Tubal ligation (informally known as getting one's "tubes tied") is a form of femalesterilization, in

which the fallopian tubes are severed and sealed or "pinched shut", in order to
prevent fertilization.

Procedure:

There are mainly four occlusion methods for tubal ligation, typically carried out on the isthmic
portion of the fallopian tube, that is, the thin portion of the tube closest to the uterus.

 Partial salpingectomy, being the most common occlusion method. The fallopian tubes
are cut and realigned by suture in a way not allowing free passage. The Pomeroytechnique,
is a widely used version of partial salpingectomy, involving tying a small loop of the tube by
suture and cutting off the top segment of the loop. It can easily be applied vialaparoscopy.
Partial salpingectomy is considered safe, effective and easy to learn. It does not require any
special equipment to perform; it can be done with only scissors and suture. Partial
salpingectomy is not generally used with laparoscopy.[1]

 Clips: Clips clamp the tubes and inhibits blood flow to the portion, causing a small
amount of scarring or fibrosis, in turn, preventing fertilization. The most commonly used clips
are the Filshie clip, made of titanium, and the Wolf clip (or "Hulka clip"), made of plastic. Clips
are simple to insert, but require a special tool to put in place.[1]

 Silicone rings: Tubal rings, similarly to clips, block the tubes mechanically. It encircles a
small loop of the fallopian tube, blocking blood supply to that small loop, resulting in scarring
that blocks passage of the sperm or egg. A commonly used type of ring is the Yoon Ring,
made of silicone.[1]

 Electrocoagulation or cauterization: Electric current coagulates or burns a small

portion of each fallopian tube. It mostly uses bipolar coagulation, where electric current enters
and leaves through two ends of a forcepsapplied to the tubes. Bipolar coagulation is safer,
but slightly less effective than unipolar coagulation, which involves the current leaving through
an electrode placed under the thigh.[1] It is usually done via laparoscopy.

Interval tubal ligation is not done after a recent delivery., in contrast to postpartum tubal ligation.

In addition, a bilateral salpingectomy is effective as a tubal ligation procedure. A tubal ligation can
be performed as a secondary procedure when a laparotomy is done; i.e. a cesarean section. Any
of these procedures may be referred to as having one's "tubes tied."
Tubal ligation can be performed under either general anesthesia or local anesthesia (spinal
or epidural, often supplemented with a tranquilizer to calm the patient during the procedure). The
default in tubal ligations following on from cesarean birth is usually spinal/epidural, while the
default in non-childbirth related situations may be general anesthesia as a matter of doctor
preference. However, tubal ligations under local anesthesia, either inpatient or outpatient, may be
performed under patient request.

Entry to the site of tubal ligation can be done in many forms; through a vaginal approach,
through laparoscopy, a minilaparotomy ("minilap"), or through regular laparotomy.

Another form of permanent birth control is the non-surgical Essure procedure that has been in
use since 2002. In this procedure an Essure trained doctor inserts soft, flexible inserts through
the body’s natural pathways (vagina, cervix, and uterus) and into the fallopian tubes using a
hysteroscope and the Essure placement tool. The micro-inserts produce eventual occlusion of the
fallopian tubes by causing the in-growth of tissue.
Types:

• Postpartum tubal ligation, A postpartum tubal ligation is unique in

that it occurs after a normal vaginal birth -- usually one to two days after
the birth of your child. It does not, however, typically change the amount of
time spent in the hospital after you give birth. which is done immediately
after the birth of your baby
• Laparoscopic tubal ligation. Laparoscopy is a tool used for
diagnosing and treating several different conditions by actually looking
inside the body with a specialized camera

Surgical risks
The risks of tubal ligation are the same as any surgery: bleeding, injury to other internal organ like
bladder or bowel, and infection. Your practitioner will give you information specific to the
procedure you may be having.

Long-term risks
Experts used to think that tubal ligation increased the chances of irregular menstrual cycles, but
that turned out to be a misperception. Doctors found that if a woman tended to have irregular
cycles beforeshe began taking the Pill for an extended period of time (which would eventually
regulate the menstrual cycle), she might consider herself to be regular. However, if she had a
tubal and consequently stopped taking oral contraceptives, it wouldn't be unusual for her irregular
cycles to return. Statistically, the surgery does not lead to any menstrual cycle abnormalities.

The biggest risk has to do with regretting having gone through the surgery. You must be
absolutely certain that you do not want to have any children in the future. Studies have shown
that regret is more likely in people who remarry, people who make the decision while pregnant,
and people who have the procedure when younger.
Advantages:

• It is a permanent procedure.
• Tubal ligation does not require any attention once it is done.
• It's extremely effective.

Disadvantages:

• It is a permanent procedure.
• It's not 100 percent effective.
• A tubal does not guard against sexually transmitted infections.