TUBAL LIGATION (surgical sterilization)

	What is “Tubal Ligation”?
	How does tubal ligation work?
	How effective is tubal ligation?
	Am I a good candidate for tubal ligation?
	Are there any reasons why I shouldn’t have a tubal ligation?
	What are the risks of tubal ligation?
	What are the benefits of tubal ligation?
	What should I expect on the day of my laparoscopic tubal ligation?
	What should I expect after the surgery?
	Are there any warning signs I should look out for after the surgery?

Tubal ligation is a permanent procedure.  You and your partner should be absolutely sure that you do not want anymore children—now or in the future.  If there is any chance that you might want to have children in the future, you should think about using another method of birth control.  There may be a greater chance that you will regret your decision if:

	you are young
	you are recently divorced or in an unstable marriage
	your life circumstances are changing
	you are unhappy with other reversible methods of birth control performed in the immediate postpartum period; it should be delayed if there is any issue with your baby’s health

Although in some cases tubal ligation can be reversed, it is a difficult and expensive operation not covered by health insurance.  Afterwards  there is a greater risk of ectopic pregnancy.  Tubal ligation, in general, is an elective procedure and should be delayed if there is any uncertainty.  Laparoscopic tubal ligation is not right for all women.  If you have had prior abdominal surgery, are very overweight, or have medical or gynecologic problems, a larger incision and hospital stay may be required.

The operation takes place in an outpatient surgical suite.  Consent for the surgical procedure will be obtained by your doctor.  When you sign this you are stating that you understand the risks and benefits of the operation itself, understand that the procedure is NOT 100% effective for birth control, and that you are aware of appropriate alternatives. 

An intravenous line will be started to give you fluids during the operation.  General anesthesia is necessary for the laparoscopic procedure, so you will be asleep during the operation.  After anesthesia is given, a small incision about half an inch long is made in the skin just below the navel.  Carbon dioxide is used to swell the abdomen so the pelvic reproductive organs can be seen more clearly.  The laparoscope is inserted into the abdomen through the incision.  This instrument has a bright light and lens like a tiny telescope that allows the surgeon to see into the abdomen.  A second instrument is inserted either through the laparoscope or through a small second incision made near the pubic hairline.  The fallopian tubes are grasped and sealed by using bands, clips, or electrocoagulation (electricity).  With electrocoagulation, an electric current is used to burn and block the tubes.  After the procedure, the instruments are removed and the gas is released.  The incisions are then closed.  You will be observed for a short time to be sure that everything is all right.  Most women are ready to go home 2-4 hours after the procedure.

You may feel some discomfort or have other symptoms that last for a few days.

	mild nausea from the medications or the procedure
	pains in your neck or shoulder—the gas used to distend your abdomen can irritate your diaphragm
	pain in the incisions
	scratchy throat (from the breathing tube placed in your throat during general anesthesia)
	menstrual-like cramps and bleeding
	swollen abdomen

The incision should be treated as an ordinary skin cut and kept dry for a few days to promote good healing.  A bruise around the incision, if present, will soon fade away.  If the incision appears infected or if the tenderness lasts longer than a few days, your doctor should check to make sure there is no infection.  After the incision has healed, a slight scar will remain.  A postoperative check-up will be scheduled for two weeks after the operation.

Call your doctor if you have any of the following problems:

	fever greater than 100.4°F (39°C)
	dizziness with fainting
	abdominal pain that is persistent or increasing
	bleeding or fluid coming from the incision
	if you should ever get pregnant, you must be seen immediately (there is a greater chance it may be an ectopic pregnancy)