Tubal ligation via posterior colpotomy

Abstract

Tubal sterilization is a safe contraceptive method [1]. It is estimated to be performed in 700,000 women each year in the United States [2]. Until the 1970s, most procedures were performed via laparotomic incision following cesarean section. Since then, as laparoscopic techniques evolved [3], minilaparotomic incisions have been used for sterilization, especially in the postpartum period [2]. Yet, a vaginal approach through the posterior vaginal fornix was also used before the introduction of laparoscopic procedures, as well as transcervical approaches [4]. In this study, 302 tubal ligations performed via posterior colpotomy were evaluated. The mean age of patients was 34.4 years, and mean gravidity and parity were 4.3 and 3.2 respectively. Patients were followed up for a mean period of 51.4 months. Tubal ligation alone was performed in 228 patients (75.5%). Other surgical interventions performed at the time of tubal ligation were the Manchester operation, ovarian cystectomy, anterior and posterior colporraphy, and cervical conization (Table 1). The mean operating time was 26.5 min and mean blood loss was 182 mL. Intraoperative complications, 3 rectal injuries and 1 ovarian injury, occurred in 4 patients (1.3%) (Table 2). Patients were fed intravenously for 5 days after rectal injury repair, and discharged from the hospital only after ensuring that no problem related to oral food intake would arise. Postoperative complications were encountered in 24 patients (7.9%). The most commonly observed postoperative complication was urinary retention, followed by urinary tract infection, intra-abdominal hematoma formation, intra-abdominal abscess formation, and incisional bleeding (Table 2). Urinary retention, urinary tract infection, and intra-abdominal abscess formation occurred only in patients who underwent the Manchester operation at the time of tubal ligation. Both patients who developed a hematoma were receiving anticoagulant therapy, and one was re-operated to treat the hematoma. The 3 patients (1.0%) who became pregnant following bilateral tubal ligation via posterior colpotomy underwent dilation and curettage. In conclusion, although the most preferred method for surgical sterilization is currently bilateral laparoscopic tubal cauterization, posterior colpotomy seems to be a good alternative, especially when performed by experienced hands. Advantages of posterior colpotomy include an absence of abdominal scar, minimal morbidity, and no need for special equipment. Furthermore, the operation is performed in a shorter time and convalescence is rapid, with shorter hospitalization and therefore reduced costs. The operation is performed the most safely when it is not combined with other procedures and if the patient is free of medical problems.