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{{Infobox surgical procedure
| anesthesia_type = Neuraxial or general
| airway = ETT/LMA if general
| lines_access = PIV
| monitors = Standard
| considerations_preoperative = Full stomach precautions in postpartum patients
| considerations_intraoperative =
| considerations_postoperative =
}}


A '''tubal ligation''' is a surgical procedure for female sterilization that involves severing and tying the fallopian tubes. Most are done laparoscopically, but at times it is performed during a C-section while the uterus is externalized. Some are done 8 hours post-partum. Recently, a transcervical method has emerged which can be performed in the doctor's office.
This procedure is 99% effective in the first year, but fallopian tubes can rarely reform or reconnect. Of those failures, 15-20% of pregnancies are likely to be ectopic.
== Preoperative management ==
=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|Airway challenges of pregnancy occur during postpartum procedures
|-
|Neurologic
|
|-
|Cardiovascular
|
|-
|Pulmonary
|
|-
|Gastrointestinal
|Postpartum patients should be considered full stomach
Patients should be NPO through labor and postpartum until time of surgery
|-
|Hematologic
|
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|
|}
=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===
* None
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
* Timing can be intrapartum (during C-section) or at least 8 hours postpartum
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
* Epidural from delivery can be utilized
**93% of epidural catheters were functional for postpartum tubal ligation within 1-4 hours of delivery
**Only 68% of catheters were functional during hours 5-8 after delivery.
* T4 level required for procedure
* Spinal anesthesia can also be utilized
== Intraoperative management ==
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
* Standard monitors
* 20G PIV
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
* Supine for all laparotomy/laparoscopic procedures
* For transcervical procedures, lithotomy position utilized
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
== Postoperative management ==
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
* Bleeding
* Infection
* Damage to bowel, bladder, major vessels
* Prolonged abdominal or pelvic pain
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==
{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Laparoscopic
!Mini-laparotomy
!Post-Partum
!Transcervical
|-
|Anesthetic
|GA/ETT or spinal (T4 sensory block)
|GA/ETT or spinal (T4 sensory block)
|Epidural, spinal, or GA
|GA/LMA
|-
|Position
|Supine
|Supine
|
|Lithotomy, may need slight Trendelenburg
|-
|Surgical time
|15-45 mins
|15-45 mins
|
|In office, usually 30 mins
|-
|EBL
|Minimal
|Minimal
|Minimal
|Minimal
|-
|Postoperative disposition
|
|
|
|Home
|-
|Pain management
|
|
|
|
|-
|Potential complications
|
|
|
|
|}
== References ==
[[Category:Surgical procedures]]
[[Category:Obstetric and gynecologic surgery]]

Latest revision as of 23:40, 4 April 2022

Tubal ligation
Anesthesia type

Neuraxial or general

Airway

ETT/LMA if general

Lines and access

PIV

Monitors

Standard

Primary anesthetic considerations
Preoperative

Full stomach precautions in postpartum patients

Intraoperative
Postoperative
Article quality
Editor rating
In development
User likes
0

A tubal ligation is a surgical procedure for female sterilization that involves severing and tying the fallopian tubes. Most are done laparoscopically, but at times it is performed during a C-section while the uterus is externalized. Some are done 8 hours post-partum. Recently, a transcervical method has emerged which can be performed in the doctor's office.

This procedure is 99% effective in the first year, but fallopian tubes can rarely reform or reconnect. Of those failures, 15-20% of pregnancies are likely to be ectopic.

Preoperative management

Patient evaluation

System Considerations
Airway Airway challenges of pregnancy occur during postpartum procedures
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal Postpartum patients should be considered full stomach

Patients should be NPO through labor and postpartum until time of surgery

Hematologic
Renal
Endocrine
Other

Labs and studies

  • None

Operating room setup

Patient preparation and premedication

  • Timing can be intrapartum (during C-section) or at least 8 hours postpartum

Regional and neuraxial techniques

  • Epidural from delivery can be utilized
    • 93% of epidural catheters were functional for postpartum tubal ligation within 1-4 hours of delivery
    • Only 68% of catheters were functional during hours 5-8 after delivery.
  • T4 level required for procedure
  • Spinal anesthesia can also be utilized

Intraoperative management

Monitoring and access

  • Standard monitors
  • 20G PIV

Induction and airway management

Positioning

  • Supine for all laparotomy/laparoscopic procedures
  • For transcervical procedures, lithotomy position utilized

Maintenance and surgical considerations

Emergence

Postoperative management

Disposition

Pain management

Potential complications

  • Bleeding
  • Infection
  • Damage to bowel, bladder, major vessels
  • Prolonged abdominal or pelvic pain

Procedure variants

Laparoscopic Mini-laparotomy Post-Partum Transcervical
Anesthetic GA/ETT or spinal (T4 sensory block) GA/ETT or spinal (T4 sensory block) Epidural, spinal, or GA GA/LMA
Position Supine Supine Lithotomy, may need slight Trendelenburg
Surgical time 15-45 mins 15-45 mins In office, usually 30 mins
EBL Minimal Minimal Minimal Minimal
Postoperative disposition Home
Pain management
Potential complications

References

Top contributors: Olivia Sutton and Chris Rishel

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