2. Female sterilisation involves ligation of both fallopian
tubes so that egg and sperm cannot meet.
Indications:
1. Family planning purposes
2. Socioeconomic
3. Medicosurgical indications
3. Timing of sterilisation
1.Postpartum or puerperal sterilisation (PPS)
● after 24hrs-7 days of delivery.
2.Interval sterilisation
● any time in a non pregnant woman or 6 weeks after delivery.
● Should be done within 7 days of menses to avoid risk of
pregnancy.
3.Postabortal sterilisation
4.Caesarean ligation
4. Case selection
1.Clients should be married.
2.Female clients should be below 49 and above 22.
3.The couple should have at least one child whose
age is above one year unless the sterilisation is
medically indicated.
5.Clients must be in a sound state of mind.
6.Mentally ill clients must be certified by a
psychiatrist and a statement by spouse/guardian.
5. Counselling
1.Clients must be informed of all the available methods of
family planning.
2.They must make an informed decision voluntarily.
3.They must be counselled in the language they
understand.
4.They should be made aware of the permanency of the
procedure.
•Sterilization does not protect against STIs, or HIV.
5.Reversibility is available but no guarantee of success.
6. Consent
1.Consent should not be obtained under coercion
or when the client is under sedation.
2.Client must sign the consent form before the
surgery.
3.Consent of spouse is not required.
8. 1.Minilaparotomy
1. Pomeroy method
● A loop formed 2 cm lateral
to fundus
● Base of loop tied and a
segment of loop removed
● 0 chromic catgut suture
used
9. 2.Parkland method
● A segment of tube separated
from mesosalpinx
● Freed tube ligated proximally
and distally
● Intervening portion removed
● Modification of pomeroy method
11. 4.Fimbriectomy
● ligation of the distal ampulla
of the tube and removal of
infundibulum of the tube
● Failure rate high
● Chance of reversal is poor
12. 5.Irwing technique
● Tube doubly ligated and
severed about 2.5 cm from
uterine cornua
● Medial stump buried in the
posterior surface of uterus
● Distal end buried in
mesosalpinx
● Very low failure rate
13. 6.Uchida technique
• Mesosalpinx injected with
saline and epinephrine
• Mesosalpinx is cut open&
tube pulled out to form loop
• Tube cut between clamps
• Medial end is buried in
mesosalpinx
• Lateral end ligated and kept
outside mesosalpinx
• Low failure rate
14. 7.Aldridge method
● Hole made in anterior leaf
of broad ligament
● Fimbrial end buried into
this hole
● High failure rate
15. 8.Shirodkar method
● Turning cut ends in opposite direction
● Prevent spontaneous recanalization
● No segment of tube is removed
16. Complications
● Anaesthetic hazards
● Bowel and bladder injury
● Injury to ovaries and tubes
● Broad ligament hematomas
● Wound sepsis
● Urinary & Pelvic infections
● Peritonitis
17. 2.Laproscopic sterilisation
Advantages
• Direct visualisation and manipulation of pelvic organs
• Associated pelvic and abdominal abnormality can be
detected and corrected
• Less time
• Minimal postoperative pain and discomfort
• Reversibility is more
18. 1.Rings
▪ Falope ring
• Made of silicone rubber
with barium sulphate
• Ring is placed at the
junction of proximal and
middle thirds of the tube
• 2.5cm loop of tube is
included in the ring
19. 2.Clips
●Filshie clip (silicone clip)
and Hulka Clemens clip
(spring loaded clip)
●Least damage to tube
●Chance of reversal best
●Higher failure rate
21. Complications
● Anaesthetic complications
● Injury of large vessels
● Bowel injury
● Tearing of mesosalpinx and haemorrhage
● Bleeding from epigastric vessels
● Thermal burns with electrocautery
● Surgical emphysema
● Mediastinal emphysema
22. 3.Vaginal tubal ligation
● Colpotomy performed and tubal ligation is done
● Complication : bowel injury ,pelvic abscess
23. 4.Hysteroscopic sterilisation
● Essure and Adiana
● Essure is coil device
with polyester fibres
• Placed in proximal
part of fallopian tube
• Stimulates a fibrotic
tissue reaction which
occludes tube
24. • Adiana consist of catheter electrode
• Electrodes produce radiofrequency electric current for 60
seconds to achieve a temperature of 64 C
• It causes superficial injury to inner surface
• A flexible cylindrical silicone matrix is deployed from
catheter at the site of thermal injury
• Backup contraception given for three months
• Hysterosalpingogram to confirm complete occlusion of
tubes
28. Definition –it is a procedure to restore fertility
after a women had a tubal ligation.
Reversal is achieved by microsurgical anastomosis
of the cut ends and the result depend on many
factors
29. Tubotubal anastomosis
● The term tubotubal anastomosis refers to an anastomosis
performed anywhere along the tube either to treat occlusions
resulting from disease processes or to reverse a prior
sterilization.
● Depending on the tubal segments that are approximated,
tubotubal anastomosis can be intramural–isthmic intramural–
ampullary, isthmic–isthmic, isthmic–ampullary, ampullary–
ampullary, or ampullary–infundibular.
30. Principles
● Identification of the site of occlusion.
● The tube is transected, with appropriate scissors, adjacent
to the site of occlusion or, in the case of a previous tubal
sterilization, near the occluded end.
● The occluded end or occluded segment of the tube is
grasped with a strong-toothed forceps to expose the site
and facilitate the transection which is effected with straight
scissors or a sharp microblade.
31. ● Dye solution can now escape from the transected tubal
lumen.
● The occluded tubal segment is excised from the
mesosalpinx electrosurgically or with scissors.
● The tubal segments are approximated in two layers.
● The first of these joins the epithelium and muscularis, and
the second joins the serosa.
● We generally use no. 8-0 Vicryl sutures swaged on a 130-
micron-shaft, 4- or 5-mm-long, taper-cut needle for tubal
anastomosis.
32. ● All of the sutures are placed in a
way that positions the knots peripherally.
● The first suture of the inner musculoepithelial layer is
always placed at the 6-o’clock position to ensure
proper alignment of the two segments of tube.
● Once the 6-o’clock suture is tied, the placement of
three or more additional sutures is required to
appose the inner layer.
33. ● These additional sutures can be placed by using a single
strand of suture as a continuous series of loops, including
the muscularis and the epithelium of the two segments.
● The sutures are tied individually, after the division of the
loop.
34.
35.
36.
37. Factors that affect the outcome
● The type of prior sterilisation, the site of anastomosis, and
the length of the reconstructed tube
● The status of the tubes (presence or absence of disease)
● The extent and nature of adhesions and the presence of
other pelvic disease
38. ● Age of the patient
● Status of other fertility parameters, especially that of the
male partner
39. MAJOR RISK
• Inability to get pregnant after the procedure.
• Infection
• Bleeding
• Scarring of the fallopian tubes
• Injury to nearby organs
• Anesthesia complications
• Ectopic pregnancy
40. RESULT
• Younger women –particularly those 35 and under –
tend to have much better success rates.
• In cases where tubal ligation reversal isn’t
successful, IVF may be an alternative option.
