication...
pregnancy. Time seems to be a factor as the risk of failure increases after 1 or more years post-surgery.
The risk of ectopic
Ectopic pregnancy
An ectopic pregnancy, or eccysis , is a complication of pregnancy in which the embryo implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the parent, since internal haemorrhage is a life threatening complication...
pregnancy is 12.5% for women having tubal ligation but less than those women who have not had the surgery. Recanalization or formation of tuboperitoneal fistuals occur, the openings of which are small enough for passage of sperm but too small to allow an ovum to push through, resulting in fertilization/implantation in the distal tubal segment.
Two economic studies suggest that laparoscopic bilateral tubal ligation could be less cost-effective than the Essure
Essure
Essure is a permanent transcervical sterilization procedure for women developed by Conceptus Inc. It was approved for use in the United States on November 4, 2002....
procedure, which uses a special type of fiber to induce a benign fibrotic reaction.
Reversal
Generally tubal ligation procedures are done with the intention to be permanent. Tubal reversalTubal reversal
Tubal reversal, also called tubal sterilization reversal or tubal ligation reversal, is a surgical procedure that attempts to restore fertility to women after a tubal ligation...
is microsurgery to repair the fallopian tube after a tubal ligation procedure.
Usually there are two remaining fallopian tube segments—the proximal tubal segment that emerges from the uterus and the distal tubal segment that ends with the fimbria next to the ovary. The procedure that connects these separated parts of the fallopian tube is called tubal reversal or microsurgical tubotubal anastomosis.
In a small percentage of cases, a tubal ligation procedure leaves only the distal portion of the fallopian tube and no proximal tubal opening into the uterus. This may occur when monopolar tubal coagulation has been applied to the isthmic segment of the fallopian tube as it emerges from the uterus. In this situation, a new opening can be created through the uterine muscle and the remaining tubal segment inserted into the uterine cavity. This microsurgical procedure is called tubal implantation, tubouterine implantation, or uterotubal implantation.
Tubal reversal, if done by a specialist microsurgeon, has a high success rate and few complications. Successful repair of the fallopian tubes is now possible in 98% of women who have had a tubal ligation, regardless of the type of sterilization procedure.
In vitro fertilization may overcome fertility problems in patients not suited to a tubal reversal.
Side effects
A 1998 review of over 200 articles in the English literature showed that evidence of a post-tubal sterilization syndrome (abnormal bleeding and/or pain, changes in sexual behavior and emotional health, increased premenstrual distress) was inconclusive for women over 30 years of age. The risk for women 20–29 years of age with pre-existing histories of menstrual dysfunction may be increased, "although they do not appear to undergo significant hormonal changes". A 1993 study done in Japan found the symptoms of the post-tubal ligation syndrome to be mild, and simple symptomatic treatment to be sufficient in most cases.Prevalence
Worldwide, female sterilization is used by 33% of married women using contraception, making it the most common contraceptive method. As of June 2010, there is a recent decline of tubal ligation procedures in the United States after two decades of stable rates, possibly explained by an improved access to a wide range of highly effective reversible contraceptives.Advantages and disadvantages
Tubal ligation is an abdominal surgeryAbdominal surgery
The term abdominal surgery broadly covers surgical procedures that involve opening the abdomen. Surgery of each abdominal organ is dealt with separately in connection with the description of that organ Diseases affecting the abdominal cavity are dealt with generally under their own names The term...
. One study found that postoperative complications from tubal ligation are more likely than with vasectomy
Vasectomy
Vasectomy is a surgical procedure for male sterilization and/or permanent birth control. During the procedure, the vasa deferentia of a man are severed, and then tied/sealed in a manner such to prevent sperm from entering into the seminal stream...
and more costly. However, this study did not consider post-vasectomy pain syndrome
Post-vasectomy pain syndrome
Post-vasectomy pain syndrome is a chronic and sometimes debilitating genital pain condition that may develop immediately or several years after vasectomy. Because this condition is a syndrome, there is no single treatment method, therefore efforts focus on mitigating/relieving the individual...
. In industrialized nations, mortality is 4 per 100,000 tubal ligations, versus 0.1 per 100,000 vasectomies.
Tubal ligation has a larger initial cost than other contraceptive methods. It may take more than a decade of use for tubal ligation to become as cost-effective as other highly effective, long term methods like IUD or implant. Continued method costs or costs from unintended pregnancies make many other methods as or more costly than tubal ligation if used for several years. The cost of tubal ligation is reduced if it is performed during a cesarean section since the tubes are already exposed during the laparotomy
Laparotomy
A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity. It is also known as coeliotomy.- Terminology :...
.
Tubal ligation may reduce the risk of ovarian cancer
Ovarian cancer
Ovarian cancer is a cancerous growth arising from the ovary. Symptoms are frequently very subtle early on and may include: bloating, pelvic pain, difficulty eating and frequent urination, and are easily confused with other illnesses....
, with some studies estimating the relative risk
Relative risk
In statistics and mathematical epidemiology, relative risk is the risk of an event relative to exposure. Relative risk is a ratio of the probability of the event occurring in the exposed group versus a non-exposed group....
at 0.66 for epithelial types, 0.40 for endometrioid types and 0.73 for serous types.