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Tubal ligation has become one of the most frequently performed surgical procedures, and estimates suggest that over 50 percent of all women will undergo surgical sterilization by age 45. Preventive health procedures such as Pap tests are often performed when women visit physicians for family planning and obstetric care. Since women do not visit physicians for these reasons following tubal ligation, it is important to know how their physician contact and Pap test coverage is affected by this surgery. We used data from the Manitoba Health Services Commission to construct health-services-use histories for the two years before and the two years after surgery for all women aged 25-44 who underwent tubal ligation in 1974 (n = 4,553) and for a comparison group of women who did not have the surgery (n = 5,161). Women visited physicians after surgery at the same rate as they had before surgery. However, the proportion of women receiving Pap tests fell in the years after surgery for the tubal ligation women but remained the same for the comparison group. The reasons for this decline in testing were a decline in the number of visits for gynecologic and obstetric reasons and a decline in testing because of high rates of "screening" prior to surgery. This study demonstrates both the importance of the one-time surgical event as an opportunity to offer Pap tests to women who might otherwise not visit physicians and the possibility of overtesting among some women.
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The patient described had both an intrauterine and an extrauterine pregnancy after a previous vaginal tubal ligation using a Pomeroy technique. A hysterosalpingogram showed midtubal occlusion. Although pregnancy after tubal ligation is not unusual, this case does show that a hysterosalpingogram may also be inconclusive in ruling out the possibility of future pregnancy.
Increasingly more tubal sterilizations are being performed at the time of cesarean section in the United States and probably also in developing countries. This descriptive study provides us with hitherto unavailable information on the impact of this combined procedure on the women undergoing it. Five Asian centers were included for study. In these centers, 618 women had concurrent tubal ligation at cesarean section in 1973 and 1974. During this period, 3399 women had tubal ligation soon after term vaginal deliveries. The much higher morbidity and mortality in the former group were judged to be attributable to the indications leading to, or the complications of, cesarean section and not to the concurrent tubal ligation. Women undergoing the combined procedure of tubal ligation and cesarean section were more likely to have characteristics associated with later regretting the sterilization.
Laparoscopic tubal ligation is associated with an appreciably high rate of postoperative nausea and vomiting. This study was designed to compare the effectiveness of ondansetron, dexamethasone, ondansetron plus dexamethasone or placebo in the prevention of postoperative nausea and vomiting in patients after laparoscopic tubal ligation. In a prospective, randomised, double blind placebo controlled trial, 160 ASA I-II females received one of four regimens; ondansetron 4 mg, dexamethasone 8 mg, ondansetron 4 mg plus dexamethasone 8 mg or placebo (n=40 each) intravenously immediately before induction of anaesthesia. Patients were then observed for 24 hours postoperatively. The incidence of emetic episodes in the ondansetron with dexamethasone group was lower than in the placebo (p<0.001) and ondansetron (p=0.091) and dexamethasone (p=0.143) groups. A complete response (as no postoperative nausea and vomiting) was achieved in 60% of patients given ondansetron, 63% of the patients given dexamethasone, 78% of patients given ondansetron with dexamethasone and 37% of patients received placebo. The prophylactic use of ondansetron with dexamethasone is more effective in preventing postoperative nausea and vomiting.
The mechanism of recanalization after resection of a segment of the fallopian tube by the Pomeroy sterilization method is discussed. At the level of resection, the epithelial lining of the fallopian tube tends to regenerate, covering the split ends and planes of cleavage of the resected surfaces and forming slitlike spaces and blind pouches lined by tall columnar cells. Scarring and subsequent retraction of both severed ends of the tubes tend to result in approximation; in some cases, the resected ends and the epithelial lining bridge the gap between the lumina, re-establishing patency of the tube. Surgical procedures that prevent approximation of the resected ends of the fallopian tubes or methods that seal the lumina should produce failure rates lower than those obtained with the classic Pomeroy sterilization method.
OBJECTIVE: To compare laparoscopic Pomeroy tubal ligation to standard bipolar tubal cauterization for the outcome measures of failure rate, complication rate and procedure duration, with an analysis of the effect of resident experience on procedure duration. STUDY DESIGN: Retrospective study of patients presenting for interval sterilization between August 1998 and June 2000. RESULTS: The characteristics of the laparoscopic Pomeroy (n = 99) and bipolar cautery (n = 62) patients were comparable. The mean procedure duration was 40.8 +/- 14.6 minutes for laparoscopic Pomeroy and 39.6 +/- 18.8 minutes for bipolar cautery (p < 0.68). Multiple regression analysis revealed that procedure duration was a function of both months in residency (R2 = .098, p < 0.007) and number of laparoscopic Pomeroy procedures performed (R2 = .082, p < 0.01). One complication occurred with each procedure (p < 0.576). Two sterilization failures occurred after bipolar cautery and 1 after laparoscopic Pomeroy (p < 0.33). The laparoscopic Pomeroy failure occurred in the shortest tubal segment obtained, 0.7 cm, versus the average segment length, 2.07 +/- .79 cm. CONCLUSION: Laparoscopic Pomeroy did not differ from bipolar cautery for the outcome measures studied. Both time in residency and procedure-specific experience affect the duration of laparoscopic Pomeroy. A tubal segment length of 1 cm should be removed to limit sterilization failures.
OBJECTIVE: The aim of this study is to emphasize the role of counseling methods that are meant to decrease the request for tubal ligation reversal, such as tubal ligation scoring. METHOD: This study covers 389 patients who were admitted for tubal sterilization to Cukurova University, Faculty of Medicine, Obstetrics and Gynecology Department, between 1 January 1990 and 31 December 1999. We have used the 'Tubal ligation score' on these 389 patients. Four hundred and seventeen patients who underwent bilateral Pomeroy type tubal ligation during cesarean section without having undergone tubal ligation scoring in the same time interval, were accepted as the control group. RESULTS: Laparoscopic tubal ligation (with a Yoon ring) was performed on 368 patients who had a score of 6 or higher. Twenty-one patients who got a score of 6 or lower were recounseled and another family planning method was prescribed to them. None of the 368 patients to whom tubal ligation scoring was done previous to laparoscopic tubal ligation returned to our clinic for tubal reanastomosis. Fifteen of the 417 patients (3.6%) in the control group returned to our clinic for tubal reanastomosis. CONCLUSION: Tubal ligation scoring may decrease the ratio of patients who request a tubal ligation reversal.
UNLABELLED: Postpartum bilateral tubal ligation is a brief surgical procedure with minimal tissue injury, yet postoperative recovery times and analgesia requirements are often disproportionately large. To evaluate the analgesic efficacy of local anesthetic infiltration, 20 parturients scheduled for elective minilaparotomy and bilateral tubal ligation with either spinal or epidural anesthesia participated in this prospective, randomized, controlled, double-blind trial. All patients received IV metoclopramide 10 mg and ketorolac 60 mg intraoperatively, as well as preincisional infiltration of the infraumbilical skin incision with 0.5% bupivacaine. Infiltration of bilateral uterine tubes and mesosalpinx was performed with either 0.5% bupivacaine (n = 10) or isotonic sodium chloride solution (saline) (n = 10). IV meperidine (25 mg every 3 min as needed) was given to treat pain in the postanesthesia care unit (PACU). The total amount of meperidine administered in the PACU was significantly larger in the saline group than in the bupivacaine group. Pain scores at 30, 45, 60, 75, and 90 min postoperatively and on the seventh postoperative day were significantly lower in the bupivacaine group than in the saline group. During tubal ligation, infiltration of uterine tubes and mesosalpinx with 0.5% bupivacaine significantly enhanced analgesia both in the immediate postoperative setting and on the seventh postoperative day compared with infiltration with sodium chloride. IMPLICATIONS: During bilateral tubal ligation with either spinal or epidural anesthesia, preemptive analgesia using IV ketorolac, IV metoclopramide, and infiltration of the incised skin and uterine tubes with 0.5% bupivacaine allowed 9 of 10 patients to recover with no pain, nausea, vomiting, or cramping and to maintain good analgesia for 7 days postoperatively.
Improved prognosis of tubal anastomosis after midsegment tubal ligation is an important goal. A review of the causes of failure in 124 patients operated on from 1974 through 1978 is presented. All patients were ovulatory and had normal results in postcoital tests and semen analyses. All tubal ligations had been non-coagulation. The overall pregnancy rate was 74.2%. The follow-up period was 18 months to 5 years. Of the 32 failures, 6 had bilaterally occluded tubes, 3 had severe ovulatory dysfunction, in 12 the husbands had not previously fathered a child, and 11 were unexplained. In 20.7% of successes and in 37.5% of failures the husband had not previously fathered a child. This significant difference suggests an undefined male factor.
BACKGROUND: Tubal ligation is a common method of contraception, and pregnancy after this method of sterilization is uncommon. We here present a report of Tubal pregnancy after a Bilateral Tubal Ligation (BTL). METHOD: The case notes of a 35 year Nigerian female who presented with a tubal pregnancy after BTL and a review of literature on the subject was used. RESULT: A 35-year-old para 4=0 had bilateral tubal ligation during caesarean section for her last childbirth. She presented 3 years later with a six weeks history of irregular vaginal bleeding and lower abdominal pain and had a laparotomy for a right tubal ectopic pregnancy. CONCLUSION: Ectopic pregnancy after bilateral tubal ligation is uncommon. Females who undergo BTL should be adequately counseled on the possibility of failure of this procedure for contraception.
Osteoporosis is a major public problem. More than 35 million Americans are at risk of developing osteoporosis. Nearly half of all women will have an osteoporotic fracture in their lifetime. Tubal ligation (tubal sterilization) is used more than any other single method of contraception in the USA and worldwide. In 1995, 34.6% (approximately 7 million) of ever-married US women between ages 35-44 years had undergone tubal ligation. Tubal sterilization may disturb ovarian function and be associated with more menstrual and menopausal symptoms and, thus, may be a risk factor for osteoporosis. The objective of this paper is to examine the possible association between tubal sterilization and osteoporotic fractures. Data are from a questionnaire mailed to a previously identified cohort of college/university alumnae who had graduated between 1926 and 1981. This study was performed during 1996 and 1997, 15 years after the initial study. The subjects were 3,940 women participants in the follow-up study. Their mean age was 53.7 years at time of reporting, ranging from 37 to over 80 years. Excluding deaths and non-deliverables the response rate was 85%. Of the 3,940 subjects, 491 (12.5%), and, of the ever-pregnant women, 15.5%, had undergone tubal sterilization (TS); 899 (22.8%) reported at least one fracture after age 20, and 70 (1.8%) at least one vertebral fracture after age 20, which had been confirmed by X-ray. TS was strongly associated with self-reports of vertebral fractures that had been confirmed by X-ray. The multivariable adjusted odds ratios and 95% confidence intervals for women 50 years and over and for women 55 years and over were, respectively, 2.7 (1.4, 5.0) and 3.3 (1.5, 7.0). Having had any fracture was not significantly associated with TS: odds ratio (OR) = 1.1 for women 50 years and older and OR = 1.3 for those 55 years and older. This epidemiological study in a cohort of highly educated, mostly Caucasian women shows an association between past tubal sterilization and self-reported X-ray-confirmed vertebral fractures. These results need to be confirmed in other cohorts--the pathophysiology of this association is worthy of further study.
Pomeroy tubal ligation is a widely-used method for surgical female sterilization. A laparoscopic technique of Pomeroy tubal ligation using endoloop sutures is compared with the conventional technique of Pomeroy tubal ligation by minilaparotomy. Forty-four women requiring sterilization were randomly selected for either laparoscopy (n = 24) or minilaparotomy (n = 20). Mean operative time in the laparoscopy group (18.90 +/- 5.56 with a range of 12-35 minutes) was not significantly different from that in the minilaparotomy (23.12 +/- 8.24 with a range of 15-45 minutes) group. In all women, tubal specimens confirmed tubal histology. Both laparoscopy and minilaparotomy procedures may be performed for Pomeroy tubal ligation with minor morbidity. In clinics with appropriate conditions, Pomeroy tubal ligation by laparoscopy may be preferable to minilaparotomy.
Acute salpingitis subsequent to tubal ligation is an uncommon event. Multiple studies have given credence to the assumption that salpingitis after tubal ligation does not occur. Four cases of salpingitis after tubal ligation are reported during the period of January 1980 to May 1985. This relates to an incidence of one in approximately 450 cases of acute salpingitis. A case of acute stump salpingitis with sequela from tubal rupture is reported and represents (to the authors' knowledge) the third reported case in the literature. Salpingitis can occur in the proximal stumps of tubes that have been ligated.
Postpartum bilateral tubal ligation (PPBTL) causes postoperative pain. We designed this study to determine the efficacy of 50 microg intrathecal morphine for analgesia after PPBTL. Sixty-five women received spinal anesthesia with 12.75 mg hyperbaric bupivacaine, 20 microg of fentanyl, and either 50 microg of morphine (morphine group) or 0.05 mL of saline (control group). Postoperative analgesia was provided with regular naproxen 500 mg and oxycodone 5 mg/acetaminophen 325 mg mixture as needed. Overall, satisfaction was higher (P=0.003) and pain was less intense at rest (P=0.008) and on movement (P <0.0001) in the morphine group. There was no significant overall difference in nausea, pruritus, or sedation scores, but vomiting occurred more frequently in the morphine group (21.4% versus 3.5%; P=0.052). In post hoc comparisons, pain at rest within the morphine group was significantly less at 4 h (P=0.006), pain on movement was significantly less at 4 h (P=0.002) and 12 h (P=0.0004), and pruritus was significantly more frequent at 12 h (P=0.002) compared with the control group. Oxycodone 5 mg/acetaminophen 325 mg mixture consumption was significantly smaller (P=0.006) and the time to first request of analgesia was significantly longer (P=0.006) in the morphine group. We conclude that the addition of 50 microg of morphine to intrathecal hyperbaric bupivacaine and fentanyl provides improved postoperative analgesia in women undergoing PPBTL.
Three cases of tubal patency following Uchida-type tubal ligation were identified. A histopathologic study of the excised segments in question revealed incomplete transecton of the tube. Modification of the Uchida procedure by attempting to remove a small segment of tube led to simple unroofing of the fallopian tube. This procedural defect was suspected by the presence of incomplete lumens in the tubal segments initially submitted to pathology. The author stresses the importance of proper exchange of information between the surgeon and pathologist to avoid tubal ligation failures that could be identified and otherwise prevented.
BACKGROUND: To evaluate the histopathological effects of tubal ligation on ovary and endometrium in a rat model. METHODS: Twenty-four female Wistar albino rats weighing 220-260 g were used. The rats were assigned randomly into tubal ligation and control groups. While tubal ligation was applied to the first group of rats, only a laparotomy was performed in the second group. Six weeks later, a second laparotomy was performed and uterine horns and ovaries of the rats in the two groups were excised for histopathological assessment. A pathologist blinded to the groups made histopathological examination including quantification of endometrial phases, presence of endometrial inflammation and counting the number of tertiary follicles and corpora lutea in each ovary. RESULTS: We found no significant difference between tubal ligation and control groups related to the number of tertiary follicles and corpora lutea (p > 0.05). However, in the tubal ligation group, endometrial inflammatory infiltration was significantly higher than in the control group (p < 0.05). CONCLUSION: Tubal ligation does not affect ovarian histology as an indicator of ovarian function. However, endometrial inflammation may occur after tubal ligation and lead to menstrual irregularities as an early complication.