Tubectomy

PRIYADARSHINI
2005 BATCH
 Definition
 It is a permanent form of female sterilization,
in which the fallopian tubes are sealed or
pinched shut in order to prevent fertilization.

 Also known as salpingectomy.

 First described by Ralph Pomeroy in 1930.

Generally performed

 After child birth or an abortion

 As a separate procedure
 Advantages after child birth
 Patient is already in the hospital.

 Easier for the physician to access the fallopian

tubes.

 If the pt has a caesarian section, her abdomen

is already opened.

 It will not lengthen the pt postpartum hospital

stay.
 Preparatory steps
Patient should follow all the steps recommended
by their physician

 Dietary changes

 Changes to a medication regimen

 If OP surgery is scheduled, should have

someone else drive her home
What are the procedures???

1. Laparoscopy

2. Minilap operation

3. Essure procedure
 Laparoscopy
This is a technique through abdominal approach
with a specialized instrument called laparoscope.

 Abdomen is inflated with gas ex: CO2.

 Laparoscope is introduced into abdominal

cavity to visualize tubes.

 Falope rings are applied to occlude tubes.

 Patient selection
 Not advisable for postpartum patient for 6
weeks.

 Hb should not less than 8.

 No associated disorders like heart / respiratory

disease, DM, HTN.
 Advantages
 Short operating time.

 Short stay in hospital.

 Small scar.

Become very popular in India, nearly 38% of

all female sterilizations during 2000-01 were
through this method.
 Mini lap
 Modification of abdominal tubectomy.
 Much simpler procedure.
 Requires a small incision of only 2.5-3 cm
local anesthesia.
 Suitable.
1. At primary health centre level
2. In mass campaigns
3. For postpartum tubal sterilization
 Essure procedure
 Most recent sterilization technique
 Less commonly performed
 In use since 2002
1. Catheter is used to introduce a soft, flexible,
metallic micro insert through the vagina and
into each fallopian tube.
2. With in 3 months scar tissue forms around the
micro insert and blocks off the fallopian tube.
Advantages
 Can be completed with in 35 minutes.
 Does not require any incisions.
Disadvantages
 Not all women achieve successful results.
 As relatively new, long term results are un known as
of yet.
 After 3 months , the patient is required to have
hysterosalpingogram, a dye test.
 Not considered effective and should not be used as
contraception, until dye test has proved that the tubes
are blocked.
 Benefits
Among the most effective methods of permanent
birth control
 Less intense menstrual periods

 Fewer days of bleeding

 Less blood loss

 Reduced pain

 Reduced risk of ovarian cancer

 Does not effect any glands or hormones

 Risks
 Pelvic infection.

 Reaction to the anesthetic.

 Injury to blood vessel in the abdomen.

 Injury to the bowel or bladder.

 Burns resulting from cauterization.

 Failure rate
 According to the food and drug administration
(FDA), less than 1% of women who have a
tubal ligation become pregnant each year.

 Failure rates increases over time as fallopian

tubes fuse back together.

 This is especially seen in women who had the

procedure early in their reproductive years.
 Tubal reversal
 Tubal ligation can be reversed but not always
successful.
 Women will be at increased risk for ectopic
pregnancy.
 It is a micro surgery to repair the fallopian
tubes after a tubal ligation.
 It has a high success rate of 98% and few
complications.
Most common reasons for opting tubal reversal

 Change in marital status

 Age at the time of procedure

 Out side factors that influenced the decision to

under go the procedure
 Ectopic pregnancy
 Women who get pregnant after a tubal ligation
are at higher risk.

 Recently published results from a 14 yrs study

that was supported by the NIH found that likely
hood of ectopic pregnancy varied according to
the method of sterilization and the age at which
the patient under went the procedure.

 It may occur as many as 10 yrs after tubal

ligation.
Symptoms

 Severe pain in one or both sides of the lower

abdomen.

 Abdominal pain and spotting, particularly after

a missed period.

Patient should seek immediate medical care.

 Access
 In developing countries tubal ligation is
generally a popular form of birth control.
 It is widely available.
 Currently female sterilizations account for
about 85 % of all sterilizations in India.
 Some Muslim countries e.g.: Egypt and
Indonesia don’t permit tubectomy.
 Faith based medical institutions in developed
countries will some times refuse to perform
tubal ligation.
 Tubectomy
Type Sterilization
First use 1930
Failure rate 0.5%
Duration Permanent
Reversibility Some times
Benefits Almost perfect
contraception
Disadvantages No STD protection