Tubectomy – Know If It’s For You
Tubectomy is a permanent method of contraception for females. In this method both the fallopian tubes (fallopian tubes are tubular structures which transport ovum) are tied or cut so that it no longer can help the ova meet the sperm, thus inhibiting fertilization and pregnancy. Here, we explain what you need to know about tubectomy and what it involves.
How It Works
In the female reproductive system there is one uterus, two ovaries and two fallopian tubes. These fallopian tubes are 10cm long tubular structures attached to either side of the uterus with the other end of tubes open in the abdomen. The main function of these tubes are to carry the ovum from the ovaries, when it is released for fertilization.
In tubectomy, a gynaecologist tries to block the fallopian tubes by cutting, ligating or putting a ring on it, so that it is obstructed and it can no longer transfer the egg for fertilization.
The different methods to block the tubes in tubectomy are by ligating the tubes, by cauterizing and cutting them. by putting a fallope ring to occlude them or by applying a clip on the tubes.
Approaches To Do Tubectomy
- Laparoscopic
- Mini-Laparotomy
- Laparotomy (concurrent with caesarean section)
- Hysteroscopic
Laparoscopic Sterilisation/ Tubectomy: This is a day care procedure whereby two small holes are made under anaesthesia and the abdomen is inflated with carbon dioxide. Under vision, the tubes are ligated with falope rings or sometimes they are cauterized and cut at the isthmic region.
Mini-Laparotomy: A small incision is made in the supra-pubic region and tubes are pulled out and ligated with thread and cut. It can be used in the interval period for sterilization. This method can be opted for in the immediate post-partum period after delivery, but the site of the incision will be higher as the uterus is bigger at that time. Also, this technique can be used where laparoscopy facilities are not available.
Laparotomy (Concurrent With C-Section): Tubectomy can also be done during a caesarean section if a patient wants it and her family is completed. However, this should be postponed, it any complication for the mother or the new-born is anticipated.
Hysteroscopic: This method is not exactly tubectomy, but it is tubal occlusion whereby a device named Essure is put hysteroscopically at the tubal ostia under vision. This too is a permanent method of family planning. The method takes three months for completion as the device causes fibrosis and occludes the ostia, The advantage of Essure includes no incision or scar on the abdomen, rapid recovery and a day care procedure. And the disadvantage of Essure is that, it is a costly procedure and is not immediate – one has to wait for three months.
Important: Proper counselling and informed consent is mandatory before doing this procedure and women should be well informed that this is a permanent method of sterilization. A woman should also be mentally stable to take this decision. She must be aware that there is a small chance of failure with this procedure as well and chances of getting an ectopic pregnancy, il the procedure fails.
A woman undergoing this procedure should fully understand that it is a permanent method of family planning
Contraindications For Tubectomy
- Laparoscopic approach is contraindicated it there is a severe heart or lung disease.
- Special legal and ethical formalities should be carried out in the case of psychological or intellectual disability.
- Make sure the woman is not pregnant.
- Concurrent sterilization should be deferred if neonatal or maternal complications are suspected.
- The patient should make the request herself and she should not be under external pressure.
Is Tubectomy Reversible?
A woman undergoing this procedure should fully understand that it is a permanent method of family planning. In rare cases, women do ask for a reversal of the procedure, but it involves a major and complicated surgical procedure and also the success rate of the reversal is not very good, in terms of pregnancies after the reversal. Also, there are high chances of getting an ectopic pregnancy after the reversal.
Complications
As this is an abdominal surgery done under anaesthesia, complications can happen related to anaesthesia, bleeding, infection and also sometimes the procedure may fail resulting in an ectopic pregnancy.
Tubectomy VS Vasectomy
As tubectomy is for women, vasectomy is for men. Both are permanent methods of family planning. In vasectomy seminal vesicles are cut unlike tubectomy where fallopian tubes are cut. Tubectomy is an abdominal surgery and may involve complications at times, related to anaesthesia and infections or bleeding, whereas vasectomy ¡s a simpler procedure as compared to tubectomy. In this procedure, the seminal vesicles are cut. These tubes are present very close to the skin and can be accessed easily, so it is not a major surgery which can be done under local anaesthesia.