Answer
The risk of complication with postpartum minilaparotomy and tubal ligation is low. As with all surgery, there is some risk associated with anesthesia. These risks are generally low, but they depend on the method and route of anesthesia used.
Some of the most serious complications occur during entry into the abdomen. A patient with a history of abdominal surgery or pelvic infection may be at greater risk of complication upon abdominal entry and result overall in a more difficult surgery. Additionally, care must be taken with the tube during the procedure, as excessive traction on the fallopian tube can lead to mesosalpingeal tearing or tubal laceration leading to intra-abdominal hemorrhage. [12] Before the start of the procedure the surgeon must assess the level of the fundus, ensuring the adnexa is adequately accessible. This will aid in decreasing risks associated with difficulty in locating structures.
Failure rates should be discussed with any patient considering postpartum tubal sterilization. One third of tubal failures will be ectopic pregnancies. Of all female sterilization procedures, postpartum partial salpingectomy has the lowest cumulative pregnancy rates: 6.3 per 1000 procedures at 5 years and 7.5 per 1000 at 10 years. [13, 14]
Despite early reports of increased menstrual abnormalities in women after tubal ligation, later analysis failed to show a significant difference in menstrual patterns in sterilized women relative to nonsterilized women. [15]
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Instruments for postpartum sterilization by minilaparotomy.
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Entering the abdomen.
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Using the Army-Navy retractors.
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Packing with a small laparotomy sponge.
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Elevation of the fallopian tube through the incision.
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Ligating the fallopian tube in the mid-isthmic region using 2-0 plain gut suture.
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Piercing the mesosalpinx with Metzenbaum scissors.
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Excising the tubal segment. Note that the tube is being held by a hemostat to avoid retraction into the abdomen after complete excision.
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Visualizing the cut ends of the fallopian tube.
