Laparoscopic Tubal Ligation Performed at the Time of Bariatric Surgery

Abstract

Study Objective: To evaluate all patients who underwent laparoscopic tubal ligation in combination with laparoscopic bariatric surgery. Design: Case controlled retrospective study performed between January 2009 and March 2014. Setting: University based tertiary care medical center. Patients: Four reproductive age women undergoing bariatric surgery with desire for permanent surgical sterilization. Intervention: Laparoscopic vertical gastric sleeve procedure and laparoscopic tubal ligation. Measurements and Main Results: Four combined laparoscopic tubal ligations and gastric sleeve procedures were attempted. All four cases were successfully completed using a minimally invasive approach. The mean age of the patients was 44.25 years; the mean BMI was 49.25 kg/m (mean weight 303.75 lbs). The mean parity was 2.25 and none of the patients were nulliparous. Two patients had one prior cesarean section. Co –morbid conditions included hypertension, sleep apnea, polycystic ovarian disorder, type II diabetes mellitus, and gastro esophageal reflux disease. All patients successfully underwent laparoscopic tubal ligation as well as laparoscopic vertical gastric sleeve procedure. There were no intraoperative complications were noted in any of the cases. Post-surgical complications were reported in one of the four patients. Complications were related to intraabdominal adhesive disease and development of a paraesophageal hernia. This patient underwent lysis of adhesions and paraesophageal hernia repair with mesh. This complications were not thought to be related to the tubal ligation. Conclusion: Performing tubal occlusion at the time of bariatric surgery is a safe and effectiveway to eliminate the risk of future pregnancy. Fifty percent of pregnancies are undesired despite adequate and available contraception. Pregnancy presents additional risk to obese patients and those who have undergone bariatric surgery. It is therefore reasonable to screen patients for their desire for future child bearing and offer combined surgical tubal ligation in patients planning to undergo bariatric weight loss surgery.