Laparoscopic tubal ligation is a surgical sterilization procedure in which a woman's fallopian tubes are either clamped and blocked or severed and sealed. Both methods prevent eggs from being fertilized. Tubal ligation is a permanent method of sterilization.
About 20% of women choose tubal ligation as their contraceptive method, making it the second most common form of female contraception in the United States. The use of tubal ligation increases with parity: 59% of women who have had 3 children undergo sterilization versus 13% after 1 child. Of women who decide not to have more children, 44% choose sterilization over reversible contraceptive methods.
The number of tubal ligation procedures performed in the United States has recently declined somewhat. This decline is thought to be attributable to the introduction of more options for long-acting reversible contraception, an aging baby-boomer population, and access-to-care issues.
Tubal ligation can be performed in the peripartum period or at any time remote from pregnancy (referred to as interval sterilization). Approximately half of female sterilizations are interval sterilizations, and the other half are performed at the time of cesarean delivery or immediately postpartum. Most interval sterilizations are performed laparoscopically.
Laparoscopic tubal ligation has many advantages that explain its use as the interval procedure of choice. It offers the opportunity to explore pelvic and abdominal anatomy, especially if the patient has complaints such as pelvic pain. The procedure is an outpatient surgery with a rapid recovery, allowing patients to return quickly to work or home. All laparoscopic methods are immediately effective. Laparoscopic tubal ligation is attractive to surgeons because many gynecologists are well trained in laparoscopic techniques and it involves a short operating time.
Disadvantages of laparoscopic tubal ligation include the need for anesthesia and cost of laparoscopic equipment. The procedure is usually performed under general anesthesia, which has its own risks. There is inherent risk with any surgery in which the peritoneal cavity is entered, including the rare risks of bowel injury, hemorrhage, transfusion, and, with some sterilization methods, thermal injury. All sterilization methods have risks of failure and regret.
