Tubal surgeries related to family planning include tubal sterilization and tubal anastomosis.
Tubal Sterilization
The fallopian tube serves as the pathway where eggs are fertilized by sperm and the fertilized egg is transported to the uterus. Tubal sterilization refers to a procedure or drug-induced blockage of the fallopian tubes to prevent sperm and eggs from meeting, thereby achieving sterilization. It is a safe and permanent form of contraception that can be performed via laparoscopy, laparotomy, or vaginal surgery. Laparoscopic tubal sterilization is currently the preferred method.
Indications
These include:
- Women voluntarily seeking sterilization and without contraindications.
- Women with severe systemic diseases unsuitable for childbirth.
Contraindications
These include:
- Two consecutive temperature measurements of ≥37.5°C within 24 hours.
- Poor general health, such as cardiorespiratory insufficiency or hematologic disorders, rendering the patient unable to tolerate surgery.
- Severe neurosis.
- Acute phase of various diseases.
- Active abdominal skin infections, acute or chronic pelvic inflammation.
- Abdominal adhesions, diaphragmatic hernia, or other conditions requiring laparotomy.
Preoperative Preparation
For non-pregnant women, surgery is performed 2–7 days after menstruation. For breastfeeding or amenorrheic women, early pregnancy must be excluded before sterilization.
Addressing psychological concerns, providing explanations, consultation, and obtaining informed consent.
Taking a detailed medical history and performing physical, gynecological, and cardiopulmonary examinations are required. Laboratory tests include routine vaginal discharge analysis, blood and urine tests, coagulation function, liver function, etc.
Surgical Steps
Surgery is performed under epidural or general anesthesia, with the patient in a Trendelenburg position. A 1-cm incision is made below the umbilicus to insert a Veress needle, inflate the abdominal cavity with 2–3 liters of CO2, and place a trocar for the laparoscope. Under laparoscopic guidance, tubal occlusion is achieved by methods such as segmental tubal excision, application of spring clips, or placement of silicone sterilization rings at the isthmus of the fallopian tube. Bipolar electrocautery may also be used to cauterize the isthmus. Failure rates for different techniques vary: bipolar electrocautery has the lowest recanalization failure rate (0.19%), silicone rings have a rate of 0.33%, and spring clips as high as 2.71%. Mechanical methods cause less tissue damage compared to electrocautery, potentially improving success rates for future tubal recanalization. Based on the theory that ovarian cancer originates from the fallopian tubes, opportunistic salpingectomy instead of tubal blockage may reduce the risk of ovarian cancer.
Postoperative Care
These include:
- Bed rest for 4–6 hours, after which light activities can be resumed.
- Monitoring vital signs for any changes.
Postoperative Complications
Complications are rare but may include:
- Hemorrhage or Hematoma: Resulting from excessive traction on the fallopian tube or injury to mesosalpinx vessels, potentially causing intra-abdominal bleeding or hematoma formation.
- Infection: Including local or systemic infections due to pre-existing infections, inadequate sterilization, or insufficient adherence to aseptic techniques.
- Injury: Situations involving unclear anatomical structures or improper handling may lead to damage of the bladder, ureter, or bowel.
- Tubal Recanalization: Post-sterilization recanalization has a rate of 0.2%–2%.
Advantages of laparoscopic tubal sterilization include shorter operative time and faster recovery. Open tubal sterilization methods such as segmental excision with embedding, silver clip application, or tubal ligation with resection are less commonly performed alone and are usually done concomitantly with other surgeries.
Tubal Anastomosis
Tubal anastomosis, also known as sterilization reversal or tubal recanalization, involves surgical intervention to restore fertility in women who previously underwent tubal sterilization. The procedure removes the ligated or blocked segments of the tube and reconnects the two ends after preparation. Depending on the location of the blocked segment, methods such as end-to-end anastomosis, angled suturing, funnel-shaped suturing, or sleeve suturing may be employed. The procedure is suitable for women with functional fertility and good health, as well as healthy partners.
Increased precision and success rates can be achieved by performing the surgery under magnification using loupes or a surgical microscope. To minimize adhesions caused by tissue trauma, modern advancements in laparoscopic and robot-assisted minimally invasive techniques have largely replaced conventional open microsurgical tubal anastomosis.
Surgical Procedure
The procedure involves exposing and examining the status of both fallopian tubes. The blocked segment is identified by injecting dye through the fimbrial end. The serosal layer of the tube at the blockage is incised, and the internal core is freed for about 0.5 cm, followed by excision of the ligated section and surrounding scar tissue. A stent is inserted through the fimbrial end into the proximal tubal lumen, and dye is injected to confirm patency. Layered suturing is performed, starting with interrupted sutures for the muscularis of the fallopian tube, followed by closure of the serosal layer.