Tubal ligation
| Tubal ligation / Tubectomy | |
|---|---|
 Left tubal ligation | |
| Background | |
| Type | Sterilization |
| First use | 1930 |
| Failure rates (first year) | |
| Perfect use | 0.5% |
| Typical use | 0.5% |
| Usage | |
| Duration effect | Permanent |
| Reversibility | Sometimes |
| User reminders | None |
| Clinic review | None |
| Advantages and disadvantages | |
| STI protection | No |
| Risks | Operative and postoperative complications. |
Tubal ligation or tubectomy (also known as having one's "tubes tied" (ligation)) is a surgical procedure for sterilization in which a woman's fallopian 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.
Procedure
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.
Gender Comparison: The alternative/corresponding male surgical sterilization procedure known as vasectomy is considered minor surgery done with local anesthesia and typically done in an out-patient setting.
Effectiveness
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.[1] 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 the Essure procedure, which uses a special type of fiber to induce a benign fibrotic reaction.[2]
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 segments—the 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, regardless of the type of sterilization procedure.[citation needed]
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 20–29 years of age with pre-existing histories of menstrual dysfunction may be increased, "although they do not appear to undergo significant hormonal changes".[3] A 1993 study done in Japan found the symptoms of the post-tubal ligation syndrome to be mild, and simple symptomatic treatment to be sufficient in most cases.[4]
Prevalence
Worldwide, female sterilization is used by 33% of married women using contraception,[5] making it the most common contraceptive method.[6] As of June 2010, there is a recent decline of tubal ligation procedures in the United States after two decades of stable rates, possibly explained by an improved access to a wide range of highly effective reversible contraceptives.[7]
Advantages and disadvantages
Tubal ligation is an abdominal surgery. One study found that postoperative complications from tubal ligation are more likely than with vasectomy and more costly.[8] However, this study did not consider post-vasectomy pain syndrome. In industrialized nations, mortality is 4 per 100,000 tubal ligations, versus 0.1 per 100,000 vasectomies.[9]
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 or more costly than tubal ligation if used for several years.[8] 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 for epithelial types, 0.40 for endometrioid types and 0.73 for serous types.[10]
References
- ^ Shah JP, Parulekar SV, Hinduja IN (1991). "Ectopic pregnancy after tubal sterilization". J Postgrad Med. 37 (1): 17–20. PMID 1941685.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1016/j.fertnstert.2009.02.080, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with
|doi=10.1016/j.fertnstert.2009.02.080instead. - ^ Gentile GP, Kaufman SC, Helbig DW (1998). "Is there any evidence for a post-tubal sterilization syndrome?". Fertility and Sterility. 69 (2): 179–186. PMID 9496325.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help); Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Satoh K, Osada H (1993). "[Post-tubal ligation syndrome] [Article in Japanese]". Ryōikibetsu shōkōgun shirīzu (1): 772–3. PMID 7757737.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ "Family Planning Worldwide: 2008 Data Sheet" (PDF). Population Reference Bureau. 2008. Retrieved 2008-06-27.
{{cite journal}}: Cite journal requires|journal=(help) Data from surveys 1997-2007. - ^ World Health Organization (2002). "The intrauterine device (IUD)-worth singing about". Progress in Reproductive Health Research (60): 1–8.
- ^ Chan LM, Westhoff CL (2010). "Tubal sterilization trends in the United States". Fertil. Steril. 94 (1): 1–6. doi:10.1016/j.fertnstert.2010.03.029. PMID 20497790.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ a b James Trusell; et al. (1995). "Economic value of contraception" (PDF). American Journal of Public Health. 85 (4): 494–503. doi:10.2105/AJPH.85.4.494. PMC 1615115. PMID 7702112.
{{cite journal}}: Explicit use of et al. in:|author=(help); Unknown parameter|month=ignored (help) - ^ Ninaad S. Awsare, Jai Krishnan, Greg B. Boustead, Damian C. Hanbury, and Thomas A. McNicholas (2005). "Complications of vasectomy". Ann R Coll Surg Engl. 87 (6): 406–410. doi:10.1308/003588405X71054. PMC 1964127. PMID 16263006.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1093/humupd/dmq030, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with
|doi=10.1093/humupd/dmq030instead.
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