Special Surgical Procedures II
LESSON 2: Procedures in Gynecological and Obstetrical Surgery
2-43
2-43. TUBAL LIGATION
a. General.
(1) This operation is the interruption of fallopian tube continuity, resulting in sterilization of the patient. In general, the indications for sterilization can be divided into three groups: psychiatric, medical, and obstetrical and gynecological. Evaluation and recommendation of sterilization is made by the attending physician. A sterilization permit and a procedure consent form must be signed by both the husband and wife.
(2) The optimum time for sterilization is approximately 24 hours after vaginal delivery, but an objection to this is that the danger of hemorrhage still exists soon after delivery. If a cesarean section is done, the tubes are ligated at this time; with a normal delivery, tubal ligation is done on the first to third postpartum day.
b. Patient Preparation. The patient is placed in a supine position and a catheter placed in the bladder. Skin prep and draping is as for laparotomy.
c. Operative Procedure.
(1) The location of the fundus is determined, and a midline incision is made approximately 2 inches below it. The abdomen is opened in the usual manner.
(2) Each tube is delivered and grasped with two Babcock forceps and clamped with two Crile forceps.
(3) The section between the Babcock forceps is resected with Metzenbaum scissors and saved as a specimen. Each tube is doubly ligated with silk sutures number 2-0 about I inch from the uterine cornu. The sutures on the proximal end of the tube are left long. This tubal stump is then mobilized by dissecting it free from the mesosalpinx.
(4) A very small cut is made in the serosa on the posterior surface of the uterus near the cornu, and the musculature is penetrated with a Crile forceps for about 1/2 inch, spreading the clamp sufficiently to admit the tube.
(5) One of the ligatures attached to the tubal stump is threaded on a needle, sutured to the bottom of the pocket and carried out to the uterine surface. The other suture attached to the tubal stump is treated in a similar manner. Traction is placed on the sutures, thus the tubal stump is buried in the uterine musculature.
(6) The sutures are tied together, and silk sutures number 4-0 are used to close the edges of the pocket more tightly about the tube. The end of the tube may also be buried within the leaves of the broad ligament.
(7) The abdominal incision is closed in layers and the wound dressed.
