Tubal Sterilization, Office Procedure, Or The Old Fashioned Way?

Right fallopian tube getting a laparoscopic cautery sterilization
A healthy left fallopian tube undergoing laparoscopic sterilization, the instrument is holding the tube, the white blanch is the tube being heated so that it will seal closed, and a  normal left ovary is shown next to the tube
Once you've make the decision not to have more children using some type of long term contraception definitely simplifies life. For many women, once they have had their children, they still want to retain fertility, so that the Implanon (now they have updated, and most of us use Nexplanon) device or Intrauterine devices Mirena and ParaGard are good choices as they last for many years and can successfully prevent pregnancy a high percentage of the time. For others however, if you are sure you do not want children then tubal sterilization is the solution.For most women getting the Essure procedure is going to be a better choice than the old fashioned surgeries shown here. At Women's Health Practice we perform same day office surgeries for the Essure, and it is now being covered 100% by most insurance companies. When women are deciding to have an open procedure or a procedure that does not involve cutting your abdomen, there are many factors to consider. These pictures are of an old fashioned tubal ligation, and this woman has normal anatomy and healthy tubes, she likely just wanted sterilization; and the office Essure is what our gynos recommend. Once the tubes are either sealed or cut a woman doesn't need additional contraception and it is most likely you will have no new gynecological symptoms either. But some women will develop pains or other problems after sterilization and the question may be why. Endometriosis, exactly in a small foci, at the cut boarder of the fallopian tubes has been seen after sterilization and this might be one thing to consider if you newly have symptoms after a successful tubal ligation procedure with no complications at the time. The theory is that endometriosis can develop because there is greater access of blood from these cut surfaces and perhaps this tissue was more likely to implant on the healing surface of where the cuts were made. Although the methods of Essure (in the past there was also Adiana transcervical sterilization techniques) hasn't been with us long, the fact that the fallopian tubes remain intact, and inserts are only on the inside of the uterus, should reduce the chances of new endometriosis from occurring. For both types of sterilization techniques: whether the laparoscopic operating and cutting vs the tubal block techniques, both should reduce that back flow of lining debris that we think is also causative of endometriosis. Gynos have also seen less ovarian cancer after ligation of the fallopian tubes. In fact the Canadian Society of Gynecologic Oncology has issued a position paper in 2011 that specifically states that women should be offered tubal removal at the time of hysterectomy in order to prevent ovarian cancer. Since the Essure seals the tubes, we anticipate some of the same non-contraceptive benefits as older methods. So there's another reason to consider sterilization once you've made your decisions. If you have received an Essure, yet you are having unexplained pains or concerns. It is possible to have bilateral tubal removal and removal of the coils at the same time. It's not a procedure done frequently, but it can be done on an outpatient basis with a relatively quick recovery.


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