What Is Tubal Ligation with Clips?

The fallopian tube is the tube that transports the eggs, and is also the place where the eggs and sperm are combined to fertilize. Fallopian tube ligation is a safe and permanent birth control method to achieve the purpose of sterilization by cutting, ligating, electrocoagulation, clamping, and looping the fallopian tube so that the sperm and the egg cannot meet. Surgical procedures can be performed through the abdominal wall / laparoscope or transvaginally.

Basic Information

Chinese name: Tubal ligation
Anesthesia: Local infiltration anesthesia, spinal anesthesia, epidural anesthesia

Indication: Voluntary sterilization, not fertile
complication: Infection, abdominal wall hematoma, postoperative syndrome

Fallopian tube ligation

Local anesthesia, spinal or epidural anesthesia was used.

Preoperative preparation for tubal ligation

1. Assess the psychological state of the subject and relieve ideological concerns.

2. Inquire about the medical history in detail, do systemic examination, gynecological examination and corresponding laboratory examination.

3. Routine skin preparation and procaine skin test.

4. Fast in the morning, measure body temperature and empty the bladder before surgery.

5. Sedatives were given 30 minutes before surgery.

Indications for tubal ligation

1. With the consent of both parties, voluntarily request sterilization without contraindications.

2. Those who are not suitable for childbearing due to a certain disease.

3. Simultaneous second cesarean section.

4. People with severe systemic diseases such as heart disease, kidney disease, genetic disease, etc. are not suitable for childbearing.

Contraindications of tubal ligation

1. Abdominal skin infection, post-abortion infection, postpartum infection, postpartum infection, etc. or severe skin diseases.

2. Poor body conditions are not sufficient for surgery, such as cardiac insufficiency and blood diseases.

3. Patients with severe neurasthenia and neurosis, who are emotionally unstable and who are concerned about surgery. .

4. If the temperature is measured above 37.5 twice within 24 hours, the operation will be suspended.

5. Pelvic inflammatory diseases.

Timing of tubal ligation surgery

1. 3 to 7 days after menstruation is clean.

2. Within 48 hours after labor or mid-term pregnancy, after induced abortion.

3. Normal spontaneous abortion after menstruation, 2 normal menstruation after medical abortion.

3. Early pregnancy must be ruled out before amenorrhea during lactation.

4. After the IUD is removed, the ectopic pregnancy is performed at the same time.

5. Simultaneous cesarean section.

Fallopian tube ligation surgery method

1. Core-pulling near-end embedding method (Irving method)

It is characterized by the absence of vascular areas in the isthmus of the fallopian tube; ligation and cutting of the fallopian tube core, which is embedded at the proximal end, free at the distal end, and the mesangium is basically intact without affecting the blood supply. The core remains outside the mesangium, and the two broken ends are separated by serous membranes. Is an ideal method of ligation.

Use two tissue forceps to clamp the serosal membrane at both ends of the tubal isthmus, and inject 1 ~ 2ml of 0.5% procaine into the serosal membrane to separate the serosal membrane from the fallopian tube core, and run the bulge at the dorsal side of the fallopian tube. Cut the serous membrane about 2cm, and clamp the edges of the serous membrane with two mosquito forceps, gently separate the serous membrane layer, clamp the two ends of the core, the clamping distance is 1.0cm, and cut the oviduct between the two clamps. About 0.5 to 1 cm, two broken ends were respectively ligated with a No. 4 silk thread, and the proximal end was embedded in the mesangium. The serous membrane incision was sutured intermittently with a No. 1 silk thread, and the distal end was sutured and fixed outside the serosa with a No. 1 silk thread.

2. Cuff ligation method (Uchida method)

It is roughly the same as the core-pulling and embedding method. This method is characterized by a serous membrane as a circular incision, a small incision, simple operation and easy operation.

In the fallopian tube canal, lift the serosa with small mosquito forceps and inject 1 to 2 ml of 0.5% procaine under the serosa to separate the serosa layer from the tube core. At the proximal end of the isthmus, separate the serosa layer and the tube. Cut the core together, the cut should not be too deep, just cut the tube core to prevent the mesangial tear. The two broken ends of the tube core were clamped with mosquito forceps, and the serous membrane was peeled with another mosquito forceps to make it sleeve-shaped, separated from the core. The core was peeled off about 1 cm, and the two ends were ligated with 4 wire. The end tube core is retracted into the serous membrane mouth, shaped like a "sleeve", the distal tube core is exposed outside the serous membrane, and the distal serous membrane layer is sutured with 1 or 2 stitches, and the exposed broken end is closed. Fixed outside the serosa.

3. Fallopian tube ligation and cutting method (Pomeroy method)

This method is simple, safe, and easy to implement, but has a higher failure rate than the previous two methods.

Hold the fallopian tube tightly against the isthmus of the fallopian tube with tissue forceps and fold it. At about 1 to 1.5 cm from the top of the forceps, clamp the fallopian tube with the vascular forceps to suppress the muscle layer and endometrium. Remove the vascular forceps and use No. 4 silk suture Tie the mesangium that has been crushed, ligate the indentations, and cut the fallopian tube above the ligature.

4. Fallopian tube resection (Fimbriectomy method)

Umbrella department is easy to find and identify, can avoid mistaken tie, and the method is simpler, suitable for permanent sterilization.

Use tissue forceps to clamp the fallopian tube umbrella. The vascular forceps and the near umbrella portion of the fallopian tube are vertically clamped, including a part of the mesentery. After resection, they are sutured with a No. 4 silk thread, and then stitched with a No. 7 silk thread. Buried in the anterior leaf of the broad ligament.

5. Umbrella end embedding method

The operation is relatively simple and does not damage the physiological function of the fallopian tube. It is suitable for those who need to restore fertility in the future. At that time, the embedded umbrella end can be separated and restored to the original position.

The abdominal wall incision is about 3 ~ 4cm longer than the incision of general ligation. After entering the abdominal cavity, make a vertical incision about 2cm in length from the fallopian peritoneum near the umbrella end, and use a curved vascular forceps to extend into the incision to separate the front and back leaves. The peritoneum is about 2cm deep, and a small round needle is used to thread No. 1 silk suture through the serosal layer of the fallopian tube, one needle before and one through the serosal muscular layer. Into the separated bag, use the No. 1 silk thread to cut the suture of the peritoneum of the broad ligament and the plasma muscular layer of the fallopian tube to close the incision. The suture should not be too thin to prevent failure.

Complications of tubal ligation

Abdominal wall hematoma

Often due to bleeding or failure to treat the rectus abdominis or preperitoneal fat during surgery.

2. infection

Including abdominal wall incision infections and pelvic infections.

3. Syndrome after tubal ligation

Appeared as abdominal pain, low back pain, sexual intercourse pain. Some patients have increased or decreased menstruation or even amenorrhea.

Precautions for tubal ligation

1. The operation time should be before ovulation.

2. Surgery should be strictly performed aseptically to prevent postoperative infection, and the bleeding point should be carefully ligated to prevent bleeding and hematoma formation.

3. The thickness of the ligature should be in accordance with the prescribed standards, and the ligature should be moderately tight to avoid causing fallopian fistula or slippage.

Nursing after tubal ligation

1. You can go to the ground on the day of surgery.

Pay attention to urinate within 2.4 to 6 hours to avoid urine retention.

3. Can enter semi-liquid or ordinary diet.

4. Keep the wound locally hygienic and clean after surgery, and avoid sexual life within 2 weeks.

5. Post-abortion, post-induction, post-partum sterilization at the same time, should not have sex and tub bath within 1 month after surgery or before bleeding is clear.

6. Avoid heavy physical labor or strenuous activities.

7. One review and one review after 3 months.