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Tubal ligation or tubectomy (also known as having one's "tubes tied" (ligation)) is a surgical procedure for sterilization in which

a woman'sfallopian tubes 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.

Tubal ligation is considered major surgery requiring the patient to undergo general anesthesia. It is advised that women should not undergo this surgery if they currently have or have had a history of bladder cancer. 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 (ligates) them off thereby preventing the travel of eggs to the uterus. Other methods include using clips or rings to clamp them shut, or severing and cauterizing them. Tubal ligation is usually done in a hospital operating-room setting.

See also: Comparison of birth control methods 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 vasectomy 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 who have had tubal ligation, which is a greater risk than for those who have not had the surgery. Recanalization or formation of tuboperitoneal fistulas occur, the openings of which are large 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 [2] the Essure procedure, which uses a special type of fiber to induce a benign fibrotic reaction.

Tubal ligation Methods

Bipolar Coagulation The most popular method of laparoscopic female sterilization, this method uses electrical current to cauterize sections of the fallopian tube. Depending on the number of sites coagulated, tube damage is typically only 2 or 3 centimeters in length and pregnancy rates after reversing this procedure are about 70%. Fimbriectomy By removing a portion of the fallopia n tube closest to the ovary, fimbriectomy eliminates the ovarys ability to capture eggs and transfer them to the ovary. Reversing this procedure involves opening the remaining fallopian tube and folding out the inner tubal lining so that egg capture is again

possible. This procedure has the lowest success rates and repair is therefore not recommended. In vitro fertilization is usually the preferred treatment in these cases. Irving Procedure This procedure calls for placing two ligatures (sutures) around the fallopian tube and removing the segment of tubing between the ligatures. Then to complete the procedure, the ends of the fallopian tubes are connected to the back of the uterus and the connective tissue respectively. Fortunately, this procedure usually leaves two healthy fallopian tube sections and a pregnancy rate of around 70% on average. Monopolar Coagulation Less common than Bipolar Coagulation, Monopolar Coagulation uses electrical current to cauterize the tube together, but also allows radiating current to further damage the tubes as it spreads from the coagulation site. Many cases involve a cutting of the tubes after the procedure. Due to the fallopian tube damage from this procedure, pregnancy rates drop to approximately 45%. However if tubal length is still greater than 5 centimeters, then a 70% pregnancy success rate can be achieved. Tubal Clip The tubal clip or Hulka Clip technique involves the application of a permanent clip onto the fallopian tube. Once applied and fastened, the clip disallows transference of eggs to the ovary. Reversal and pregnancy success is best with this procedure and can be as high as 85%. Tubal Ring The silastic band or tubal ring method involves a doubling over of the fallopian tubes and application of a silastic band to the tube. Pregnancy success rates can also be very high with this method if only a small portion of the tube is damaged by the rings. Pomeroy Tubal Ligation In this method of tubal ligation, a loop of tube is strangled with a suture. Usually, the loop is cut and the ends cauterized or burned. This type of tubal ligation is often referred to as cut, tied, and burned. These are usually very good for reversal. The fact that the ends are burned doesnt matter because that part is going to be lost anyway during the tubal reversal. Essure Tubal Ligation In this method of tubal ligation, two small metal and fiber coils are placed in the fallopian tubes. After insertion, scar tissue forms around the coils, blocking off the fallopian tubes and preventing sperm from reaching the egg. Adiana Tubal Ligation In this method of tubal ligation, two small silicone pieces that are placed in the fallopian tubes. During the procedure, your health care provider heats a small portion of each fallopian tube and then inserts a tiny piece of silicone into each tube. After the procedure, scar tissue forms around [3] the silicone inserts, blocking off the fallopian tubes and preventing sperm from reaching the egg.

Main article: Tubal reversal Generally tubal ligation procedures are done with the intention to be permanent. Tubal reversal is microsurgery to repair the fallopian tube after a tubal ligation procedure. Usually there are two remaining fallopian tube segmentsthe 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, [citation needed] 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 2029 years of age with pre-existing histories of menstrual dysfunction may be increased, "although they [4] 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 [5] sufficient in most cases.

Advantages and disadvantages

Tubal ligation is an abdominal surgery. One study found that postoperative complications from tubal [9] ligation are more likely than with vasectomy and more costly. However, this study did not consider postvasectomy pain syndrome. In industrialized nations, mortality is 4 per 100,000 tubal ligations, versus 0.1 [10] 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 [9] 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 [11] for epithelial types, 0.40 for endometrioid types and 0.73 for serous types.