TYPES OF TUBAL LIGATIONS

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Types of Sterilizations:

Before discussing current rates of success, it is of use to first go over

the various types of sterilization procedures, as the type of procedure has

a lot to do with the likelihood of a successful reversal. While there are

some minor variations to the different types of sterilization, there are

essentially three (3) major methods in current use. These methods are:

1. Pomeroy method. This procedure is the typical " cut and tie " method. It is

typically done at the time of a C-section or on the first day after a

vaginal delivery. However, it can also be done at a later date months or

years later. In order to tell if this technique was used, you should look

for a 1 to 2 inch incision, generally below the navel, that was used to

remove a portion of the tube. The method usually involves cutting out about

½ to 1 inch from the center of the fallopian tube and tying off the cut

ends. The advantage of this method is that the remaining tube both

" up-stream and down-stream " is left in good physiologic health. The

potential disadvantage is that the surgeon may cut out too much tube and

thus lower the chances of a successful reversal. Overall, women who have

been sterilized using the Pomeroy method are the second most likely group to

have successful reversals.

2. Laparoscopic cauterization (LTC). This procedure is generally done as an

interval procedure, in other words, not at the time of a delivery. The

method involves inserting a small telescope through the belly wall just

below the navel. The tube is grasped in the middle and usually about ½ to 1

inch is burned until the tube separates into two halves. For the purposes of

sterilization, this technique offers many advantages, as it is a quick and

easy out-patient procedure that most women fully recover from within a day

or two. Unfortunately, in term of sterilization reversals, this method

leaves us with some deleterious effects. The heat from the cauterization

spreads both " up-stream and down-stream " , leaving the remaining tube in a

compromised physiological state. If you have been sterilized using this

technique, don’t be discouraged, as even the majority of these patients are

able to conceive. Our office has done pioneering work in the United States

by even reversing the more difficult triple burned tubes with many

successful pregnancies resulting

3. Laparoscopic banding, clamping or clipping. These three procedures are

all very similar. Like the LTC, cautery type of procedure, they are done as

interval procedures. These methods involve inserting a small telescope

through the belly wall just below the navel. The tube is grasped in the

middle and a silastic (rubber) band, Hulka clip or metal clip is used to

pinch off a very small part of the tube. Each of these devices is similar to

putting a clothes pin on the tube and squeezing it off. After several days,

the pressure of the device causes the tube to separate into two separate

halves. The advantage of this procedure is that the tube is left in

wonderful condition both from the standpoint of amount of tube remaining as

well as the superb physiologic state of the tissue. In fact, there are

really no disadvantages to this procedure, as it is virtually impossible for

the surgeon to remove too much tube with these three methods. These

procedures yield the highest rates for successful reversals

Taken from www.babies-by-levin.com

Hart

Wife to Jon, Love of My Life

Mom to 4:

Arianne (16) ~ a(7)

(4) ~ (My TR Baby - born 6/20/02)

Glory to God and Many Thanks to Dr. Levin

http://www.geocities.com/thehartclantx/Thehartclantx.html