Laparoscopic Tubal Ligation

What is a laparoscopic tubal ligation?

Laparoscopic tubal ligation is a procedure in which Dr. Lichtenstein passes a thin, telescope-like viewing instrument (a laparoscope) inside your abdomen, and then uses a separate instrument to block your fallopian tubes (the tubes that carry eggs from the ovaries to the uterus).  If the fallopian tubes are blocked, this prevents fertilization of eggs by sperm.  Tubal ligation is a highly effective form of birth control - approximately 99% effective.  In terms of its effectiveness, tubal ligation is comparable to Depo-Provera and the IUD.   Tubal ligation is a bit more effective than oral contraceptives (birth control pills), which are at best 98% effective at preventing pregnancy.  A tubal ligation is sometimes called a female sterilization.

When is laparoscopic tubal ligation performed?

This procedure is performed if you have considered your birth control options, and decided that a tubal ligation will provide the best form of birth control for you.  A tubal ligation is performed at your request only, not because you have a disease or medical condition that requires treatment.  A tubal ligation is difficult to reverse if you decide that you want more children later in life.  Therefore, you should consider your other birth control options carefully before you decide to have a tubal ligation.  These other options include:

• birth control pills
• Depo-Provera injections
• the IUD
• vasectomy (male sterilization)
• barrier methods, such as condoms, the diaphragm, or the cervical cap

Dr. Lichtenstein will refuse to perform a tubal ligation for you if he does not feel that you are a good candidate for the procedure.

How do I prepare for a laparoscopic tubal ligation?

The preparations for a laparoscopic tubal ligation are usually fairly straight-forward.   You will see Dr. Lichtenstein for a pre-operative appointment, where Dr. Lichtenstein will review your medical history, examine you, discuss the procedure with you, and perform the informed consent process with you.  As part of the consent, Dr. Lichtenstein will emphasize the following risks to you:

1) Death.  Extremely rare in such a minor surgery.  However, you must remember that this is surgery, and death is a risk of every surgical procedure.

2) Bleeding.  Again very rare, but a possibility.  If this happens, a blood transfusion may be necessary.  If you are unable to accept a blood transfusion due to religious considerations, Dr. Lichtenstein will advise you to consider other contraceptive options.

3) Infections, which happen in less than 5% of the patient.  They are usually easily treated with antibiotics.  In rare cases, re-hospitalization may be needed for IV antibiotics.

4) Surgical damage to other organs is another rare complication.  The probability of such a complication increases if you had previous abdominal surgery, such as a cesarean section or gall bladder removal.  If you sustain injury to another organ, most commonly the urinary or the bowel, Dr. Lichtenstein may have to open your abdomen in order to repair it.

5) Pain is really not a complication, but an expected and unwelcome consequence of any surgery.  You will be very sore for about two days, and experience mild discomfort for up to 6 weeks.

6) Bruising occurs in about 10% of the cases.  You may get a fairly large red bruise on your stomach.  Over the next two weeks it will turn purple, then blue, then green, and finally yellow.  Bruises are not dangerous, but they are painful and quite ugly.

7) Failure.  It is important to remember that one out of 200 women who undergo tubal sterilization will become pregnant.  Dr. Lichtenstein will ask you to write a short note in your own handwriting indicating that you understand that sterilization procedure is not 100% effective.

We typically give you your post-operative medications at this visit, and have you do any required lab work (such as blood tests) after this visit.  You will need to meet with other members of the healthcare team, such as the staff in the pre-op clinic.  You will also meet with the anesthesiologist before the procedure.

You should not eat or drink anything after midnight and the morning before the procedure.  This includes coffee, tea, and water.

This procedure is done as a same-day surgery at Fresno Community Hospital - you come in during the morning for the procedure, and go home that afternoon.

You may drive yourself in for the procedure, but you will require a ride home from somebody else after the procedure.

You have only one choice for anesthesia for this procedure: general anesthesia.

Once you have received your anesthetic, Dr. Lichtenstein begins the laparoscopic tubal ligation by inserting a laparoscope through the umbilicus.  Once the laparoscope is inside the abdomen, Dr. Lichtenstein will examine your pelvic and abdominal organs, and insert a second instrument through a second incision just above your pubic bone.  Dr. Lichtenstein may perform the tubal ligation by burning, banding, clipping, or cutting your fallopian tubes; most typically he is using Filsche clips, which look a bit like large staples.  Sometimes, additional surgery at the time of a tubal ligation is advisable, such as removing adhesions (scar tissue), removing endometriosis, taking biopsies, or draining cysts.  Dr. Lichtenstein may only discover the need for additional surgery at the time of the tubal ligation.  If you require additional surgery, and if the risks of that surgery are minimal, Dr. Lichtenstein may perform the additional surgery at the time of the tubal ligation.  That way, you potentially avoid a second trip to the operating room for another surgery.  Dr. Lichtenstein may make additional incisions on your abdomen in order to perform the additional surgery.  At the end of the procedure, Dr. Lichtenstein removes the laparoscope, deflates the abdomen, sews up your incisions, and places sterile bandages on the incisions.

What happens after the procedure?

After a laparoscopic tubal ligation, the recovery process is generally very straight-forward.   You typically stay in the recovery area for 2-4 hours, where you remain under observation.  Once you have recovered sufficiently, you may go home.  This almost always occurs on the same day as the procedure. We typically see you back in the clinic 2-3 weeks after the procedure.

After the procedure, you may experience any, all, or none of the following

• Feeling sleepy or groggy from the anesthetic - this usually passes by the next morning.
• Shoulder pain, bloated feeling - this is caused by the gas, and typically passes within 1-2 days.
• Incisional pain - this usually subsides within 2-5 days after the procedure.
• Pelvic cramps - these usually pass within 1 or 2 days after the procedure, and usually aren't that bad.
• Vaginal bleeding - this is usually light, and may last up to 1 to 2 weeks after the procedure.
• Watery vaginal discharge - if we have checked your fallopian tubes to see if they are open.  This usually stops within 1-2 days after the procedure.

After a laparoscopy, you should avoid lifting anything heavier than a gallon of milk (approximately 10 pounds) for at least 2 weeks.

What are the benefits of this procedure?

The fallopian tubes are blocked after a tubal ligation, which provides a highly effective form of birth control (over 99% effective).  Once you have had a tubal ligation, generally speaking, you do not need to worry about birth control again.  A tubal ligation may provide a better form of birth control than other types of birth control that you have used in the past.

What are the risks associated with this procedure?

As discussed above, the risks of this procedure include:

• Anesthetic complications - your anesthesiologist will discuss these risks with you before your procedure.
• Excessive bleeding - usually the blood loss with this procedure is minimal, but it is possible that the bleeding could be heavier than expected.
• Infection - the risk of infection after this procedure is low.  If you were to develop an infection, we would probably be able to treat it with oral antibiotics.
• Accidental internal injuries - such as injuries to the intestines, reproductive organs (uterus, ovaries, and fallopian tubes), urinary organs (bladder, ureters, and kidneys), nerves, or blood vessels.  Such injuries are quite rare.  If an injury were to occur, Dr. Lichtenstein might have to perform additional surgery to correct the injury, either at the time of your laparoscopy, or at a later date.
• Blood clots - rarely, a blood clot (deep venous thrombosis or DVT) can form in your veins after this procedure.  Rarer still, the blood clot can break off and travel to your heart or lungs.
• Inability to perform the procedure - rarely, it is impossible to safely perform this procedure.
• Menstrual changes - typically, your periods get a little heavier and a little more crampy after this procedure.  Although you may notice such changes, such changes will not typically affect you much if at all.
• Sterilization - you should consider a tubal ligation to be permanent.  If you have any doubts about whether you might want more children in the future, you should not get a tubal ligation.  A tubal ligation is difficult to reverse, and the reversal procedure does not always work.  If you have a reversal of a tubal ligation, your risk for ectopic (tubal) pregnancy increases.

When should I call Dr. Lichtenstein?

Call Dr. Lichtenstein immediately at (559) 486 8888 if you develop chest pain, shortness of breath, dizziness, excessive pain, bleeding, fevers, chills, sweats, nausea, vomiting, redness or discharge from an incision, or any other unusual symptoms.

Call during office hours if you have any questions about the procedure, the results of the procedure, or if you need to make a follow-up appointment.