Difference between revisions of "Tubal ligation"
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{{Infobox surgical procedure | {{Infobox surgical procedure | ||
| anesthesia_type = | | anesthesia_type = Neuraxial or general | ||
| airway = ETT | | airway = ETT/LMA if general | ||
| lines_access = | | lines_access = PIV | ||
| monitors = Standard | | monitors = Standard | ||
| considerations_preoperative = Full stomach precautions in postpartum patients | | considerations_preoperative = Full stomach precautions in postpartum patients | ||
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}} | }} | ||
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. | 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. | 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. | ||
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=== 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. --> === | === 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 | * 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 | * T4 level required for procedure | ||
* Spinal anesthesia can also be utilized | * Spinal anesthesia can also be utilized | ||
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[[Category:Surgical procedures]] | [[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 | |
| 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