Background Information:

What are the other Names for the Procedure?

• Fallopian Tube Tying
• Sterilization Surgery for Females (Tubal Ligation)
• Tying the Fallopian Tubes

What is the Tubal Ligation surgical procedure?

Tubal Ligation is a sterilization surgical procedure that involves closing or sealing a woman’s fallopian tubes to prevent unwanted pregnancies.

What part of the Body does the Procedure involve?

A Tubal Ligation procedure involves the fallopian tubes.

Why is the Tubal Ligation surgical procedure Performed?

A Tubal Ligation procedure is performed to prevent unwanted pregnancies.

What are some Alternative Choices for the Procedure?

Alternative methods of birth control include the use of oral contraceptive pills and barriers such as condoms. Additionally, male sterilization (vasectomy) surgery may be performed on the partner too.

What are the Recent Advances in the Procedure?

Minimally-invasive surgical techniques for Tubal Ligation procedure have undergone further refinement.

What is the Cost of performing the Tubal Ligation surgical procedure?

The cost of Tubal Ligation procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Tubal Ligation procedure and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

Prior to Tubal Ligation surgical procedure:

How is the  Tubal Ligation surgical procedure Performed?

The Tubal Ligation procedure may be performed under general or spinal anesthesia.

• The surgeon usually carries out Tubal Ligation using a minimally-invasive technique (laparoscopy)
• The surgeon makes multiple small incisions on the abdomen to introduce a laparoscope (tube fitted with a camera) and surgical instruments
• The fallopian tubes (thin tubes on either side of the upper end of the womb) are identified
• The tubes are blocked using heat, using clips, or a ring (a band) is placed around each of the tubes
• Sometimes, the surgeon opens the abdomen using a larger incision known as a laparotomy. After dissecting through the layers, Tubal Ligation is performed and the abdomen is again closed in layers

Where is the Procedure Performed?

The Tubal Ligation surgical procedure is performed at an out-patient surgery center facility or in a hospital.

Who Performs the Procedure?

A general surgeon or an obstetrician-gynecologist performs a Tubal Ligation procedure.

How long will the Procedure take?

The Tubal Ligation procedure may take up to a half an hour to perform.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Tubal Ligation procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Tubal Ligation procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Tubal Ligation surgical procedure?

Before a Tubal Ligation procedure, the patient has to undergo certain tests such as:

• Routine blood and urine analysis
• Other tests as may be requested by the healthcare provider

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Tubal Ligation surgical procedure?
• How will this procedure help?
• Will the procedure in any way impair my mobility?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• Are there any complications after the procedure or during recovery?
• How long will it take to recover? When can I resume normal work?
• Are there any lifestyle restrictions or modifications required after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
• How many such procedures have you (the physician) performed?
• What are the costs involved?

During the Tubal Ligation surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia by injection, spinal anesthesia by injection, or general anesthesia by injection and inhalation are administered for this procedure.

How much Blood will you lose, during the Procedure?

There is not much blood loss during an uncomplicated Tubal Ligation procedure.

What are the possible Risks and Complications during the Tubal Ligation surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
• Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders and chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Tubal Ligation surgery are:

• Excessive bleeding
• Infection within the surgical wound
• Anesthetic complications
• Accidental damage to surrounding structures

What Post-Operative Care is needed at the Healthcare Facility after the Tubal Ligation surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise. 

After the Tubal Ligation surgical procedure:

What are the possible Risks and Complications after the Tubal Ligation surgical procedure?

The possible risks and complications that may arise after a Tubal Ligation are:

• Excessive bleeding
• Excessive diarrhea
• Infection within the surgical wound
• In very rare cases, the sterilization procedure may fail

What is the Prognosis after the Surgery?

The prognosis after a Tubal Ligation procedure is usually good.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain that worsens and swelling of the surgical wound
• Bleeding or fluid drainage from the surgical wound
• The occurrence of any symptom that causes uneasiness such as nausea, vomiting, abdominal swelling, or constipation
• Signs of an infection
• Headache, muscle aches
• Dizziness
• Fever, feeling sick
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Tubal Ligation surgical procedure?

At home, the following post-operative care is recommended after the Tubal Ligation procedure:

• Slowly resume regular/daily activities as early as possible, which aids in a faster recovery
• Use a heat pad or warm compress to relieve pain due to the incision
• Use alternative method of birth control until the next menstrual period, in case ovulation has already occurred
• Complete the course of prescribed medication, as advised by your physician
• Take stool softeners to prevent constipation, as advised by your physician
• Take antibiotic medication to help combat or prevent infection, per your physician’s advice
• Avoid taking nonprescription medications such as aspirin. However, individuals may take acetaminophen to relieve pain (per the physician’s advice)
• Resume driving only after 3 days of being discharged from the healthcare facility, or as advised by your physician
• Avoid sex until complete healing has taken place (under advise by the physician)
• Individuals are advised to have clear liquids immediately after surgery until the gastrointestinal tract begins properly functioning. They may then proceed to eat a well-balanced diet, which can aid in a faster recovery

How long does it normally take to fully recover, from the Procedure?

Complete recovery from a Tubal Ligation procedure may take 4-7 days.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The Tubal Ligation procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient

Who will you receive a Bill from, after the Tubal Ligation surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• An out-patient surgery center facility or a hospital
• An anesthesiologist
• General surgeon or an obstetrician-gynecologist

The patient is advised to inquire and confirm the type of billing, before the Tubal Ligation surgical procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA