What Is a Laparotomy (Open Tubal Ligation) Procedure?

Learn Why and How Laparotomy Is Done

Having Consultation With General Practitioner
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A laparotomy, or open tubal ligation (commonly called “having your tubes tied”), is one of several surgical methods of permanent birth control in which a woman’s fallopian tubes are cut, tied, or blocked. The procedure stops her eggs from reaching her fallopian tubes, where fertilization takes place. 

  • These birth control methods are considered permanent because they aren’t generally reversible, although attempts at reversal are occasionally successful.
  • Because of this, a woman considering having one of these procedures should be certain that she doesn’t want to become pregnant again.

When Is a Laparotomy Performed?

In contrast to the more commonly performed laparoscopy and mini-laparotomy methods, a laparotomy or open tubal ligation is usually performed immediately before or after another type of abdominal surgery, such as giving birth via cesarean section (c-section).

  • If you’re having a c-section delivery, your surgeon can perform the laparotomy in just a few extra minutes while you are still under anesthesia and your abdomen is open.

A laparotomy may also be recommended if you have or have had pelvic inflammatory disease (PID), endometriosis, or earlier abdominal or pelvic surgery. These conditions often cause abdominal tissue and organs to scar or stick together (adhesion).

In addition, a laparotomy may be necessary if you have a condition that makes one of the other procedures, laparoscopy or mini-laparotomy, more difficult and therefore more risky.

Along with the conditions listed above, these include being significantly overweight, having a heart condition or diabetes, and smoking.

How Is This Procedure Done?

Laparotomy requires general or regional (commonly known as epidural) anesthesia. Your surgeon will make a fairly large incision (2 to 5 inches) in your abdomen, pull your fallopian tubes up into or out of the incision, close them off with a special device, and put them back into place.

Then he or she will stitch the incision shut.

What Happens Afterward?

If you have a laparotomy, you may need to stay in the hospital for 2 to 4 days. Full recovery could take several weeks.

  • If your laparotomy is done after a c-section, your hospital stay may be extended by 1 or 2 days.

“Should I be concerned about complications?”

Minor complications include separation of the tied tubes and infection.

Major complications seldom occur with laparotomy procedures. They include heavy blood loss, problems with general anesthesia, the need to enlarge the incision during surgery, and organ damage.

What’s the Risk of Becoming Pregnant After Laparotomy?

None of the surgical procedures for permanent birth control, including laparotomy, is 100% effective. On average, pregnancy after laparotomy occurs in about 5 out of 1,000 women after 1 year and in about 13 out of 1,000 women after 5 years.

A woman may become pregnant after laparotomy because, for example:

  • Her fallopian tubes grow back together.
  • Recanalization occurs (formation of a new passage that allows the egg and sperm to meet).
  • The woman was already pregnant when the surgery was done.
  • There was a problem with the surgery.

Ectopic Pregnancy Risk. Becoming pregnant after a laparotomy carries an increased risk of an ectopic pregnancy, in which the fetus develops outside the inner lining of the woman’s uterus, most commonly in a fallopian tube. Symptoms of an ectopic pregnancy include stoppage of menstrual periods, vaginal bleeding, lightheadedness, shoulder pain, and abdominal or pelvic pain. Ectopic pregnancy can be a life-threatening medical emergency. If you think you may have an ectopic pregnancy, contact your doctor as soon as possible.

Sources:

“Tubal ligation and tubal implants: surgery overview.” Healthwise.interactivehs.com (2014).   

“Ectopic pregnancy.” MayoClinic.Org (2015).   

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