Often there are situations when, for one reason or another, a woman does not want to have children. This is not about the classic methods of contraception, with the abolition of which pregnancy will occur, but about sterilization, when it will no longer be possible to give birth in the future. Bandaging is one such method of female sterilization. fallopian tubes, the pros and cons of which we will reveal in our article.
In contact with
The fallopian tubes are the place where the egg moves after maturation and release from the follicle. In addition, it is there that fertilization and further movement of the embryo into the uterine cavity with its subsequent fixation to the wall takes place. Violation of the patency of the tubes by ligation is considered one of the most reliable methods of contraception, which almost 100% protects against unwanted pregnancy.
It is not necessary to have any pathologies or diseases in order to perform such an operation. In most cases, this is done by perfectly healthy women who have decided that they will not give birth to children. These are not only childfree, who are categorically against children, but also women who already have one or more. Also, tubal ligation in a woman can be performed due to the presence of certain health problems in which it is risky to give birth to children. It could be:
- serious heart defects, vascular diseases;
- diabetes;
- genetic hereditary diseases;
- malignant tumors;
- pathology of the lungs, kidneys and others.
Often, tubal ligation is done during a caesarean section, if there are any problems or pathologies during the first pregnancy, which make it clear that further births can be life-threatening for the mother.
The main types of dressings
Pipes can:
- cut;
- bandage;
- seal by soldering.
The most common techniques used for tubal ligation are:
- laparotomy;
- minilaparotomy;
- laparoscopy.
Depending on the chosen method, the cost may vary.
The main plus is a 100% guarantee that pregnancy will not occur. But, this is also the main disadvantage, because the process is almost irreversible. This means that the woman who made the dressing, then, if she changes her mind and decides to give birth to another child, will not be able to do it. In rare cases, tubal patency can be repaired with surgery, but this is very difficult. IVF is the only way to get pregnant. But this procedure does not give a 100% guarantee, because the first time it may not work.
Consequences of the operation
If everything is in order, there will be no negative consequences after tubal ligation, except that the woman will lose her childbearing function. It's mechanical surgical intervention, so there is no negative effect on the body. There is no hormonal failure, as, for example, often happens when taking oral contraceptives. Also this procedure does not affect a woman's libido in any way. Therefore, in general, everything will be the same as before, except that pregnancy will not occur even with unprotected intercourse. Of course, this does not mean that a woman can sleep with different partners, often change them and not be protected. No, the number of partners is her own business, but if she is not sure about him, that he is healthy, it is better not to risk it and use a condom so as not to pick up anything.
How much does a tubal ligation cost
The cost of a tubal ligation operation is different, depending on the city in which it is performed, in a public clinic or a private one, which method is used. Tubal ligation prices range from 4,000 to 50,000 rubles. In some public health facilities, this procedure can be performed free of charge with the help of a compulsory health insurance. Also, do not forget that this is a surgical intervention, before which it is necessary to pass a series of tests, which are also paid in most cases. Prices can be found in advance on the websites of selected clinics. But, it is better to focus not only on the cost, but also on the reputation of the institution itself, doctors, patient reviews.
Tubal ligation is one of the most effective procedures for preventing unwanted pregnancies, as future conception becomes almost impossible. Usually, such a step is taken by girls who voluntarily gave up the prospect of having a child, as well as women for whom pregnancy itself can become a threat to life and health.
Female sterilization is a surgical intervention that is performed to create an artificial obstruction of the tubes. Today, this method of contraception can be called the most effective and at the same time the most radical. How does tubal ligation surgery prevent pregnancy?
The ovum, having matured, leaves the ovary and moves to the fallopian tubes, where fertilization should occur. Then it enters the uterine cavity. After the operation, the passage becomes blocked - fertilization becomes impossible and pregnancy does not occur. This is the contraceptive effect.
In addition to the desire of a woman to exclude the possibility of pregnancy, there are medical indications that may affect the need for surgery.
Indications
- Rupture of the uterus
- Leukemia - cancer of the blood
- Severe diabetes mellitus
- Chronic diseases of the heart and blood vessels
- Malignant neoplasms
- History of removal of vital organs
- Mental illnesses such as schizophrenia
- Congenital heart defect
Types of surgical sterilization
- subdivided into laparoscopy and laparotomy.
Laparotomy performed under general anesthesia. The operation involves dissection of tissues in the abdomen and subsequent ligation of the tubes. Most often, the doctor recommends an open dressing if the patient has a history of pelvic inflammatory disease. The fact is that such pathologies cause scarring of tissues - this fact makes other types of surgical intervention impossible. A laparotomy can also be part of another operation in the abdomen, such as a caesarean section.
Laparoscopy requires general anesthesia is carried out through a small incision in the abdomen - about 5 cm. A camera is inserted through the incision into the abdominal cavity and surgical instruments are manipulated. After that, a second incision is added (for clamping), already in the pubic area. Bandaging is carried out with clips or a metal clip. After exposure, the ends of the tubes are cauterized or sealed by electrocoagulation.
Often tubal ligation is used immediately after childbirth, literally 1-2 days later. Of course, such an operation is planned in advance and discussed with the attending physician. This is due to the fact that after childbirth, the tubes are higher than normal due to the increase in the uterus. Therefore, during the operation, an incision is made in the navel.
- vaginal method is a tubal ligation using a colpotomy. That is, the surgeon performs a tissue incision through the back wall of the vagina - this provides access to the abdominal cavity. Next, the necessary manipulations are performed to ligate the fallopian tubes. When tubal ligation by this method increases the risk of infection - accordingly, after colpotomy, it is necessary to give up sexual activity for 1-2 months.
IMPORTANT! There is only minimal possibility of functional recovery reproductive organ after surgery, which is why surgical sterilization is called an irreversible method of contraception.
Postoperative period
Due to the movements of the uterus during the operation, the rehabilitation period is often accompanied by bleeding from the vagina. In addition, after the intervention, bloating, discomfort and back pain may occur. But these unpleasant consequences quickly disappear. After a day, the patient can take a shower, but it is not recommended to touch the site of tissue incision for 7-10 days.
Of course, the rehabilitation period means giving up intensive physical activity and sexual contact within 1-2 weeks. In the future, additional contraception will not be required. 14 days after the operation, you need to visit the doctor who performed the operation - it is necessary to examine and monitor the patient's condition.
Tubal ligation: pros and cons
- Almost 100% contraceptive effect. During sexual intercourse, protection is not required, since after a correctly performed operation, pregnancy is excluded.
- Excludes hormonal changes and the occurrence side effects- for example, a sharp increase in body weight or diseases of the female genital organs.
- The absence of changes in sexual desire - the libido does not change, the cycle is not broken.
- There is no need for special preparation for the operation - the dressing can be performed immediately after childbirth or during a caesarean section.
- The intervention does not affect the overall health of the woman.
Despite a number of advantages and confidence in contraception, tubal ligation has its drawbacks. However, in most cases they depend on the quality of the surgical intervention and the skill of the doctor.
- Possible complications - infection, etc.
- The negative aspects of the rehabilitation period are weakness, nausea, vomiting.
- Surgeon negligence can lead to ectopic pregnancy patients in the future.
Possible Complications
Any operation entails certain consequences - they may be irreversible, but it is also possible to restore all body functions. The irreversible consequences of surgical sterilization are, of course, the inability of a woman to become pregnant. This fact cannot be fully called a consequence of the operation, since it is at the same time its goal.
The most popular complication is the risk of infection, as well as the possibility of side effects. This is especially true of the vaginal method - often during the colpotomy, vessels are damaged, open inflammatory processes and bleeding occurs. These facts have a negative impact on the health status of women and the rehabilitation period. You may need additional therapy after tubal ligation surgery.
It is worth considering the individual reaction of the patient - an allergy may occur. Moreover, such a response of the body can follow not only anesthesia (any type of anesthesia), but also medicines, which are applied during the recovery period after surgery. These consequences occur quite rarely and depend on individual characteristics - on the characteristics of the body and the qualifications of doctors.
When thinking about surgical sterilization, it is worthwhile to thoroughly analyze the situation and weigh all the pros and cons, because the result of the operation cannot be canceled, the woman will lose the opportunity to conceive and bear a child. Having decided on the ligation of the fallopian tubes, one should responsibly approach the choice of a doctor and the implementation of his recommendations before and after the intervention.
Sometimes situations arise when a woman does not want to have children. In this case, the doctor offers her various options for preventing accidental pregnancy. In most cases, the lady chooses one of the proposed methods and uses it for a long time.
But what about those women who never want to have children again? Some time ago, doctors began to perform an operation called "surgical sterilization" (tubal ligation). It is worth saying that this procedure does not pass without a trace. Like any surgical intervention, tubal ligation in women has a wide variety of consequences.
Manipulation principle
The procedure is performed when a woman is sure that she no longer wants to have children. Also, if pregnancy can cause irreparable harm to a lady, tubal ligation may be recommended. How is the fallopian tubes tied? There are several ways to make a woman completely infertile. Let's consider them.
Tubal ligation: methods
The procedure has almost irreversible consequences. This must always be remembered. There are three ways to do it:
- Laparoscopy.
- Mini laparotomy.
- The use of implants.
In the first two cases, tying, dressing and cauterization can be done. Let's consider what are the differences between these methods and what problems await a woman after tubal ligation.
Laparoscopy
This procedure is performed under general anesthesia. The doctor introduces several manipulators and a video camera into the woman's abdominal cavity. Looking at the image on the screen, the surgeon bandages the fallopian tubes or ties them. Also, these organs can be completely removed if necessary.
Laparotomy
This procedure also takes place under general anesthesia. This method is often used when scheduled after a caesarean section. In this case, no additional incisions are required, all manipulations are carried out through the incision that was made to accept the child.
Application of implants
This method is the most gentle, however, it must be remembered that such tubal ligation in women has irreversible consequences. The procedure does not require the use of painkillers. A woman, who is on a gynecological chair, is injected into the uterus with implants that penetrate the fallopian tubes. Within a few months, connective tissue grows around these artificial parts, and the fallopian tubes are completely blocked.
Tubal ligation and aftermath
Depending on which method of the procedure you choose, various complications may occur. Every woman who decides on such a procedure should know about them. So what are the consequences of tubal ligation in women? Let's consider each of them in detail.
Inability to conceive a child
Experts say that tubal ligation as a method of contraception is not dangerous, but it has a consequence - infertility. Perhaps now this is exactly what you need. But everyone knows that life changes, and sometimes a person finds himself in a completely unforeseen situation. Sometimes it happens that a woman deliberately makes herself infertile. At this moment, she thinks that she will never want to give birth again. But due to prevailing life situations the lady subsequently regrets this and asks the doctor to restore her fertility.
If the procedure was done by tying or ligating the fallopian tubes, then they can be untied. However, this does not guarantee that subsequently a woman will be able to conceive a child on her own.
In the case when implants were installed, tubal ligation in women has irreversible consequences. Such a representative of the fair sex will never be able to conceive a child on her own.
Ectopic pregnancy
If tubal ligation is done, what other consequences can there be?
A serious complication of this procedure is an ectopic pregnancy. If the manipulation is performed poorly and the fallopian tubes are tied loosely, then the male spermatozoon can penetrate through the small lumen to the egg. In this case, fertilization will occur, but the fetal egg will not be able to descend into the uterine cavity. As a result, the embryo will begin to develop in the blocked tube.
The woman at this moment is sure that pregnancy is impossible. The lady is not even aware of her interesting position, which can lead to death. If the fact of pregnancy is not established in time, then after a few weeks the fallopian tube will simply burst under the influence of the growth of the fetal egg, and extensive internal bleeding will begin.
Inflammatory processes
Tubal ligation in women has consequences in the form of inflammatory processes. Before the procedure, it is always necessary to conduct an examination. If this is not done, then minor inflammation can lead to a serious complication. Especially often such consequences occur after the installation of implants. It happens that pathogenic bacteria are present in the uterus, but under the influence of immune protection, they cannot penetrate the fallopian tubes and infect the ovaries. When implants are installed, these same bacteria penetrate, together with a foreign body, into the fallopian tubes and affect the sex glands.
Consequences of anesthesia
If the ligation of the fallopian tubes was carried out using laparoscopy or laparotomy, then the woman was in a state of general anesthesia. This is a prerequisite for manipulation. After such a procedure, the patient may experience memory disorders and absent-mindedness. Hair loss and skin deterioration are also quite common.
Damage to internal organs
Such consequences occur quite rarely, but they have the right to life. If laparoscopy is performed, then the doctor can damage neighboring organs with the manipulators used: the uterus, intestines, bladder or ovaries. As a result, bleeding occurs.
In the event that the laparotomy method is chosen, an unskilled surgeon may accidentally make an incision in the uterus or bladder. Such cases end rather badly, as the woman then becomes disabled.
If the procedure is carried out on the introduction of implants, walls may appear. This phenomenon requires immediate surgical intervention, as it can threaten the life of a woman.
The occurrence of adhesions
Would you like a tubal ligation? Read the reviews of those who did this to get started. In most cases, such a procedure always ends with an adhesive process. In itself, this phenomenon gives a woman considerable discomfort. The lady constantly complains of pain in the lower abdomen, which intensifies during critical days. Also, after the restoration of fertility, it can cause infertility.
Aesthetic flaws
The tubal ligation procedure has some aesthetic implications. If the method of laparoscopy or laparotomy is used, then in abdominal cavity always need to make an incision. After the suture has healed, an ugly scar will form in its place, which will always remind the fair sex of the procedure. It is because of this that many pregnant women who do not want to have children anymore, who are shown to write an application for simultaneous tubal ligation. Otherwise, the lady will again have to lie down on the operating table and get new scars.
Conclusion
Now you know which are the most dire consequences tubal ligations occur in the fairer sex. Before deciding on such a procedure, you need to think it over several times, weigh the pros and cons, and also consult with your partner.
You don't know what will happen to you in five or ten years. Perhaps life will force you to look at the current situation with different eyes. Most likely, after such manipulation, you will never be able to conceive a child on your own. And in the event of pregnancy, it will develop outside the uterine cavity.
Try to use more gentle means to protect against unplanned pregnancy. Nowadays, you can certainly find what is right for you. Only resort to such drastic measures when absolutely necessary. In Russia, fallopian tube ligation is allowed only after the age of 40, provided that the woman already has several children. The only exceptions are those cases when the procedure is recommended by a doctor and is carried out according to weighty indications. Listen to the advice of your doctor and be healthy!
is a surgical operation during which the fallopian tubes are blocked, ligated or cut off. According to many experts, this is a reliable method of contraception, but there is still no 100% guarantee, and already a year after such an operation, 5 women out of 1000 can become pregnant, and after another 10 years - 18 women out of 1000.
Ineffective ligation occurs in the case of tubal fusion, when there is a passage into which spermatozoa penetrate, as well as in case of improperly performed sterilization.
To understand the essence of the operation, it is necessary to recall that reproductive system in women, it includes two ovaries, two fallopian tubes, a uterus, and a vagina. Normally, both ovaries are able to expel an egg ready for fertilization (this process is called ovulation). This phenomenon occurs on the 12-17th day. menstrual cycle monthly. The egg is released from the ovary into the fallopian tube and travels through it to the uterus due to muscle contractions and movements of small, hair-like cilia.
Types of surgery
Laparoscopy
Closing of the fallopian tubes or tubal sterilization can be done by laparoscopy with the introduction of a microscopic camera and a surgical instrument through a small incision made in the abdomen. The operation is done under anesthesia in two ways.
Laparoscopic dressing begins with gas injection into the abdomen to make the procedure more comfortable. The fallopian tubes are then sealed with a ring, clip, or electric current.
The upper section, as seen in the figure, is intended for the indicated device, and the lower one is for the clamp. The dotted line marks the sites of incisions.
Mini laparotomy
A mini-laparotomy ("mini-paw") involves removing part of the tube and sealing the remainder with sutures, tapes, clips, or electric shock. Any woman over the age of 35 who does not want to give birth again can use this method of protection against unwanted pregnancy. This method of contraception is irreversible, does not allow you to conceive a child naturally, so such a decision should be well thought out. Both fallopian tubes are crossed in a woman.
A mini-laparotomy is performed through an incision that is less than five cm long. As part of the operation, the surgeon makes two minor incisions. One of them falls on the pubic area. This type of intervention allows you to permanently prevent the onset of pregnancy.
An open laparotomy is performed through a significant incision in the abdomen.
An abdominal operation is required for the purpose of a caesarean section;
Have pelvic inflammatory disease, endometriosis, or require pelvic surgery for another reason.
In some cases, resort to postpartum tubal ligation. Since in this case the fallopian tubes are located higher in the abdominal region, the incision is made below the level of the umbilicus. It is best to carry out the operation in the first one and a half days after the birth of the child. Because after 48 hours, the uterus shrinks, and postpartum tubal ligation will be much more painful and problematic.
It should be noted that laparoscopy is usually performed under general anesthesia. But all forms of this operation can be carried out not only under general, but also under local (epidural) anesthesia.
Tubal implant method
Implants are introduced into the area of the fallopian tubes without surgery and without anesthesia. It takes no more than half an hour, before the start of the operation, the woman should sit in a chair, as usual at a gynecologist's appointment. First of all, the cervix should open - this will help avoid damage to it.
Next, the specialist introduces a catheter through the vagina into the cervix, then into the organ cavity, and then into the fallopian tube: first into the first, and then into the second. A catheter is used to place implants in the tubes. In some cases, spasms similar to occur during the procedure.
Over time, a scar tissue forms, which grows near the implants and overlaps the fallopian tubes. The presented type of operation makes it possible to prevent the removal of the egg from the ovaries into the fallopian tubes. As you know, it is in them that fertilization becomes possible.
To make sure that the pipes are securely closed, it is necessary to take an x-ray. In the first three months after implantation, it is recommended to change the method of contraception. At the end of this period, a dye is introduced into the area of \u200b\u200bthe uterus and an x-ray examination, or hysterosalpingography, is again performed. This will make sure that the implants have not moved and the tubes are 100% blocked by scar tissue.
Operation with an incision of the suprapubic zone
Conventional surgery with an incision in the suprapubic area of the abdomen requires a long stay in the clinic. After the operation is formed. With a culdoscopic operation, which is a puncture of the posterior wall of the vagina, no scars remain, there are no complications, and tissue heals quickly. It is known that such sterilization does not cause hormonal disturbances, libido and a normal menstrual cycle are preserved.
Mature eggs are absorbed in the abdominal cavity, and women have no fear of a possible unwanted pregnancy. As a rule, most patients prefer postpartum sterilization, which is performed immediately after childbirth. The operation usually takes less than 30 minutes and does not require a long hospital stay. Women after such a procedure may experience minor pain and cramps in the abdomen, decreased physical activity, and nausea.
Should I use this method of contraception?
Tubal ligation is a radical type of contraception that is almost impossible to reverse in the future.
Voluntary sterilization is allowed for women of reproductive age who already have at least one child and do not want to have children in the future. Tubal ligation is indicated for a number of diseases that can pose a threat to life and health during pregnancy.
Many women have contraindications to taking hormonal contraceptives and use intrauterine devices, then sterilization becomes the only reliable means of protection. Tubal ligation is highly effective and is the most popular method of contraception among mature adults. couples already having children. However, a serious complication of sterilization is an increased risk of ectopic pregnancy.
Although doctors warn that tubal ligation is irreversible, and ask for good thought before doing it, if necessary, you can try to restore the functions of the tubes, after which pregnancy occurs in 60-80% of women. These are microsurgical operations that take place under general anesthesia, the difficulty arises with the reunification of the dissected ends of the fallopian tubes.
Before you make a decision, you should be aware of the statistics that show that many women who have had tubal ligation surgery regret it. Science does not stand still, and today a new, simpler and safer method has been developed that does not require intervention in the abdominal cavity. Its essence is the introduction of various drugs or devices into the uterus that cause local damage and an inflammatory reaction, as a result of which the connective tissue grows and the fallopian tubes become impassable.
The effectiveness of this method is more than 99%, but it is not yet used in clinics in the CIS countries.
The most reliable way is to simply cut the pipe with a scalpel or an electric knife, after which a puncture is made with a needle with a nylon ligature in two places of the pipe in its middle part. The ends of the threads are tied and cut off. Also no less reliable is sterilization by the type of resection of a part of the tube with immersion of its ends under the peritoneum.
What to expect after surgery?
After tubal ligation
After a successful tubal ligation, the patient returns to normal life within a day. However, minor bleeding from the vagina may occur. After laparoscopy is completed, abdominal distention is noted due to the gas used to lift the skin and muscles above the peritoneal organs, which is necessary for the operation. This effect usually wears off within a few days.
It is likely that there will be pain in the back or shoulders due to gas in the abdominal cavity, which will also pass after the gas is fully absorbed. It is permissible to take a shower a day after the operation, but without rubbing and other influences during the week.
Full recovery of the body after tubal ligation occurs after about 7 days.
Besides:
You can have sex if there is no pain;
No need for application additional method birth control.
After implant placement
After the implants are inserted, women return to their daily activities within a day. Precautions include using another method of contraception for three months and until an absolute blockage of the fallopian tubes is confirmed by X-ray.
How effective is such an operation?
Tubal ligation at the entrance to the uterus, as well as the introduction of implants, cannot be considered one hundred percent effective methods for preventing unwanted pregnancy.
There is a relatively small chance of getting pregnant after the tubes have been tied in this way. Five out of 1000 women experience this 12 months after surgery. 10 years after the intervention, at least 18 out of 1000 may already be in position.
This can happen if:
The tubes have grown together or a new passage has formed through which the egg will be fertilized by the sperm;
The dressing was done incorrectly;
The woman was already pregnant at the time of the operation.
What if tubal implants were used? This method does not have long-term statistics, since it is relatively new. Ongoing studies show that less than one in 100 women with implants become pregnant in two years.
Reasons for visiting a specialist
You should immediately consult a doctor if symptoms of pregnancy are noted. This may be a failure in the menstrual cycle, increased sensitivity of the breast, as well as nausea. Causes for concern should be considered pain on either side of the lower abdomen, loss of consciousness and dizziness.
Risks and complications after bandaging
Tubal ligation is characterized by the fact that after it no severe complications are formed. Less serious consequences include infection and dehiscence. It occurs in 11% of women after mini-laparotomy and in 6% after laparoscopy. More serious complications include tangible and dangerous blood loss, problems that are provoked by general anesthesia, as well as damage to organs during the operation and the need for even more significant incision.
Although there are fewer complications with laparoscopy than with other types of tubal ligation surgery, these complications can be more threatening. For example, when introducing a laparoscope, damage to the bladder or intestines is likely. The risk within the operation increases if the woman has nicotine addiction or cardiovascular disease.
Risks and complications after tubal implants
After implantation, pain in the pelvic area may not go away. In such situations, the implants are removed six weeks after insertion into the fallopian tubes. This increases the risk of developing diseases of the pelvic organs. Before the implementation of the intervention, it is recommended to undergo an examination. This will make sure that the patient does not have infectious diseases reproductive system.
The risk of developing an ectopic pregnancy
If the process of resection of the fallopian tubes or implantation was unsuccessful, and the woman nevertheless became pregnant, then her probability of forming an ectopic pregnancy increases many times over. This can happen several years after surgery, and most likely after three years or more.
What should you think about?
It is necessary to take into account the following points that are associated with tubal ligation and implant placement:
All materials on the site are prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and are not applicable without consulting the attending physician.
Effective methods of preventing unwanted pregnancy have always been a topical issue for women. Today, there are many ways to prevent conception, but all of them are not without flaws, and the likelihood of pregnancy, although scanty, is. Tubal ligation is one of the most effective ways contraception, which is carried out surgically.
After ligation of the fallopian tubes, the possibility of fertilization and development of the embryo is completely excluded, therefore the result of the procedure in the form of infertility is considered irreversible. This is always made known to a woman who, for some reason, decided on surgical sterilization.
Indications for tubal ligation are strictly defined, and a patient who wishes to have such an operation signs documents confirming her consent and awareness that pregnancy will never occur again.
It happens that after dressing, after a few years, a woman's life circumstances change, she may get married again, want to have another child, but infertility caused by the operation will not give such an opportunity, so doctors suggest that you carefully consider your decision, consult with life partner or close relatives.
As a rule, surgical sterilization is carried out when there are medical contraindications for subsequent childbearing, for example, a serious illness of a woman. Much less often, the operation is used solely for the purpose of contraception in the full health of the patient.
Advantages and disadvantages of surgical sterilization
tubal ligation
The fallopian tubes play a transport role for the egg released from the ovary, here it is fertilized and delivered to the uterine cavity for further development embryo. The purpose of tubal ligation is to exclude the possibility of meeting germ cells, so pregnancy will not occur after the operation under any circumstances.
It is believed that it is impossible to get pregnant after the operation, however, isolated cases of spontaneous restoration of tubal patency are known. Probably, the reason for this is a violation of operational technology or the choice of the wrong method of manipulation. It is possible to restore the patency of the pipes with the help of various plastic surgery which are very complex and do not guarantee a positive result.
If a woman after bandaging wants to have a baby, then most likely she will have to turn to reproductive specialists who can offer the method of in vitro fertilization (IVF). This method of childbearing also does not always give one hundred percent result, it is complex, expensive and often difficult both physically and emotionally for the potential future mother therefore, in the case when a woman cannot be completely sure that there will be no desire to have a child, it is better to refuse bandaging.
Tubal ligation is an operation that, like any other radical impact, is not without its pros and cons. Of course, the complete elimination of the likelihood of pregnancy can be considered an undoubted advantage, but the disadvantages should not be ignored.
Among advantages of the method compared with other methods of preventing pregnancy indicate:
- Zero chance of pregnancy in the future;
- Lack of influence on the hormonal background, general condition and libido;
- Possibility of bandaging after caesarean section.
The disadvantages of tubal ligation are:
- The possibility of complications after surgery - bleeding, inflammation, etc .;
- irreversible infertility;
- The risk of ectopic pregnancy in violation of operational technology;
- The need for anesthesia.
It is not difficult to notice that the complete absence of the possibility of becoming pregnant in the future is attributed by experts to both the advantages and disadvantages of the method. This is understandable, because the main goal - sterilization - is successfully achieved, but there is almost never a full guarantee that a woman will not regret her decision. Moreover, statistics show that more than half of the patients wished to restore fertility in the future.
An important advantage of surgical sterilization is the absence of its influence on the hormonal background. Crossing the tube does not affect the functioning of the ovaries, hormones are released in the right amount according to the age of the woman, the menstrual cycle does not change.
Indications and contraindications for tubal ligation
Indications for surgical sterilization are:
- A woman's unwillingness to have children in the future if she already has at least one child and she is over 35;
- Medical reasons that make pregnancy and childbirth dangerous for the health and life of a woman are severe pathology of the heart, lungs, kidneys, malignant tumors, genetic anomalies that will be inherited by offspring, decompensated diabetes mellitus, etc.
In both cases, a woman’s written desire to ligate the fallopian tubes is necessary, consent to the operation must be signed by the woman herself and certified by specialists, but if the presence of children is taken into account with a voluntary desire to tie the tubes, then medical contraindications to pregnancy and childbirth, dressing can be performed even in their absence.
Surgical sterilization of women with severe mental pathology is possible, while the patient is recognized as incapacitated, and the decision on tubal ligation is made by the court.
Contraindications for surgical contraception- inflammatory processes in the small pelvis, a high degree of obesity, tumors of the genital organs and intestines, a strong adhesive process in the cavity of the small pelvis. The operation may not be possible due to general serious illnesses from the side internal organs making anesthesia and surgery very risky.
Preparation for the operation and its technique
At the stage of preparation for a tubal ligation operation, a woman must undergo a series of examinations:
These diagnostic procedures you can go to your clinic until the time of hospitalization, but some of them (coagulogram, gynecological examination and smear) can be repeated immediately before the operation. According to the indications, an ultrasound of the pelvic organs is performed, in all cases the probability of an already occurring uterine pregnancy is excluded.
At any time during the preparatory period, the woman may withdraw from the planned intervention if, for any reason, she changes her mind. At this stage, she has to repeatedly answer the question of her absolute certainty in the need for sterilization, so there are cases of refusals of tubal ligation.
Tubal ligation surgery lasts an average of about half an hour, is performed under general anesthesia, spinal anesthesia is acceptable when the patient is conscious during the intervention. For manipulation on the pipes, laparoscopic access, minilaparotomy, open laparotomy are usually used. In more rare cases, hysteroscopic and colpotomy approaches are used.
The technique of intervention and anesthesia depend on the condition of the woman, the qualifications of the staff, the availability of appropriate equipment for minimally invasive operations.
Before the intervention, a cleansing enema is performed in the evening to empty the intestines and prevent some unpleasant consequences after anesthesia and the imposition of pneumoperitoneum. A gynecologist and an anesthetist are talking to the patient. The last meal is in the evening, with severe anxiety, sedatives or sleeping pills may be prescribed at night.
Laparoscopy
Laparoscopic tubal ligation is the most popular surgical technique. Its advantages are a short rehabilitation period, the possibility of local anesthesia and outpatient treatment, the absence of significant and noticeable scars on the skin.
laparoscopic tubal ligation
During laparoscopy, instruments, a camera and a light guide are inserted through small holes in the abdominal wall, and the abdominal cavity is filled with carbon dioxide to improve visibility. When the surgeon, after examining the internal genital organs, reaches the tubes, the violation of their patency can be achieved by electro- or photocoagulation, laser evaporation. These methods, as a major risk, have the possibility of heat damage to surrounding tissues, in order to prevent which, the abdominal cavity is filled with a sufficient volume of gas and flushed with saline to cool it. Mechanical violation of the patency of the pipes during laparoscopy is carried out using special rings, clips, brackets.
Minilaparotomy
Minilaparotomy is a fairly simple way to get to the tubes and tie them, it does not require expensive and complex equipment for the operating room and a very highly qualified gynecologist. With a minilaparotomy, a small incision of about 3 cm is made above the pubic joint, through which the doctor opens the way to the pelvic organs, examines them, finds the tubes and breaks their patency mechanically or by another method.
minilaparotomy
The advantages and disadvantages are similar to those of the laparoscopic approach, but this type of surgery is preferred after childbirth. It is not advisable to use it for uterine myoma, severe obesity. Minilaparotomy is considered as an excellent alternative to laparoscopic surgery in the absence of appropriate equipment and a trained surgeon.
Laparotomy
During laparotomy, the abdominal cavity is opened through a suprapubic or median incision. This method of operation can be applied when caesarean section, after which ligation of the fallopian tubes is also possible.
Hysteroscopic and colpotomy approaches
In the presence of hysteroscopic equipment, a violation of the patency of the fallopian tubes can be carried out directly when exposed to the inner layer of the tube. The basis is usually coagulation, that is, thermal damage to the mucous membrane. Hysteroscopic sterilization does not require abdominal incisions, the equipment is inserted through the vagina into the uterine cavity, then to the tubes.
With colpotomy access, they enter the pelvic cavity through the vagina, making an incision in its posterior wall and penetrating through the tissue between the vagina and the rectum. The tube is pulled into the wound, bandaged, then the tissues are sutured. The advantage of access is relative simplicity, availability and cheapness, the absence of skin incisions and sutures, among the most significant disadvantages is the likelihood of infection.
To disrupt the patency of the fallopian tubes with the above interventions, they can use:
- Ligation with suture material with excision of a fragment of the pipe;
- Rings and clips are less traumatic, give more chances for the restoration of childbearing function through plastic surgery;
- Coagulation by electric current, laser, ultraviolet.
The surgical sterilization operation can be performed at different times - in the absence of pregnancy in the second phase of the cycle, after a medical abortion, six weeks after delivery or during a caesarean section. After natural childbirth, tubal ligation is possible within the first two days or after three days to a week.
Postoperative period and complications
The postoperative period does not have any significant differences from that in other operations. If the tubes were tied during colpo- or hysteroscopy, then in a day the patient can leave the clinic, after laparoscopy, observation is required for 2-3 days. The postoperative period with laparotomy takes 7-10 days, after which the sutures are removed.
Surgical sterilization requires physical rest for a week, the same period you must refrain from sexual activity. For the first few days, water procedures are highly discouraged.
Tubal ligation surgery is considered safe regardless of the method that was used. However, in rare cases there are complications. During the intervention, there is a risk of bleeding and damage to other abdominal organs, especially when coagulating the tubes. If the operation technique is not followed, the risk of infection and inflammation in the pelvic organs increases. Very rarely happen allergic reactions for anesthetic drugs. Among the long-term effects are possible, although unlikely, menstrual irregularities, bleeding, tubal pregnancy.
When ligating the fallopian tubes for caesarean section, the consequences are similar to those outside childbirth. Sterilization does not affect the hormonal function, milk production and feeding of the baby. Both sexual behavior and the general well-being of the mother do not change, but due to low awareness and the lack of clearly formulated indications for puerperas, surgical ligation of the fallopian tubes in this category of women is quite rare.
Tubal ligation surgery in public hospitals is carried out free of charge under the CHI system. The costs are borne by the state. If desired, it is possible to undergo paid treatment in private clinics or even in public ones, but with the right to choose more comfortable conditions for staying in a hospital.
The cost of tubal ligation ranges between 7-9 and 50 thousand rubles. The price includes the payment for the operation itself, Supplies and medicines, examinations, being in the ward, food, etc.