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Procedures

Sterilization

Tubal Ligation: Laparoscopic Surgery
(Surgical Sterilization; TL; Tubal Sterilization; Sterilization, Tubal; Sterilization, Surgical) by the Editorial Staff and Contributors, Health Library

Definition: This is a surgery to close a woman''s fallopian tubes. A fallopian tube runs from the ovary (where the eggs develop) to the uterus (womb). Closing this tube makes it so that a woman cannot get pregnant.

Options to Close Tubes:

Tubal ligation is done if you do not want to become pregnant. If you have this surgery, you will still ovulate and menstruate. The cut or blocked tubes keep the egg and sperm from meeting. When the egg and sperm cannot meet, fertilization does not happen and pregnancy cannot occur.

This surgery is not recommended as a temporary or reversible procedure. Make sure you consider all the birth control options for you and your partner.

Possible Complications: Complications are rare, but no procedure is completely free of risk. If you are planning to have tubal ligation, your doctor will review a list of possible complications, which may include:

  • Infection
  • Bleeding
  • Anesthesia-related problems
  • Damage to other organs
  • Pregnancy - If pregnancy occurs, there is an increased risk that the egg will implant outside of the womb.

Some factors that may increase the risk of complications include:

  • Obesity
  • Previous abdominal surgery

Be sure to discuss these risks with your doctor before the procedure.

What to Expect

Prior to Procedure: Your doctor may do the following:

  • Physical exam
  • Discuss your reason for this procedure
  • Pregnancy test

Leading up to your procedure:

  • If you had to stop medicines before the procedure, ask your doctor when you can start again. Medicines often stopped include:
  • Anti-inflammatory drugs (eg, aspirin)
  • Blood thinners, like warfarin (Coumadin)
  • Clopidogrel (Plavix)
  • The night before, eat a light meal. Do not eat or drink anything after midnight.

Anesthesia: You may receive one of the following:

  • General anesthesia: blocks pain and keeps you asleep through the surgery
  • Spinal anesthesia: numbs the area from the chest down to the legs; given as an injection in the back

Description of the Procedure: The doctor will make a small cut in the area of the navel. Through this cut, the doctor will inject a harmless gas into your abdomen. The gas will inflate the abdominal cavity. This will make it easier for the doctor to see the internal organs. The doctor will then insert a long, thin tool (called a laparoscope). This tool will contain a small camera and lighting system which let the doctor see inside the abdomen. The doctor may make a second cut just above the pubic hair to insert a tool for grasping the fallopian tubes. The tubes will be closed by one of the following ways:

  • Tying and cutting (ligation)
  • Sealing by creating scar tissue
  • Removing a small piece of the tube
  • Applying plastic bands or clips

The tools will then be removed and the openings will be closed with stitches.

In some cases, the doctor may switch to an open surgery. She will either make a small cut just above the pubic hair or below the navel, or a 2 to 5 inch cut in the abdomen to do the surgery.

Immediately After Procedure: You will be brought into the recovery room. You will rest there until the anesthesia wears off.

How Long Will It Take? 20-30 minutes

How Much Will It Hurt? You may have some pain during recovery. Ask your doctor about pain medicine. Also, since your abdomen will be injected with gas, you may feel bloated and have pain in your shoulder or chest after the surgery. This may last up to three days. Walking, using a heating pad, or taking a warm shower can help to decrease discomfort.

Average Hospital Stay: You can usually go home the same day as the surgery. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care: When you return home, do the following to help ensure a smooth recovery:

  • Remove the bandage the morning after surgery. Let the small paper strips fall off on their own.
  • Do not drive or drink alcohol for at least 24 hours after surgery.
  • Do not lift anything heavy or perform hard labor for at least a week.
  • If you are nauseous, try tea, toast, or crackers.
  • Avoid sexual activity for one week, or as directed by your doctor.
  • Be sure to follow your doctor''s instructions.

You should be able to return to work in 1-7 days. Your menstrual cycle will resume in 4-6 weeks. Sterilization success rates are greater than 99% during the first year. Tubes may later grow together, increasing pregnancy risk.

Call Your Doctor After arriving home, contact your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision sites
  • Severe and continuous abdominal pain
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting
  • Fainting or dizziness
  • Pain and or swelling in one or both legs
  • Nausea and vomiting lasting more than a day
  • Heavy vaginal bleeding after the first day
  • Missed menstrual period

In case of an emergency, CALL 911.

RESOURCES:
The American Congress of Obstetricians and Gynecologists
www.acog.org/publications/patient_education/
Planned Parenthood
www.plannedparenthood.org
Women''s Health.gov
www.womenshealth.gov/

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Sterilization
The American College of Obstetricians and Gynecologists Patient Education

Sterilization is a permanent method of birth control. The procedure for women is called tubal sterilization. The procedure for men is called vasectomy.

Sterilization is a major decision that should be made with care. Women and men who have this procedure should be certain that they do not want to have any more children - now or in the future. Reversing the procedure requires major surgery and is not always effective. If you plan to have a sterilization procedure, you may want to think about vasectomy for your male partner. It is a simpler procedure and has fewer risks.

Sterilization for Women

Tubal sterilization works by surgically blocking or cutting the fallopian tubes. Sterilization does not affect a woman''s menstrual cycle or sexual activity.

Tubal sterilization can be done in different ways. The two methods used most often are laparoscopy and minilaparotomy. Through a small cut, the fallopian tubes are closed by tying, banding, clipping, blocking, or cutting them, or by sealing them with electric current. Anesthesia is used with all methods, and a hospital stay is not required.

One form of sterilization does not involve surgery. For this procedure, a hysteroscope is placed through the cervix into the uterus and a tiny springlike device is inserted through the scope into each fallopian tube. The device causes scar tissue to build up, which blocks the fallopian tubes and prevents the sperm from reaching the egg. It takes 3 months for the scar tissue to grow, so women should use another method of birth control during this period. The woman then may need to have an X-ray test to be sure the fallopian tubes are blocked. The procedure can be done in a doctor''s office without anesthesia.

Some women have tubal sterilization right after giving birth. This is called postpartum sterilization. If you are having a cesarean birth, sterilization may be performed at the same time, without the need for an additional operation or a prolonged hospital stay.

You will need to consent to have a sterilization procedure. Depending on the type of insurance you have, you may have to wait for a certain number of days after signing a consent form before having the procedure done.

The American College of Obstetricians and Gynecologists
409 12th Street, SW
PO Box 96920
Washington, DC 20090-6920
Phone: (202) 638-5577
Fax: (202) 484-5107