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Getting Your Tubes Tied

Surgical Tubal Ligation Options

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Updated April 09, 2014

Getting Your Tubes Tied

Laparoscopy Tubal Ligation

Photo Courtesy of Cincinnati Fertility
You may have heard the term "having your tubes tied." But what does it actually mean? What are your options?

Tubal ligation (or having one's tubes tied) is a permanent form of contraception. Transabdominal sterilization, a type of tubal ligation, is surgery that closes off a woman's fallopian tubes. Once the tubes are sealed, sperm will not be able to fertilize an egg, so pregnancy can't take place. There are several methods by which this can be achieved.

A woman's health may determine which procedure is best to use; two factors to consider include a woman's body weight and if she has had previous surgery.

Surgical Tubal Ligation Options:

Laparoscopy:

Laparoscopic sterilization is one of the two most common methods of having your tubes tied. During this procedure, a small incision is made to allow for a laparoscope (a small, telescope-like instrument with a light) to be inserted. This allows for the surgeon to see the fallopian tubes. The surgeon closes the fallopian tubes by using rings, clamps, clips, or by sealing them shut with an electric current (electrocautery). Then, the incision is closed. A tubal laparoscopy procedure takes about 30 minutes. There is minimal scarring, and most women can go home the same day as the procedure.

Mini-Laparotomy:

Mini-laparotomy is the other most common method of having your tubes tied. Most women opt to have this procedure done right after giving birth. For a mini-laparotomy (or "mini-lap"), the surgeon makes a small incision at or above the pubic hairline. She then pulls the fallopian tubes up into or out of the incision, closes them off with a device that ties and cuts them (or seals them shut), puts the tubes back into place, and stitches the incision shut.

Laparotomy:

A laparotomy procedure (open tubal ligation) is considered to be major surgery, so it is less commonly used than laparoscopy and mini-laparotomy. The surgeon will make a larger incision (2 to 5 inches) in the abdomen. The fallopian tubes will then be pulled up into or out of the incision, closed off (tied, clipped, or sealed shut) with a device, and put back into place. The incision will be stitched shut. An open tubal ligation is usually performed right before or after some other type of unrelated abdominal surgery, such as a Cesarean section.

Culdoscopy and Colpotomy:

Culdoscopy and colpotomy are two types of vaginal sterilization approaches. The vaginal method of tubal ligation was once the preferred technique. However, since it is associated with higher risks than laparoscopic surgery, surgeons have been favoring the abdominal approach to transvaginal procedures.

Culdoscopy and colpotomy tend to be reserved for obese patients or for women with a retroverted uterus. Both procedures involve a small incision made into vaginal wall. Research is showing that these methods are safer than originally thought. Both procedures are difficult to perform as they require a woman to be in a knee-to-chest position while under anesthesia.

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Hysterectomy:

Hysterectomy is a procedure to remove the uterus; it is considered major surgery. A hysterectomy is usually not used for sterilization, but it can be because the removal of the uterus makes it impossible for a woman to bear children. A hysterectomy can be performed through the vagina (vaginal hysterectomy) or abdomen (abdominal hysterectomy). Laparoscopically assisted vaginal hysterectomy is also another option. Types of hysterectomies include partial (or supracervical) hysterectomy, total hysterectomy, radical hysterectomy or complete hysterectomy.

Medical and Noncontraceptive Advantages of Tubal Ligation:

Women who have chosen a tubal ligation or having your tubes tied (performed in any of the ways mentioned) as a permanent method of birth control may attain an extra medical benefit. Researchers have shown that a tubal ligation appears to lower a woman's risk for ovarian cancer. In fact, this is a well-established protective effect; tubal ligations seem to reduce the risk of ovarian cancer by about 30%. Although the exact relationship is unknown, the two main theories suggest:
  • The interference with the blood supply to the ovary or some other mechanism reduces the level of hormones produced, which results in the reduced risk.
  • The closing off of the fallopian tubes may, perhaps, protect the ovaries from environmental agents that could cause cancer.

Additionally, tubal ligation may lower a woman’s risk of pelvic inflammatory disease (PID).

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