Tubal ligation is the general term for any surgical procedure that blocks the fallopian tubes to prevent pregnancy.
Sperm enter the fallopian tube through the uterus, and eggs enter from the ovarian or fimbrial end of the tube. When the fallopian tubes are blocked, sperm and eggs are kept apart and fertilization is prevented.
Ligation means to apply a ligature or tie, and tubal ligation is often called "tying" the tubes. Many people picture tying a fallopian tube like tying a shoe lace or a bow, and wonder why the tube can't simply be untied to restore fertility.
Pomeroy Tubal Ligation: Tied and Cut
Tubal ligation and resection (removal) of a portion of the fallopian tube is the most frequent method of blocking the tubes. This involves tying a segment of tube and removing it. There are many variations of this technique. The tubal ligation procedure described by Dr. Ralph Pomeroy a century ago is most commonly used today.
With the Pomeroy method of tubal ligation, part of the tube is elevated to create a loop or knuckle. An absorbable ligature is tied around the base of the elevated segment, and the tubal segment is cut out.
Within a few days, the peritoneum (tissue that lines the organs of the abdominal cavity) grows over and covers the cut ends of the tubal segments. The cut ends of the fallopian tube separate as the ligature dissolves. The peritoneal covering and separation of the remaining tubal segments prevent them from re-attaching to each other.
Doctors like the Pomeroy procedure because it is simple and effective. Pomeroy tubal ligation is most often performed after delivery by cesarean section.
Tubal Ligation with Tubal Rings or Tubal Clips
Tubal rings and tubal clips are mechanical methods of tubal ligation applied to the fallopian tubes through a laparoscope.
The tubal ring (also called the Falope ring, Yoon ring, or Lay loop) is a small silastic band placed around a loop of the fallopian tube. With this method of tubal ligation, a 2-3 cm segment of fallopian tube is drawn inside a narrow cone-shaped applicator. The silastic ring (that previously has been stretched over the outside of the applicator) is then released onto the tubal loop. As the ring contracts due to its elasticity, it constricts the base of the loop and blocks the fallopian tube. Deprived of its blood supply, the constricted loop is replaced with scar tissue, and the remaining healthy tubal segments separate, similar to the Pomeroy tubal ligation method.
Far upper left is a healthy uterus without rings. Then ring added to left, and then to right side, and final picture with rings on both fallopian tubes.
The spring clip or Hulka Clip also causes mechanical obstruction of the fallopian tube. When open, the hinged clip made of plastic with a gold spring lock, is placed across the narrow muscular or isthmic segment of the fallopian tube close to the uterus. When the clip is compressed, the spring locks the clip tightly across the tube. Because of its narrow width (7 mm), the tubal clip damages the least amount of fallopian tube of any tubal ligation method.
Another tubal clip is the Filshie clip that is made of titanium and silastic.
Photo of two filshie clips, one on each fallopian tube.
Bipolar Coagulation
Bipolar tubal coagulation is the most popular method of laparoscopic female sterilization in the United States. With this method of tubal ligation, the fallopian tube is grasped between two poles of electrical conducting forceps, and electrical current passes through the tube between the two ends of the forceps. Damage to the tube is limited to the segment between the forceps. Often, two or three adjacent sites are coagulated resulting in loss of approximately 2-3 cm of fallopian tube.
