Tubectomy
Tubectomy
Tubectomy (also called tubal ligation) is a permanent surgical method of contraception for women, where the fallopian tubes are cut, tied, or sealed to prevent eggs from reaching the uterus. Indication -
Completed family - most common indication where the women or couple is not desirous of more children.
Serious medical illness where pregnancy can worsen or condition or can be fatal to the mother eg - severe cardiac disease.
In case of genetic abnormalities - as a form of contraception when either partners carry a genetic disorder and not wish to pass on the condition eg - huntingtons, Marfans.
Recurrent contraceptive failure or non - compliance to temporary methods.
In cases of mental incompetence - where pregnancy can pose a long term burden.
Methods:
LAPAROSCOPIC TUBAL LIGATION
Under general or local anesthesia the tubes are tied or clipped through a keyhole incision and laparoscopic approach. The visualization of the tubes are done using camera which is inserted into the abdomen using keyhole incision.
Recovery
Can ambulate as soon as the anesthesia wears off.
Start oral liquids, followed by solid foods within hours of surgery.
Can be discharged the same day if no complications.
Back to routine within 1-2 days.
MINILAPAROTOMY
The tubes are tied through a small transverse incision made below the umbilicus or above pubic bone under spinal, general or local anesthesia. Fallopian tubes are bought up to the incision and cut and tied or blocked with clips or rings. The incision is then sutured.
Women is advised to ambulate or walk as soon as the anesthesia wears off.
Start oral fluids and followed by solids within 6-8 hours of surgery.
Can be discharged within 1-2 days.
Avoid heavy lifting for a week.
Back to routine in 5–7 days.
Efficacy: Either methods of tubectomy is equally effective with a efficacy of 99% -99.5% Failure rate: 0.5%–1.0% Considered permanent with low chances of successful recanalization.
Availability & Cost in India:
In India, both laparoscopic and minilap is free under public health programs (eg - Mission Parivar Vikas). This can be availed at government hospital through out the country and in some aided and private hospitals.
Private hospitals: ₹5,000–₹30,000 depending on the method and facility, covered under most insurances.
Types of permanent contraception
Advantages:
Permanent, one-time high effective procedure.
Immediate effectiveness thus not requiring backup contraception.
Has no hormonal side effects.
Disadvantages/Complications:
Requires anesthesia.
Small risk of surgical complications (bleeding, infection).
It is not easily reversible if fertility is desired later on.
Does not protect against STIs.
Special considerations
Postpartum sterilization - Here tubectomy is done via minilap within 48 hours of childbirth.
Interval sterilization - Here tubectomy is done via laproscopy or minilap within 6 months of childbirth.
Note: 1. According to Indian national guidelines, informed, voluntary consent is mandatory. 2. Minimum age: 22 years (in public health programs). 3. Preferably tubectomy to done after counseling and a cooling-off period of at least 1 week (unless performed with childbirth).
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