Permanent methods ofxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx.pptx

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1. Permanent methods of Contraception

2. Permanent methods of contraception is suitable for those who have completed their families and do not want to use temporary method. It includes Tubectomy Vasectomy

3. Tubectomy

4. Timing of sterilisation Postpartum or puerperal sterilization It can be done after 24 hrs and up to 7 days of delivery It should not be done after 7 days because access to tubes becomes difficult. Bacteria are often present in the tubes which increases the risk of infection . Interval sterilisation This can be done at any time in a non pregnant woman or 6 weeks after delivery. It should be done within 7 days of menses to avoid the risk of pregnancy. Postabortal sterilisation This can be performed within 7 days following an induced following an induced abortion or after evacuation of the uterus in incomplete abortion .

5. Concurrent with other surgery Tubal ligation can also be carried out along with caesarean section, salpingectomy.

6. Surgical Approach Minilap Tubectomy The patient is asked to void urine just before the procedure. It is done under local anesthesia . In the case of postpartum sterilisation, the abdomen is opened by a 2-3cm subumbilical incision 2cm below the fundus Interval minilap is performed with 2-3cm transverse suprapubic incision 2.5cm above the pubic symphysis. The abdomen is opened and tubal ligation is performed by Pomeroy’s technique The tubes should be identified by fimbrial end.

7. Modified Pomeroy’s technique A loop of fallopian tube is formed 2cm lateral to the uterine fundus using Babcock forceps. A round bodied needle with 0 chromic catgut is passed through the mesosalpinx.the base of the loop is tied leaving about 2cm of loop above the tie. Then about 1.5cm of the loop isremoved The stumps are carefully inspected to ensure hemostasis. The rationale of the procedure is that since catgut suture is used, there will be prompt absorption of the ligature and subsequent

8. separation of the cut ends. Parkland Procedure After identifying the tube, an avascular area in the mesosalpinx adjacent to the tube is perforated with artery forceps and the jaws opened to separate the tube from the mesosalpinx for 2.5cm. The freed tube is doubly ligated proximally and distally 2.5cm apart with 0 chromic catgut and then the intervening portion is excised. The advantage is that the approximation of the cut ends of tube is avoided.

9. Madlener Procedure Here, a knuckle of the tube is crushed at the base and ligated with silk There is no resection. The failure rate is high. Fimbriectomy It involves removal of distal tube. The failure rate is high and chance of reversal is poor

10. Irwing Techniqe The tube is doubly ligated with 0 chromic catgut about 2.5cm from the uterine cornua and then tied. The medial end is mobilised and a small tunnel made on the posterior surface of the uterus near the cornua . The medial stump is then buried in this tunnel. The tunnel is closed over the stump with catgut. The distal end is buried in the mesosalpinx.

11. Uchida Techniqe In this method, saline with epinephrine is injected in the mesosalpinx and then the tube is separated from the serosa. The mesosalpinx is cut open and the tube pulled out to form a loop. Then the tube is cut between clamps. The medial end is dissected free and after removing 5cm of the tube, the medial stump is buried in the mesosalpinx, which is then closed. The lateral stump is ligated and kept outside the mesosalpinx.

12. Aldridge Method A hole is made in the anterior leaf of the broad ligament and the fimbrial end is buried into this. Schrodkar Method Shirodkar method consists of turning the cut ends in opposite direction so that spontaneous recanalization does not occur.

13. Complications Anesthetic hazards Bowel and bladder hazards Injury to tubes and ovaries Broad ligament hematomas Wound sepsis Urinary infections Pelvic infection Peritonitis

14. Laparoscopic sterilisation Laparoscopic sterilisation is usually performed in the interval period. It is performed at the end of a menstrual period or soon after the period It is not recommended postpartum or after abortion. Advantages Permits direct visualization and manipulationof pelvic organs Associated pelvic and abdominal abnormality can be detected Hospitalisation not required Needs less time Minimal post operative pain