Scarless Sterilization in Women
Female Sterilization is surgery to block a woman’s Fallopian tubes and it is a permanent form of birth control. After this procedure has been performed, an egg cannot move from the ovary through the tubes (a woman has two Fallopian tubes), and eventually to the uterus. The egg then dissolves and is absorbed by the body. Also, sperm cannot reach the egg in the Fallopian tube after ovulation (release of an egg from the ovary). Thus, pregnancy is prevented.
This procedure is also called tubal ligation or having one’s “tubes tied“. More formally, it is known as a bilateral tubal ligation (BTL).
Pre-Operative Assessment:
- Detailed history and clinical examination – ensure that the patient does not have concurrent conditions which may require additional or alternative procedures or precautions.
• Ensure that the woman has used effective contraception up until the date of the procedure. Otherwise defer procedure until the follicular phase and advise the woman to use effective contraception until her next period
• Perform pregnancy test to exclude pre-existing pregnancy. Negative test does not exclude luteal phase pregnancy.
The Operation
Sterilization may be performed with a method called Laparoscopy or another one called Minilaparotomy (open procedure). It can also be done at the time of a caesarean section or immediate after the delivery of a baby or any time remote from pregnancy (referred to as interval sterilization). Most interval sterilizations are performed laparoscopically.
Both methods have similar success rates and risks. Both can be done as outpatient procedures, which means you can go home the same day. The patient is usually put to sleep with a general anaesthetic.
Laparoscopy Tubal Ligation
Laparoscopic tubal ligation has many advantages that explain its use as the interval procedure of choice. It offers the opportunity to explore pelvic and abdominal anatomy, especially if the patient has complaints such as pelvic pain. The procedure is an outpatient surgery with a rapid recovery, allowing patients to return quickly to work or home. All laparoscopic methods are immediately effective. Laparoscopic tubal ligation is attractive to surgeons because many gynaecologists are well trained in laparoscopic techniques and it involves a short operating time.
Laparoscopy Tubal Ligation Procedure
While the patient is under anaesthesia, one or two small incisions (cuts) are made in the abdomen (one usually near the navel), and a device similar to a small telescope on a flexible tube (called a laparoscope) is inserted.
Using instruments that are inserted through the laparoscope or the second incision, the tubes (Fallopian tubes) are coagulated (electrocoagulation), cauterized (burned), or a small clip is placed on each tube. The skin incision is then closed.
In Oriental Melaka Straits Medical Centre, we are able to do this procedure with only make 1 small cut (1cm) near your navel. As a result, there is even less blood loss, less scarring, and less post-operative pain. The recovery time is significantly shorter as well.
Open Mini-laparotomy
Mini-laparotomy is rarely used other than when laparoscopy fails or is contra-indicated. If technical difficulties arise during a laparoscopy, the operation may need to be converted to an open procedure. The risk of laparotomy is increased if the patient is obese or has had previous abdominal surgery. It takes slightly longer and is associated with more minor morbidity.
A small incision is made just above the pubis at the level of the pubic hairline.
Tubal Ligation Risks
As with any surgery, there is always a risk when a person is given general anaesthesia. Surgery itself may present problems with bleeding, infection, or damage to surrounding organs. However, tubal ligation is considered to be a very safe procedure with an overall complication rate of less than 1%.
Woman rarely become pregnant because the tubes can come back together again after being cut. The failure rate is low at 2-10/per 1,000 women. Should you become pregnant, you will usually have a normal pregnancy.
Tubal Ligation Recovery and Results
Most women recover from the laparoscopic procedure with no problems. There are no tests required to confirm that the woman is now sterile (that is, unable to become pregnant) after a laparoscopic procedure.
Most patients feel well enough to go home after the procedure in the day-care surgery centre after a few hours.
The health care professional may prescribe analgesic medications to manage post-operative pain.
Most women return to normal activities, including work, in a few days, although some women may be advised not to exercise for a short time. Sexual intercourse may resume when the patient is comfortable.
What are the advantages of female sterilization?
It is permanent and you (and your partner) don’t have to think about contraception again. There are no hormones involved, so you do not have the side-effects of many other types of contraception. It does not affect your periods.
What are the disadvantages of female sterilization?
Sterilization is a permanent, surgical procedure and often cannot be reversed. It may not be a good choice for you if you may want to have a child biologically in the future.
Article by,
Dr. Tan N. Cipto 陈明医生
FICS (USA), MD (Ina), MOG (Malaya), SpOG (Ina)
Master in Clinical Embryology (S'pore)
Fellowship in Infertility & Reproductive Medicine (UKM)
Diploma in American of Aesthetic Medicine (USA)
Masters Course in Aesthetic Gynaecology (USA)
Specialty:
Obstetrics & Gynaecology