Tubul ligation

It is female sterilization.
Time of operation:
1. Postpartum done within first week when pt is hospitalized.
2. Interval sterilization is done when woman is not pregnant or any time after 6 weeks of delivery.

Methods of sterilization
1. Laprotomy
-pomeroy method
-madlener method
-irving method
-aldridge method
-cornual resection
-uchida method

2. Mini laprotomy

3. Vaginal route

4. Laproscopy

5. Hysteroscopy

laprotomy sterilization is performed when abdominal incision  extends over 5 cm & is done during lscs & during gynec surgery.

Mini laprotomy is done through small suprapubic incision.
Pomeroy method is most popular technique of tubal ligation & is described here.
A. The tube is identified on each side brought out through the incision & middle portion is formed into a loop.
B. It is tied at d base with catgut & excised.
C. Failure rate is 0.4% and is due to spontaneous canalization.
D. The procedure is simple & requires short hospital stay. And does not require sophisticated instruments.

Vaginal route is not used due to high mortality & failure rate.

Laproscopic sterilization is done as usual by creating pneumoperitoneum created by using verres needle & CO2.
Each tube is picked up near isthmus & clipped(silastic bands) or divided after cauterization.
The procedure is expensive & has long learning time.
It is contraindicated in heart or lung disease.

Hysteroscopic sterilization is abandoned due to high failure rate & complications..

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