Ligation Methods

Tubal ligation is a permanent method of birth control in which a woman’s fallopian tubes are cut or blocked. When a woman ovulates, an ovum is released from the ovary and travels through the fallopian tubes to the uterus. Pregnancy results when an ovum is fertilized by a sperm in the fallopian tubes. Tubal ligation prevents the ovum from reaching the uterus, and prevents the sperm and ovum from joining in the fallopian tubes. There are several tubal ligation procedures.

Laparotomy

• A laparotomy is a surgical procedure that involves a large incision in the abdominal wall. This type of tubal ligation is a major surgery performed under general anesthesia or may be done with an epidural during a Caesarean section. Often, this type of tubal ligation is performed as a secondary procedure during a surgery requiring a lapartomy. In the past, this was the primary procedure for tubal ligations; however, other less-invasive procedures are now more common.

Minilaparotomy

• In this procedure, an instrument inserted into the cervix is used to lift the uterus toward the abdominal wall. A small incision is made over the uterus. The tubes are brought into view and either cut, tied or cauterized. The incision is then closed. The minilaparotomy takes about 30 minutes to perform and is often done on an outpatient basis.

Laparoscopy

• This procedure is often called Band-Aid surgery. It involves two small incisions, one just below the navel and one lower on the abdomen. The surgeon inserts an instrument called laparoscope into one of the incisions, which enables him to see the fallopian tubes. Another instrument inserted into the other incision is used to cut the fallopian tubes. The incisions are closed following the procedure.

Colpotomy

• This type of tubal ligation leaves no visible scarring; however, it is considered to be the least effective and carries a higher risk of postoperative complications. An incision is made in the vagina, just behind the cervix. The fallopian tubes are brought out through this incision and either tied or clipped. This procedure is generally not recommended for women who have given birth in the last six weeks, have a history of pelvic inflammatory disease, had previous abdominal surgery or have a sexually transmitted disease.

Essure

• This procedure is referred to as hysteroscopic sterilization. A device is inserted into each fallopian tube via the cervix and uterus without the need for an incision. The Essure device causes irritation in the fallopian tube, which leads to scarring that permanently blocks the tube. Because the scarring process takes time, women are advised to use an alternate method of birth control for at least three months following the procedure. A special type of X-ray, called a hysterosalpingogram, is done three months after the procedure to confirm that scar tissue has effectively blocked the fallopian tubes. According to WebMD, Essure is 99.8 percent effective in preventing pregnancy after four years.

Adiana

• Adiana appeared to offer a viable alternative to Essure until production was discontinued in April 2012. This procedure utilized a microimplant in the segment of fallopian tube located in the uterine muscle and radio frequency technology to block the fallopian tube. A catheter inserted into the opening of the fallopian tube delivered a low dose of radio frequency that removed a 1-centimeter section of the tube. An implant was then placed into the opening of the fallopian tube. Scar tissue growing through the implant then created a permanent block in the tube. Women were advised to use an alternate method of birth control until a hysterosalpingogram confirmed that the tubes were blocked.