Female Surgical Sterilization

Sterilization is a permanent method of birth control. To avert pregnancy, the female egg and the male sperm should be prevented from fusing. This can be done in women through two female sterilization methods; tubal ligation (surgical) and hysteroscopic sterilization, an essure procedure (non-surgical). Tubal ligation is considered to be a safe, reliable and highly effective form of female sterilization. The surgery is done to close a woman’s fallopian tubes. Two common methods of tubal ligation are:

Minilaparotomy: It involves making a small incision in the abdomen. The fallopian tubes are brought to the incision in order to be cut or blocked. The purpose of the procedure is to obstruct the fallopian tubes. Mini laparotomy is easier when done right after childbirth (post-partum period). It can also be done as a non-pregnancy related procedure. Minilaparotomy is considered to be a quick, highly effective, safe outpatient procedure that can be performed under local anesthesia.

Laparoscopy: It involves making a small incision just under the navel and inserting small, thin instruments to perform the procedure. Also termed as 'getting your tubes tied', herein a woman’s fallopian tubes are cut, clamped, blocked or tied with rings, bands or clips to prevent her eggs from traveling down to the uterus from the ovary. The procedure also restricts the male sperm from reaching the fallopian tube to fertilize an egg. An outpatient surgery which is done by administering local anesthesia, the patient may return home the same day and resume normal activities after a week. Slight stomach or shoulder pain, feeling dizzy, nauseated, bloated or gassy are possible symptoms that are likely to last for a few days after the surgical procedure.

Male Surgical Sterilization

Sterilization is a permanent method of birth control. To avert pregnancy, the male sperm and the female egg should be prevented from meeting. This can be done in men through vasectomy, male surgical sterilization procedure. The surgery involves removing a portion of vas deferens or vasa, the tubes that carry sperm from the testicles into the urethra. The vasa are tied, cut, clipped or sealed to prevent the release of sperm. Vasectomy ensures that no sperm passes through and gets released to fertilize a woman's egg during sexual intercourse.

An outpatient surgery, vasectomy is the safest and easiest form of male surgical sterilization. Local anesthesia is administered to numb the scrotum region. A very small hole is made on one side of the scrotum to pull out part of the vas deferens. A small section of the vas deferens will be removed. The procedure will be repeated on the other side of the scrotum. The hole is very small and requires no stitches. In about two weeks the area will appear normal as before. Within a day or two it would be possible for men to resume normal activities. To resume sex, it would be best to wait for two semen tests post surgery as it takes time to clear remaining sperm in the tubes.

Post surgery, it is normal to experience some mild discomfort, swelling and bruising of the scrotum for a few days. Painkillers prescribed by the health care provider will provide relief from associated discomfort. Spermatic granuloma’s, congestive epididymitis and in very rare cases long lasting pain are some of the long term after effects experienced by men post vasectomy.

Pomeroy technique

Named after Dr. Ralph Pomeroy, Pomeroy technique is a process of tubal ligation i.e. removal of a portion of the fallopian tube. It is a sterilization procedure for women devised by Dr. Ralph Pomeroy at the end of the 19th century and start of the 20th century. This procedure is still popular as it is an effective yet simple method to block the fallopian tubes.

The Pomeroy Technique

The technique adopts a simple yet effective procedure for tubal legation.

• In this technique, part of the tube (proximal portion of the tubal ampulla) is elevated so as to create a loop or a knuckle.
  
• An absorbable ligature (suture material) is tied around the base of the elevated part, and the tubal segment is cut out.
  
• Within a few days, the peritoneum, i.e. tissue that lines the organs of the abdominal cavity, grows and covers the severed ends of the tubal section.
  
• As the ligature dissolves, the severed ends of the fallopian tube separate from one another.
  
• The fallopian tubes remain separate without reattaching because of the above mentioned separation and the peritoneal covering.
  
• Eggs cannot travel down the separated fallopian tube, and so the woman does not get pregnant.

Variations of the technique include the following. These variations determine the length of the tubal segment that can be repaired from the remaining tube.

• Length of the tube that is tied up and cut.
  
• Location of the tube where it is going to be tied and cut.
  
• Number of ligatures placed around the tube.
  
• Type of ligatures placed around the tube.
  
• If the cut ends are crushed or coagulated.

There are many advantages of the modified Pomeroy technique. In rare cases, the severed ends drift back together and heal, or the suture does not dissolve and the fallopian tube becomes connected again.

The Pomeroy procedure is:

• Simple to perform
  
• Highly effective depending on the length of the tube removed
  
• Pomeroy ligation technique leaves two healthy segments of the fallopian tube which can be rejoined, if required through a tubal legation reversal surgery.
  
• Successful reversal rates are quite high; about two thirds of the women become pregnant following reversal of this procedure.
  
• Prior to tube reversal, the length of the tube that has been removed can be determined from the tube legation report.
  
• Procedure can be performed vaginally, abdominally or through laparoscope.
  
• Minimal complications.