3. TIMING OF STERILISATION
1. Postpartum sterilisation
• After 24 hrs to 7 days of delivery
2. Interval sterilisation
• Non preg , >6 weeks, within 7 days of menses
3. Postabortal sterilisation
4. Caesarean sterilisation
• Laparoscopic tubal ligation –not recommended? when?
*tubes are vascular & oedematous , may get torn easily
4. CASE SELECTION
• Females – 22 to 45 yrs (male – below 60y)
• Married
• Atleast one child , above one yr
• Sound state of mind
• Mentally ill patients - psychiatrist & legal guardian
5. Delay procedure….
• Suspected pregnancy
• 7-42 days postpartum
• Active pelvic infection/ peritonitis
• PID within 3M
• STD
• Active liver/gall b disease
• Cerebrovascular/ CAD
• Complicated heart diseases
• Severe anemia
• Psychiatric disorder
• Multiple scars of prev laporotomies
6. • Pregnancy conditions-
• Puerperial sepsis
• PROM >24 hrs
• Postpartum Psychosis
• Severe trauma to genital tract
• Recent septic abortion
• Severe post abortal hemorrhage
• Pre ecclampsia/ ecclampsia
11. MINI LAPAROTOMY
• Post partum, post abortal, or interval period.
• Interval sterilisation –
• Empty stomach , void urine
• Local anaesthesia
• Premedication – meperidine, promethazine
• Uterine manipulator
• 2-3cm transverse suprapubic incision, 2.5cm above.
12. Post partum sterilisation
• local anaesthesia
• 2-3 cm subumbilical incision, 2cm below the fundus
• Tube identified by the fimbrial end
• Tubal ligation done using modified Pomeroy’s method /
clips or rings
• Kept for observation for 4 hrs,discharged
• Antibiotics & analgesics are given
26. • Lithotomy position
• Local anaesthesia
• Bladder catheterised, uterine manipulator applied
• Trendendeleburg position ( head down 15o ) after placing
first trocar
• Entering abdominal cavity –
1. Veress needle
2. Direct trocar
3. Open laparoscopy
37. COMPLICATIONS
• Anaesthetic complications
• Injury of large vessels
• Bleeding from epigastric vessels – trocar
• Tearing of mesosalpinx & hemorrhage
• Bowel injury
• Thermal burns
• Surgical & Mediastinal emphysema
38. CONTRA INDICATIONS
• Severe cardio pulmonary disease
• Prior abdominal surgery
• Postpartum sterilisation
• Extreme obesity, umbilical hernia
Laparoscopy best used for interval sterilisation or
following abortion of less than 12 weeks.
43. • Due to –
• Recanalisation
• Incomplete division
• Incomplete occlusion
• Ligation of round ligaments in place of tubes
• Presence of early pregnancy
44. REVERSAL
• Micro surgical anastomosis
• Depends upon –
• Type of procedure
• Length of tube remaining
• Associated conditions like endometriosis, post op adhesions
affecting infertility