Most commonly performed type of tubal ligation in current practice:
Ans. a (Pomeroy's method). (Ref. Textbook of Gynecology by Shaw 13th ed. 236)TUBAL STERILIZATIONOperationa) Pomeroys technique: This technique involves grasping and elevating a 2-cm midsegment of tube, ligating the tubal loop with a 2-0 chromic or plain catgut suture, and then excising the distal portion of the loop,b) Parkland method: opening created in mesosalpinx and prox portion of tube is cut.c) Irving procedure: Begins similarly to the Parkland method. However, after the knot on the proximal tubal segment is secured, the ties are left longd) Uchida method : Tubal serosa is first separated from the muscularis by a subserosal injection of a dilute saline solution of epinephrine (1:100,000). A longitudinal incision is made in the ballooned serosa on its surface opposite the mesosalpinx. The serosal peritoneum then is grasped and dissected away from the underlying tubal muscularis. Following this dissection, a 5- cm midsegment of dissected fallopian tube is ligated proximally and distally with 2-0 chromic or plain catgut suture, and then resected. The raw serosal edges are reapproximated, burying the proximal cut tubal end within the leaves of the broad ligament and exteriorizing the distal end from the broad ligamentLaparoscopic# 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.Steps: 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.The Pomeroy method of tubal ligation is good if tubal reversal surgery is to be considered later. Approximately two- thirds of women with a Pomeroy tubal ligation become pregnant following tubal ligation reversal.Laparoscopic tubal sterilization methods:# Unipolar coagulation (First method of LTD to achieve widespread use)# Bipolar coagulation (Least failure rate)# Silicone rubber bands (Yoon's clip)# Spring clips (Hulka's clip)# Filshie clipModified Pomeroy Method. Many modifications of the Pomeroy technique have been described. One technique creates an avascular window in the mesosalpinx at a midpoint along the tube. Through this window, suture similar to that used for the Pomeroy method is passed. The portion of tube that lies proximal to this window is ligated first. The long ends of this suture then are tied around the entire tubal loop, as in the Pomeroy method. The distal portion of the loop is excised.
Pomeroy's method
Irwing's operation
Yoon ring application
Madlener procedure
Operative Gynaecology