Laparoscopy for Tubal Ligation

What is a laparoscopy for tubal ligation?

A laparoscopy for tubal ligation is a procedure in which your healthcare provider closes a woman's fallopian tubes to prevent pregnancy. It is a type of sterilization for women. The fallopian tubes carry eggs to the uterus. Your provider uses a laparoscope (a long, thin tube with a light and tiny camera) to see the fallopian tubes. Your provider uses another thin tube with a tool for closing the tubes. This prevents pregnancy because it stops sperm from reaching and fertilizing eggs.

When is it used?

Healthcare providers generally recommend a permanent form of birth control, such as tubal ligation, only if:

• You have had as many children as you want.
• Being pregnant might be dangerous to your health.
• You have a high risk of passing on a serious genetic disease.
• You cannot use other birth control methods.

Examples of alternatives are:

• trying other forms of birth control
• having your partner get a vasectomy.
• hysteroscopy to block the opening of the tubes
• having more extensive abdominal surgery to block the tubes.
• hysterectomy if there are other serious problems related to the uterus or ovaries.

You should ask your provider about these choices. You should have this procedure only if you are sure you do not want to become pregnant again. It is very difficult to reverse this procedure if later you decide that you want to become pregnant.

How do I prepare for a laparoscopy?

Your healthcare provider may do a pregnancy test before the surgery.

Be sure to tell your provider if you have ever had an allergic reaction to an anesthetic.

Plan for your care and recovery after the operation. Allow for time to rest. Try to find other people to help you with your day-to-day duties.

Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery.

Follow any other instructions your provider gives you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

The procedure may be done in a clinic, your healthcare provider's office, or a surgical center.

Before the surgery begins you are given a regional or general anesthetic. A regional anesthetic numbs part of your body, preventing you from feeling pain while you remain awake. A general anesthetic relaxes your muscles, puts you to sleep, and prevents you from feeling pain.

Your abdominal cavity will be inflated with carbon dioxide gas. This helps your healthcare provider see your organs. Your provider makes a small cut in or just below the bellybutton, puts a laparoscope through this cut, and puts another tool through a second small cut in the lower abdomen to move organs around in order to better see the female organs. The scope is used to guide the other tool to the fallopian tubes. Your provider then uses this tool to cut and tie the tubes. Or the tubes may be closed in another way, such as sealing with an electric current (electrocautery) or using clamps, clips, or rings.

When finished, your provider releases most of the gas through the tube of the laparoscope, removes the scope and any other tools, and sews up the cuts.

What happens after the procedure?

You may stay in the hospital several hours or overnight to recover. Usually you can go home the day you have the surgery. The anesthetic may cause sleepiness or grogginess for a while. You may have some shoulder pain, feel bloated, or have a change in bowel habits for a few days. You may not be able to urinate right away and may have a catheter (a small tube) placed into your bladder through the urethra (the tube from the bladder to the outside).

You should avoid heavy activity such as lifting. Ask your healthcare provider how much you can lift, what other steps you should take, and when you should come back for a checkup.

What are the benefits of this procedure?

• Closing of the fallopian tubes almost always results in lifelong sterilization. It is a very reliable form of birth control.
• Blocking of the tubes may also help to prevent a serious infection called pelvic inflammatory disease (PID).
• Lovemaking does not need to be interrupted by the insertion of a birth control device or spermicide. You do not have to take a daily pill or get shots for birth control.
• It is less painful, extensive, and expensive.

What are the risks associated with this procedure?

Complications after tubal ligation are rare.

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• A regional anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. In most cases regional anesthesia is considered safer than general anesthesia.
• The abdominal organs, glands, intestines, or blood vessels may be damaged. You may need abdominal surgery to repair them at the time of the laparoscopy.
• The lining of the abdominal wall may become inflamed.
• A blood clot may break off, enter the bloodstream, and clog an artery in the lung, pelvis, or legs. Rarely, a clot may break off and clog an artery in the heart or brain, causing a heart attack or stroke.
• Scar tissue (adhesions) may form on the pelvic organs.
• You may develop an infection or bleeding.
• You may have some pain after the procedure.
• Even though tubal ligation is considered permanent sterilization, there is a slight possibility that a woman who has had a tubal ligation could get pregnant. If you have had a tubal ligation and you get pregnant, the chances are very high that the pregnancy is outside the uterus. You will then need surgery to remove the pregnancy.

Tubal ligation does not protect you against sexually transmitted diseases, such as AIDS. Latex or polyurethane condoms are the only safe way to protect against sexually transmitted infection.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You have a fever over 100°F (38°C).
• You have bleeding or discharge from the vagina.
• You are bleeding around the surgical site.
• You notice a green or yellow discharge from the surgical site.
• You develop redness or tenderness around the surgical site.
• You have nausea and vomiting.
• You become short of breath.
• You become dizzy or faint.
• You have chest pain.
• You have abdominal pain or swelling that gets worse.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.