Sterilization via the mini-laparotomy technique.

Abstract

Mini-laparotomy is a proven method of postpartum tubal ligation using a small subumbilical incision for entrance to the peritoneal cavity. The 2 most popular sterilization procedures currently are the mini-laparotomy and laparoscopy. Laparoscopy requires expensive equipment and specialized medical training to use the equipment. Standard surgical instruments are used in mini-laparotomy. The severity of possible complications is great with laparoscopy; complications in mini-laparotomy e.g. hemorrhage or bladder injury can be easily repaired and often prevented by surgical technique. Patients should discontinue use of oral contraceptives 2-3 weeks before surgery. Contraindications against the operation are a retroflexed uterus endometriosis obesity previous laparotomy including cesarean section and chronic pelvic infection. Anesthetic may be general regional or local. With the right patient the local technique is suitable. The need for a uterine elevator and the type to be used is a controversial subject. Some doctors use the Ramathibodi elevator a Rubin cannula or a gauze pack. The procedure itself begins with a small transverse incision 3-4 centimeters long about 4 centimeters above the symphysis pubis. The rectus muscle is longitudinally split by blunt dissection and the peritoneum is identified. The peritoneum is grasped with hemostats and tented superiorly. Next the fallopian tube is elevated to the operative field.