This document provides information on permanent sterilization techniques for both males and females. It discusses the indications for sterilization and covers various surgical procedures like vasectomy, tubectomy, laparoscopy, and hysteroscopic techniques. For males, vasectomy involves dividing and disrupting the vas deferens. For females, tubectomy involves removing part of the fallopian tubes. Various techniques are described like Pomeroy's, Madlener, laparoscopic application of rings. Both procedures are generally safe and effective but have risks like infection, bleeding, and in rare cases recanalization.

1. PERMANENT
STERILISATION
BY : KARTHEESWARI.A

2. SYNOPIS
Introduction
Indication
Male Sterilisation
Techniques
Female sterilisation
Techniques
Advantages and Disadvantages

3. INTRODUCTION
Sterilisation is a permanent method of contraception
 It can be done in both males and females
 In males the procedure for sterilisation is vasectomy
 In females it is tubectomy

4. INDICATIONS
IN MALES
Sexually active and psychologically adjusted husband with
desired no of children
IN FEMALES
After having desired no of children
Medical diseases like diabetes, hypertension, renal disease
For preventing ovarian and peritoneal cancer
Fetal malformations like haemophilia ,Tay-sachs disease,
Marfan syndrome
Multiparity , 3 caesarean deliveries

5. CONTRAINDICATIONS
Young women less than 25 years
Parity less than 2 children
Local infection
Prolapse

6. MALE STERILISATION
Vasectomy consists of dividing vas deferens and disrupting
the passage of sperms
There are 2 methods of vasectomy
vasectomy
conservative
No scalpel vasectomy

7. TECHNIQUES
Procedure done under local anaesthesia
Vasa is palpated b/w top of testis and base of
penis by three fingers
Vasa is grasped with ringed clamp
Skin is punctured with dissecting forceps and
vasa is dissected using the forceps
Vasa is ligated at 2 sites 1 cm apart
The in b/w portion is resected. Fascial
interposition and diathermy is done at ends

10. CONTD….
oThe same procedure is repeated on the other side
oSkin suturing is not necessary
oWound dressing is done and scrotal bandage is worn
oHistological examination of vas for confirmation
oPost operative antibiotic and analgesic is given , heavy work
should be avoided
o20 ejaculations is required to empty semen stored in the vas,
so the man is sterile for 3 months
o2 semen analysis at 12 and 16 weeks to show the absence of
spermatozoa is required to declare the man as sterile

11. COMPLICATIONS
Immediate
• Wound sepsis, Scrotal haematoma
late
• Impotency , sperm granuloma, chronic
intra scrotal pain
• Antibody formation, spontaneous
recanalization , does not prevent
STD,HIV

12. FEMALE STERILISATION
The method of sterilisation in females is tubectomy
It is the removal of a part of fallopian tube and preventing
ovulation
PUPERAL
Operation
done
within 24-
48 hrs
after
delivery
INTERVAL
Beyond 3
months after
delivery or
abortion, in
proliferative
phase of
menstrual
cycle
WITH
LSCS
Concurrent
with LSCS or
abortion

13. TECHNIQUES
TUBECTOMY
ABDOMINAL
LAPAROTOMY
MINI
LAPAROTOMY
VAGINAL
LAPROSCOPY
HYSTEROSCOPY

14. LAPAROTOMY
ANESTHESIA : General or local anaesthesia, in case of local
inject pethidine 100 mg with Phenergan 50 mg 30 mins before
surgery
INCISION : In puerperal cases, incision of 1 inch in length and
2 finger breadth is made below fundal height
In interval cases incision is made above pubic symphysis
DELIVERY OF THE TUBE :
Index finger is passed through incision, passed through post
surface of uterus and broad ligament
Tube is identified by fimbrial end and mesosalphinx
containing utero ovarian vessels

15. TECHNIQUES
POMEROY ‘S :
The tube is brought out and middle portion is formed in to a
loop and tied at the base using catgut
About 1 to 1.5 cm loop distal to the ligature is excised
The same procedure is repeated on the other side
Because of absorption of the ligature both ends get sealed off
and separated
This technique is easy to perform ,so done in PHC and its is
reversible

17. MADLENER :
The loop of the tube is crushed and ligated with non
absorbable suture, loop is not excised
Failure rate is high

18. ALDRIDGE :
Hole made in the anterior leaf of broad ligament and fimbrial
end is buried into this

19. UCHIDA :
Serosa is stripped off in the midsegment of the tube and
excised
Then proximal end is ligated and buried into broad ligament
Distal end is left free

20. IRVING :
Mid portion of the tube is ligated and intervening portion is
excised
Proximal end : buried in myometrium
Distal end : buried in broad ligament

22. CORNUAL RESECTION:
Cornual portion of the tube is resected
But uterine end may bleed heavily
KRONER:
Excision of fimbria is done
It is not reversible and not performed these days

23. MINI LAPAROTOMY
ANESTHESIA : General anesthesia
INCISION : Smaller than laparotomy about ½ inch
Special retractor is used to retract the abdomen
Uterus is pushed to one side by elevator introduced trans
vaginally for easy manipulation of tube
TECHICQUES:
Pomeroy
Madlener
Aldridge
Uchida
Fimbriectomy

24. LAPAROSCOPY
ANAESTHESIA : General or local anaesthesia
POSITION : Patient in lithotomy position table tilted to 15
degree of trendelenburg position
PNEUMOPERITONEUM :
A small incision is made just below the umbilicus
Abdomen is inflated with about 2 litres of CO2
APPLICATION OF RING :
2 silastic rings are loaded one after other through applicator
and pusher
Ring is applied at the junction of proximal and middle third of
the tube
Loop of 2.5 cm is lifted up and ring is slipped into the base of
the loop

25. RINGS USED
SILASTIC FALLOPE RING :
It is a silastic band with 3.6 mm outer ring and 1mm inner ring
diameter , 2.2 mm thick
It destroys about 2- 3cm of the tube
Barium sulphate is used for radiological visualisation
HULKA AND FILSHIE RING:
Destroys about 3-4 mm of tube
It may cause reversal of surgery

27. VAGINAL ROUTE
It is mostly combined with Manchester repair operation of
prolapse
When done in isolation the approach is posterior colpotomy
High morbidity and failure rate

28. HYSTEROSCOPY
Here we use sclerosing agents for sterilisation
ESSURE PERMANENT DEVICE:
It is a flexible inner coil made up of stainless steel coated with
polyethylene terephthalate and dynamic outer coil made of
titanium alloy
 PET fibres initiate benign local fibrous tissue growth and
occludes the fallopian tube
It takes 3 months to occlude the tube so during this period we
must use other contraceptive

30. COMPLICATIONS
Wound infection
Chronic pelvic pain
Menstrual abnormalities like menorrhagia , hypomenorrhea
Dysmenorrhoea
IN LAPAROSCOPY:
Abdominal wall empyema
Bleeding
Wrong application of ring
Spontaneous recanalization
Ectopic pregnancy
Hydrosalpinx