What is Tubectomy?
Globally female sterilization is the most acceptable and efficient method of contraception. Tubectomy or tubal sterilization is a permanent technique of female contraception. It is preferably performed in women who no more desire childbearing and wish to have an efficacious and unrivalled means of birth control. It is quite safe and perennial with minimal predisposition to complications. It involves ligating the female fallopian tubes consequently averting the eggs to reach the uterus, sequentially prohibiting implantation. The fallopian tubes are placed juxtaposed to the uterus on either side. The female egg is produced from the ovary and from there it travels through the fallopian tubes to meet the sperm. This path is altered in Tubectomy, where in the fallopian tubes are occluded either by ligating or by cutting. This prohibits the female egg to move beyond the occluded region hence fertilization is prevented. Multiple modalities are used for the same such as bipolar coagulation, monopolar coagulation, tubal clips, tubal rings and fimbriectomy.
Indications for Tubectomy:
- Permanent method of sterilization in women
- Reduce the chances of development of epithelial ovarian cancer in high-risk patients
- Diminish the risk of ectopic pregnancy
- To promote fertility in cases with hydrosalpinx i.e. blocked fallopian tubes either by serous or clear fluid
- To prohibit fertilization in women in whom pregnancy can be medically detrimental
Preoperative investigations for Tubectomy
- Pelvic examination: Genitalia and groin nodes are inspected for any pathology.
- Speculum examination: The vagina and cervix are dilated and evaluated for abnormal discharge or purulent inflammation or infection. In suspectable cases, a biopsy can be obtained for microscopic diagnosis.
- Bimanual examination: The uterus and adnexal tissues are evaluated for abnormalities.
- Pregnancy tests: It is not mandatory but is advisable in cases where the pelvic examination is ambiguous and also in subjects with early pregnancy i.e. less than 6 weeks. Patients who are obese and who have a retroverted uterus are also advised to undergo a pregnancy test.
- Routine laboratory investigations: Such as hemoglobin and urine analysis for the detection of albumin and sugar are recommended.
- Pap smear: It is done to assess any pathology in the vagina and cervix.
- Screening is done for the identification of sexually transmitted diseases.
- Ultrasound of pelvis: It aids in detection of any pathological pelvic mass.
Treatment procedure of Tubectomy
- Preoperative preparation: An informed consent is obtained from the patient. Patient is instructed to take nothing per oral for at least 6 hours prior to surgery or during the midnight if the surgery is scheduled in the morning. Analgesics and antibiotics might be prescribed preoperatively. Sedative can also be given to reduce anxiety. The abdomen and genital area need to be shaved and washed with soap and water before the surgery. This helps reduce the chances of acquiring a bacterial infection. In some cases an enema might be performed preoperatively or a laxative can be given to empty the bowel.
- Tubectomy can be performed by various techniques such as laparoscopy, mini-laparotomy, or hysteroscopy.
- Hysteroscopy: After the patient is prepared for the procedure, a paracervical block is given. A hysteroscope is inserted either through vagina or cervix. Ni-Ti coils are placed hysteroscopically into the tubal ostia which are the proximal openings of the fallopian tubes. The coils induce an inflammatory response and subsequent scar tissue formation. The resultant growth of tissues leads to the occlusion of the fallopian tubes.
- Advantages of hysteroscopy are that it is performed as in-office procedure, the surgical technique is conducted with minimal or sans sedation, it avoids skin incisions and lastly the risks of intra-abdominal entry are minimized.
- Laparoscopy: Carbon dioxide gas is pumped intraabdominally to provide more workspace. A laparoscopic tube is inserted through a tiny incision made adjacent to the belly button. The fallopian tubes are located and followed till the fimbriated end. The tubes are occluded via electrocoagulation performed either by monopolar or bipolar energy. Mechanical occlusion can be performed by devices such as Filshiedio or Hulka clip or Falope ring. Salpingectomy can also be performed, wherein the fallopian tubes are unilaterally or bilaterally removed. Care is taken to locate the mid-isthmic portion of the fallopian tube when the entire tube is not to be removed. When bipolar energy is used as a means of electro-coagulation, the three burns are placed covering roughly 3cm of the isthmus of the fallopian tube. Following this, an ammeter or a current flow meter is used for confirming the completion of desiccation. In patients who present with an abnormal configuration of fallopian tube, a partial or total salpingectomy can be performed.
- Advantages of laparoscopy are that it enables simultaneous assessment of the pelvis and it a safe procedure with less complications, an estimated rate of 0.9 to 1.6 per 100 procedures. As a small incision is made, it mandates only a short span of stay in the hospital.
- Disadvantages of laparoscopy include its increased operative time owing it being a technique sensitive procedure and enhanced chances of damaging the adnexal tissues. The procedure requires expertise and gynecological skills as well as costly high maintenance machines.
- Minilaparotomy: An incision is made in the uterine fundus. Sterilization is performed with Parkland or Pomerory techniques; mechanical devices can also be used. While the mid-isthmic tissues are grasped, a window is created in the avascular plane of the fallopian tubes, through which two pieces of chromic sutures are passed to ligate the tubes. It is advisable in patients opting for post-partum sterilization, in cases where laparoscopy is contraindicated or as an interval approach under conditions of inadequate resources.
- Though minilaparotomy is a simple procedure yet it requires a large incision consequently associated with higher risks of infections and associated pain. This in turn prolongs the days of hospital admission.
- Caesarian tubal ligation which is a combination procedure, has the benefit of circumventing an additional incision, thus reducing the dose of anesthesia and days of hospital admission consequently minimizing the financial burden on the patient.
Complications/Risk factors associated with Tubectomy
- Wound sepsis and hematoma: Small stitch abscesses can be treated via drainage and a dressing is placed over it. Severe sepsis might require incision and drainage along with antibiotics and analgesics. A small hematoma may involute spontaneously while large one might require extensive drainage.
- Intestinal obstruction and peritonitis: It is quite rare and warrants hospitalization with careful medical monitoring.
Am I a Good Candidate for Tubectomy?
Tubectomy is advised in patients who are confident or sure that they do not want to conceive or plan for a baby in the future. Women aged between 22 to 49 years are preferred. It is a suitable option in patients whose health is in jeopardy hence they want to alleviate their concerns regarding passage of defective genes to their progeny. The patient should be aware that Tubectomy is a permanent and irreversible method of sterilization. Nevertheless a minor chance of failure can be anticipated consequently increasing the likelihood of ectopic pregnancy. It is optimal if the couple has at least one child over 1 year of age, except where sterilization is medically indicated. Patient must not have undergone sterilization before. Patient must be in sound mind.
Recovery time and aftercare following Tubectomy
- The patient will be discharged once she becomes comfortable enough to retain oral fluids, pass urine, make a conversation, dress herself without assistance and can walk around normally. This usually occurs 2 to 4 hours after the procedure unless general anesthesia has been administered.
- A follow-up is scheduled one week post-operatively.
- Painkillers are advisable for the first two post-operative days.
- It is strictly instructed to visit your surgeon in case of any warning signs such as bleeding or pus discharge, etc.
- Patient is advised to take rest for the remaining intraoperative day.
- Light physical activity can be resumed 48 hours post-operatively.
- Intake of normal diet should be started as soon as possible.
- Care should be taken to maintain the site of incision clean and dry. Do not disrupt the dressing.
- Patient should bathe 24 hours after the procedure but take care not to wet the dressing. Nevertheless if the dressing becomes wet then it should be removed, the operative site should be dried and a new dressing should be placed until suture removal.
- Following hysteroscopy, a hysterosalpingogram is performed at three months post-operatively to evaluate the inflammation induced by the coils. It is imperative that the patient stays on an authentic contraceptive prior to the documentation of occlusion.
Success Rate of Tubectomy
Tubectomy is approximately 99% viable in the first year post-surgery. In the following years, a decline in adequacy of the procedure occurs, as the fallopian tubes tend to change in direction or reconnect, which can predispose to an unintended pregnancy. It is estimated that approximately 5% of women experience an ectopic pregnancy following at least one year after Tubectomy. It is mostly associated with women who underwent a divorce or remarriage following sterilization. Recanalization or development of peritoneal fistulas provide ample space for the sperm and permit an ovum to push through leading to implantation in the region of the distal tubal fragment. It is estimated that less than 1% of women experience major complications while less than 5% suffer minor complications following Tubectomy.
Benefits of Tubectomy
- Tubectomy is quite a simple procedure performed as a day care procedure.
- The procedure is easily learned hence gynecologists can be trained efficiently and effectively.
- It is a onetime procedure as it is permanent and perennial.
- Tubectomy can be easily accomplished under local anesthesia.
- It is an extremely safe procedure that causes minimal tissue damage.
- Tubectomy is a readily accessible procedure which can be opted by women of any geographical region and ethnicity.
- One of the prime importances of Tubectomy is its high efficacy rate making it one of the most sought after procedures for female sterilization.
- It is a cost-effective procedure hence women of different financial background can undergo the procedure.
- Due to its effectiveness and safety, Tubectomy is one of the most acceptable methods of female sterilization both culturally and personally.
Cost Comparisons of Tubectomy
Tubectomy is one of the commonly opted procedures by women for sterilization. Its multiple advantages hugely outweigh the minor complications experienced in few inevitable cases. India is considered to be the hub of medical advancements making it one of the most approachable countries for surgical treatments of multiple magnitudes. The Asian countries account for the major part of highly proficient medical practitioners and India being one of the stalwarts among them.
Why choose MedcureIndia?
Medical tourism has been a huge boost to medical practice. It has made availability of medical facilities convenient and comfortable. MedcureIndia is an imminent brand in medicine. We not only assist you through the operative procedure but also guide you through the postoperative period. We assist you obtaining authentic and genuine information regarding your disease through comprehensive examinations which guides you in making the most suitable choice for an effective and efficient treatment procedure.
• When should I get sterilization done?
Female sterilization can be done at various time durations such as within 7 days of delivery, tubal ligation following a caesarian procedure, interval ligation which is done 6 weeks post-delivery, tubal ligation after an abortion and a combination of ligation along with gynecological surgeries.
• When to perform post-partum sterilization?
In uncomplicated cases it can be performed after 24-48 hours as the chances of postpartum hemorrhage decrease after 12 to 24 hours enhancing the safety of the procedure. In situations where it is imperative to accurately evaluate the chances of the infants’ survival, the procedure can be delayed for up to 7 days. Post 7 days, the uterus tends to descend into the pelvis. This decreases the accessibility of the fallopian tubes. The chances of acquiring a bacterial infection increase as bacteria are more often present in the fallopian tubes and endometrial cavity. Hence it is advised to postpone the procedure 42 days or 6 weeks post-delivery in cases when the uterus involutes thus becoming less vascular.
• How do I prepare for Tubectomy?
o Stop medications prior to anesthetic administration following consulting your surgeon.
o A temporary backup method for birth control is advisable after Tubectomy. Inform your surgeon of any medical condition of concern. Birth control methods are to be continued till the day of surgery.
o Eating and drinking should be avoided following midnight.
o Wear comfortable clothing on the intra-operative day.
o Make arrangements for someone to drop you and stay with you post-surgery.
• What are the alternatives of Tubectomy?
Alternative to Tubectomy include conservative therapy and salpingostomy wherein the fallopian tubes are removed.
• What are the disadvantages of Tubectomy?
Aggressive surgical interventions of the ovaries affect fertility as well as deplete the ovarian reserve. Prodigious ovarian damage can cause alterations in ovarian functions and can also impair the outcomes of in vitro fertilization (IVF). The effects on assisted reproduction and spontaneous conception cycle can be immensely perturbing. Though for most of the indications for Tubectomy, the ovarian reserves are minimally affected that does not pose a medical risk.
• What are the contraindications of Tubectomy?
o Ambivalent patients who are in doubts or are indecisive
o Patients with financial constraints
o Young women less than 30 years who prefer to have a chance for childbirth in future
o Patients who are incapable of making an informed consent
o Patients with gynecological malignancies
o Morbid patients or obese patients who are at risk of not being able to sustain the surgical procedure
o Women in the immediate postpartum phase
• Can I have sexual intercourse after Tubectomy?
In patients who have undergone interval sterilization, they can have sexual intercourse whenever they feel comfortable. They must visit the doctor in case of missed periods within two weeks of miss.
• I have urinary bladder disease. Can I undergo Tubectomy?
Women are exhorted not to undergo Tubectomy if they have a history of bladder disease.