Definition and Overview

Laparoscopic tubal ligation is a sterilization method that involves clamping, clipping, or “tying” the fallopian tubes through a minimally invasive procedure.

Unlike males, every female produce at least a million eggs in her lifetime once she’s born. These eggs are stored in the two ovaries found on each side of the lower abdomen. The ovaries, on the other hand, are connected to the fallopian tubes. During a menstrual cycle, an egg is released from either of the two ovaries and travels through the fallopian tube, where it waits for a man’s sperm. If a couple has unprotected sex, the male ejaculates semen, which contains the sperm. The sperm then travels the fallopian tube and tries to unite with the egg. If it’s successful, the egg is fertilized.

The fertilized egg then moves from the fallopian tube to the uterus (womb) where it “attaches” or implants itself in the endometrium, which is the lining of the uterus. In times when the egg is not fertilized, the endometrium is shed, which results to menstruation. This may also happen when the fertilized egg doesn’t attach itself properly into the lining.

If it succeeds in the implantation, the body then produces a hormone known as hCG (human chorionic gonadotropin) to stop the menstruation process. This is also the hormone that is measured in a pregnancy test.

Some women, however, want to exercise family planning by preventing pregnancy. One of the most popular methods is tubal ligation. This process doesn’t mean the body stops releasing eggs or the woman no longer menstruates; it simply means the tubes are tied to prevent the sperm from fertilizing the egg.

In laparoscopic surgery, only a tiny incision is needed to allow a long thin instrument known as laparoscope to get into the body. The laparoscope is equipped with a camera and a light that illuminates the path and sends a clear visual image of the female reproductive system to a computer screen during an operation. The doctor can then perform the procedure with a greater accuracy and faster speed.

Who Should Undergo and Expected Results

A tubal ligation is a sterilization option for women. Women choose the procedure to prevent further pregnancy without compromising their sex life. Some women also prefer them than wearing intrauterine devices (IUDs) or birth control pills which intake should be strictly monitored and followed. Otherwise, a miss could result in a conception.

Sometimes tubal ligation is recommended for women who are prone to high-risk pregnancies. For example, some women may develop pre-eclampsia, where the blood pressure rises during pregnancy, or eclampsia, which is its severe form that can lead to seizure before and after pregnancy. Women who have this condition can expect recurrence, which can put them and the baby’s lives in danger in the process. To prevent this from happening, tubal ligation becomes a life-saving choice.

With laparoscopic tubal ligation, the woman is expected to recover faster because of the small incision and low risk of infection. The surgery itself should not delay the regular post-partum recovery process, including when the woman undergoes a caesarean procedure. It will also not cause sexual problems or get in the way of menstruation.

However, this kind of surgery is not ideal for all women. Those who have plenty of scarred tissues may be better off with laparotomy, which requires a larger abdominal incision.

How Does the Procedure Work?

Tubal ligation, including a laparoscopic surgery, can be performed as soon as the woman has given birth while still in the delivery room, although the woman can elect it at her most convenient time.

In this procedure, the patient is administered with general anesthesia through an IV line attached to the arm’s vein to minimize pain and discomfort. A device that goes through the vagina is then used to change the position of the uterus temporarily and allow easy access to the fallopian tubes.

The surgeon then makes a small incision in the lower abdomen, just a few inches below the navel, where the laparoscope is gently inserted. The surgeon then monitors the organs through the computer screen while moving the laparoscope in different directions. The area is also expanded to allow for a better viewing.

When ready to operate, the surgeon makes another small incision near the pubic area to access the fallopian tubes. Using multiple small surgical instruments, the tubes are then tied through clamping or clipping. The tubes can also be cut. When the procedure is complete, the incisions are stitched and the areas covered with a bandage.

Possible Risks and Complications

Tubal ligation is a generally safe procedure, more so if it’s through a laparoscopic surgery. While all surgeries have risks, this type has minimal because of the small incision. With small incisions, patients recover much faster, thereby lowering the possibility of infection. Also, bleeding is kept to a minimum.

Although the objective of tubal ligation is to prevent future pregnancies, conception can still happen in rare times. However, if this occurs, this may result in an ectopic pregnancy, where the fetus grows outside the uterus such as the fallopian tubes. With tubal ligation, the fertilized egg is prevented to travel to the uterus where it can implant itself into the wall. The baby not only dies, but the fallopian tubes are at risk of rupturing, which can result in serious bleeding.

Some women also report feeling depressed after tubal ligation, perhaps because of the thought they cannot bear children anymore. The procedure can be reversed, but even tubal ligation must be carefully thought of to ensure that it is a voluntary and acceptable decision for the patient. More often than not, obstetricians and gynecologists don’t recommend it to women who are still young or have gone through divorce as they may want to be remarried and have children with their new spouse.

References:

  • Jensen JT, Mishell DR Jr. Family planning: contraception, sterilization, and pregnancy termination. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2012:chap 13.
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