Understanding a Mini-Laparotomy

A Common Surgery for Getting Your "Tubes Tied"

Senior nurse taking patient to surgery in hospital
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A mini-laparotomy (also known as a mini-lap) is one of the two most common methods of tubal ligation, a form of surgical contraception. The other is a procedure performed using laparoscopy. Both are elective surgeries that we commonly refer to as "having your tubes tied."

Comparing Mini-Laparotomy and Laparoscopy

The mini-lap is a common procedure that is known to be safe and effective in preventing future pregnancies by stopping a woman's eggs from reaching her fallopian tubes where fertilization takes place.

It poses several advantages over laparoscopy in that it requires less sophisticated equipment, less skill to perform, and can be performed in the hospital either immediately after delivery or before being discharged. Most often, it is performed within 48 hours of childbirth.

Complications from a mini-lap are slightly higher than those for a laparoscopy, but, in both cases, they are relatively rare. If they do occur, they tend to be associated with the pregnancy itself rather than the procedure.

How the Mini-Laparotomy Is Performed

Many surgeons prefer to perform a tubal ligation shortly after childbirth. This is because you are already in the hospital, and your abdominal wall is relaxed. In addition, pregnancy pushes the top of your uterus near the belly button where the incision would be made. This allows for easier access to the fallopian tubes.

For a mini-laparotomy, you will be given either a general or regional anesthesia (most commonly an epidural).

The surgery would then be performed in the following steps:

  • The surgeon will make a small but visible incision right beneath the umbilicus.
  • The fallopian tubes will then be pulled up and out of the incision.
  • The tubes will then be put back into place and the incision closed with stitches.

Most women recover in a few days or longer if the incision is big.

Complications are uncommon but may include infection (both internal and at the incision site) and separation of the tied tubes.

Risk of Pregnancy Following a Mini-Laparotomy

The odds of becoming pregnant after a tubal ligation is 1.2/1,000 in the first one to two years and 7.5/1,000 over seven to 12 years, so it is considered a very effective means of birth control. While the odds are low, a woman may become pregnant after a mini-laparotomy if the following occurs:

  • The surgery fails to close the passageway in one or both of the fallopian tubes.
  • The fallopian tubes grow back together again.
  • Recanalization occurs, resulting in the formation of a new passage which allows the egg and sperm to meet.
  • The woman was already pregnant when the surgery was performed.

Becoming pregnant after a mini-laparotomy carries an increased risk of an ectopic pregnancy, a condition wherein the fetus develops outside of the uterus (most commonly in a fallopian tube).

Ectopic pregnancy is a serious medical condition and, if left untreated, can lead to the rupture of the fallopian tube, internal bleeding, shock, and even death. Symptoms include the stoppage of menstrual periods, vaginal bleeding, lightheadedness, shoulder pain, and severe abdominal or pelvic pain.

Symptomatic ectopic pregnancy is considered a medical emergency in need of immediate care.

Sources

  • Daniels, K.; Daugherty, J.; Jones, J.; and Mosher, W. "Current Contraceptive Use and Variation by Selected Characteristics Among Women Aged 15–44: United States, 2011–2013." National Health Statistics Reports. 2014;86.
  • Moss C, Isley MM. "Sterilization: A Review and Update." Obstetrics and Gynecology Clinics of North America. 2015; 42(4):713-24. doi:10.1016/j.ogc.2015.07.003.
  • Patil E, Jensen JT. Update on Permanent Contraception Options for Women. Current Opinion in Obstetrics and Gynecology. 201527(6):465-470; doi:10.1097/GCO.0000000000000213

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