10 - Laparoscopic Tubal Anastomosis

Summary

INTRODUCTION

Bilateral tubal ligation as a form of permanent sterilization has been carried out in females for more than a century (1). Patients who have completed their desired family size and are certain about the lack of interest in future pregnancies find this procedure to be cost effective, relatively simple, and generally free of complications. Patients find this permanent procedure convenient since they do not have to deal with the costs and potential complications of different types of ongoing contraceptive methods, such as birth control pills and intrauterine contraceptive devices.

The procedure can be accomplished effectively by different routes, including vaginal or abdominal approaches, either through a mini-laparotomy or by laparoscopy. The timing of the procedure is variable as it can be performed right after a vaginal delivery or at the time of a cesarean section. Also, it can be accomplished in a gynecologic patient (interval tubal ligation) during the preovulatory phase of the menstrual cycle, commonly by laparoscopy. As for the methods used, the fallopian tubes can be sectioned and a segment of the tube removed, or if a laparoscopic approach is used, bipolar cauterization of the tubes or application of silastic rings or clips are popular alternatives (2–4).

It is estimated that as many as 700,000 procedures are performed each year in the United States, roughly half after delivery or at the time of a cesarean section and half by laparoscopic (interval) tubal ligation (5).